Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “ENDOMETRIOSIS”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 343 records · Page 19Linked to original sources
PubMed1992

Changes in T-cell regulation of responses to self antigens in women with pelvic endometriosis.

OBJECTIVE: To study autoimmune aspects of endometriosis. DESIGN: Lymphoblast transformation and hemolytic plaque formation were used to assess specific T- and B-cell activity against endometrial antigens. SETTING: Military teaching hospital. PATIENTS: Ninety-four healthy women of reproductive age undergoing diagnostic laparoscopy as part of an evaluation for infertility or chronic pelvalgia were accordingly grouped into those with normal pelvic peritoneum (20), mild endometriosis (50), and severe endometriosis (24). MAIN OUTCOME MEASURE: The study assessed the proliferative and humoral responses of lymphocytes from women with and without endometriosis to endometrial antigens and quantified the number of B-cell precursors, T-helper cells, and T-suppressor cells to these antigens. RESULTS: Unfractionated endometrial antigens were similarly blastogenic for lymphocytes from women with and without endometriosis. Despite equivalent numbers of B-cell precursors to these antigens, antiendometrial antibody responsiveness appears to have increased in women with mild endometriosis because of a decrease in T-suppressor cell activity and declined in women with severe endometriosis because of a further drop in T-suppressor cell activity and an increase in T-helper cell activity, as compared with women without endometriosis. CONCLUSIONS: Taken together, these experiments support the possibility that pelvic endometriosis may result from a break in specific T-cell tolerance rather than nonspecific polyclonal activation of responder lymphocytes.

Autoantibodies↗
PubMed2003

[Perspectives on endometriosis: new physiopathologic approaches and treatments].

Pathophysiology of deeply infiltrating endometriosis remains controversial whereas physiopathologic mechanism of superficial endometriosis is nearly demonstrated. Superficial peritoneal implants derive from adhesion and proliferation of endometrial cells regurgitated in peritoneum with retrograde menstruation. Peritoneal inflammation involving cytokines as TNFalpha and aromatase over-expression might be involved in the endometriosis invasion processus. Specific molecular defects of both eutopic and ectopic endometrium have been identified for each of the processes involved in the disease development. Aromatase inhibitors decrease endometriosis lesions in a mouse model of endometriosis which was induced surgically. Few studies report efficacy of aromatase inhibitors in human endometriosis. Theoretically, aromatase inhibitors should not be used alone in premenopausal women because of the resultant increase in gonadotropin levels. Nevertheless, in premenopausal women, aromatase inhibitors may be used in association with Gn-RH agonists. TNFalpha is a secretory factor of macrophages that is known to be increased in the peritoneal fluid of women with endometriosis. Granulosa cells from these women produce higher levels of TNFalpha. This cytokine can stimulate adhesion and proliferation of endometrial cells and enhances metalloproteasis expression, making thus endometrial cell invasion easier. It also stimulates angiogenesis by regulating expression of IL-8. TNFalpha is also cytotoxic to gametes. In mice and baboon models with induced endometriosis, anti-TNFalpha (TNF binding protein-1) decreases AFS score stage and reduces in size the endometriotic foci. No clinical assay has studied TNFalpha efficacy on human endometriosis.

Animals↗
PubMed2005

[Expression of vascular endothelial growth factor receptors in the ectopic and eutopic endometrium of women with endometriosis].

OBJECTIVE: To study the localization and expression of the vascular endothelial growth factor receptors (VEGFR) Fms-like tyrosine kinase (Flt-1) and kinase insert domain-containing receptor (KDR) in human ectopic and eutopic endometrium of patients with endometriosis. METHODS: Specimens of endometriosis patients, aged (38 +/- 8) years, including 37 specimens of entopic endometrium, 34 specimens of ovarian chocolate cyst, 34 specimens of ovarian chocolate cyst, 15 specimens of red peritoneal endometriosis lesions, and 4 abdominal wall endometriosis lesions were collected. Specimens of endometrium of 33 patients with other gynecological diseases, aged (36 +/- 8) years, were collected during operation and used as controls. Immunohistochemistry was used to detect the location and expression of Flt-1 and KDR protein in different tissues. Western blotting was used to detect the protein expression of Flt-1 and KDR protein in different tissues. The mRNA expressions of Flt-1 and KDR were detected by RT-PCR. RESULTS: Flt-1 and KDR were expressed in the endometrial glandular epithelium and stromal cells besides the endometrial blood vessels. The positive expression rate of Flt-1 and KDR in the ectopic endometrium of endometriosis patients were 94.3% and 91.4% respectively, both significantly higher than those in the ovarian endometrial cyst (74.3% and 77.1% respectively, both P < 0.05), and similar to those in the eutopic endometrium of the endometriosis patients (93.8% and 90.6% respectively, both P > 0.05). In the eutopic endometrium of the endometriosis patients, the Flt-1 mRNA expression level was 2.4 +/- 1.2 and the Flt-1 protein expression level was 31 +/- 17, and the KDR mRNA expression level was 3.0 +/- 1.4 and the KDR protein expression level was 36 +/- 24, all significantly higher than those in the ovarian endometrial cyst (1.5 +/- 0.9 and 1.8 +/- 1.0 for the Flt-1 and KDR mRNA expressions, and 17 +/- 6 and 20 +/- 11 for the Flt-1 and KDR protein expressions, all P < 0.05), and similar to those in the eutopic endometrium of the non-endometriosis patients (1.9 +/- 0.8 and 2.3 +/- 1.3 for the Flt-1 and KDR mRNA expressions, and 24 +/- 18 and 25 +/- 16 for the Flt-1 and KDR protein expressions, all P > 0.05) CONCLUSION: VEGF may play certain biological role in the development of endometriosis through VEGFR (Flt-1 and KDR). The expression of Flt-1 and KDR in the endometriotic lesion appears to be associated with neovascualization.

Adult↗
PubMed2005

[Increased levels of prostaglandin E2 and bcl-2 in peritoneal fluid and serum of patients with endometriosis].

OBJECTIVE: To detect the concentrations of prostaglandin E2 (PGE2) and bcl-2 in sera and peritoneal fluid of women with endometriosis. METHODS: The study group included 36 samples of peritoneal fluid and serum respectively from patients with endometriosis, and control group included 30 samples of peritoneal fluid and serum respectively from patients without endometriosis (either ovary cyst or uterine myoma). The peritoneal fluids were collected at the time of laparoscopic operation, and the sera were collected before surgery. Concentrations of PGE2 and bcl-2 were determined by enzyme linked immunosorbent assay (ELISA). RESULTS: The peritoneal fluid concentrations of PGE2 and bcl-2 in study group were significantly higher than that of control group, (1987 +/- 532) ng/L vs (386 +/- 215) ng/L, (177 +/- 53) U/L vs (86 +/- 21) U/L, (P < 0.05); and the PGE2 levels of severe endometriosis were significantly higher than that of mild endometriosis, (2221 +/- 1352) ng/L vs (1694 +/- 381) ng/L, (P < 0.01). The serum concentrations of PGE2 and bcl-2 in study group were significantly higher than that of control group, (3787 +/- 514) ng/L vs (129 +/- 97) ng/L, (96 +/- 44) U/L vs (53 +/- 40) U/L, (P < 0.01). Serum PGE2 concentrations of severe endometriosis were significantly higher than that of mild endometriosis, (964 +/- 290) ng/L vs (590 +/- 362) ng/L, (P < 0.01). CONCLUSIONS: The concentrations of PGE2 and bcl-2 in peritoneal fluid are increased in endometriosis. The concentrations of PGE2 and bcl-2 are associated with the extent of endometriosis lesions.

Adult↗
PubMed2006

[Visual and histologic analysis of laparoscopic diagnosis of endometriosis].

OBJECTIVE: To determine the characteristics of anatomical distribution of pelvic endometriosis and the correlation between visual and histologic findings of endometriosis at laparoscopy. METHODS: A prospective study of 62 patients undergoing laparoscopy for the pelvic pain, infertility and/or pelvic masses was carried out. All lesions with the diagnosis of endometriosis laparoscopically were excised and examined pathologically. Normal-appearing peritoneal biopsies were obtained randomly. All lesions were identified by anatomical site and color of the foci. The positive predictive value (PPV), sensitivity, negative predictive value (NPV), and specificity were determined for visually identified endometriosis versus the histologic findings. RESULTS: Totally, 219 peritoneal endometriotic lesions, 54 normal peritoneal biopsies, and 71 ovarian endometriotic cysts were obtained. Peritoneal lesions tended to locate in posterior part of the pelvis (80.8%, 177/219) and in left (58.0%, 127/219) with most in black (39.2%). The PPV was 67.6%; sensitivity, 93.7%; NPV, 81.4%; and specificity, 38.3% for visual versus histologic diagnosis of peritoneal endometriosis. Lesions in black or from sacral ligaments were confirmed histologically in 94.2% and 84.7% respectively, and 80.3% (57/71) of ovarian endometriotic cysts diagnosed by laparoscopy were confirmed histologically with 43.6% in the left, 27.3% in the right; and 29.1% (16/55) in both sides of the ovary. In addition, 18.5% (10/54) of normal-appearing peritoneal biopsy were identified as endometriosis by pathological examination. Laparoscopy was confirmed to be in 100% diagnostic accordance with pathology for patients with endometriosis. CONCLUSIONS: Our study showed asymmetrical distribution of pelvic endometriosis. Peritoneal lesions in black or from sacral ligament are more likely to be histologically confirmed, and microscopic lesions are not a rare phenomenon of endometriosis.

Adult↗
PubMed2006

A review of current management of endometriosis in 2006: an evidence-based approach.

Endometriosis, a common cause of morbidity in reproductive age females, results in pelvic pain and infertility. Effective, evidence-based treatments of endometriosis-associated infertility include conservative surgical therapy and assisted reproductive technologies. In early stage endometriosis ovulation induction, with or without intrauterine insemination, improves pregnancy rates. In early stage disease in vitro fertilization reduces time to pregnancy as compared to controls, but does not increase the chance of pregnancy after three years. Endometriosis-associated pain can be approached with surgical or medical therapies. Conservative surgery maintains the reproductive organs and is an effective mode of treatment for endometriosis-associated pain. A more radical surgical approach of hysterectomy with bilateral salpingo-oophorectomy, not investigated in randomized controlled trials, remains a mainstay of therapy for endometriosis-associated pain in patients who have completed child-bearing. Current medical therapies rely upon interruption of normal cyclic, ovarian hormone production resulting in an environment not conducive to the growth of endometriosis. The current accepted therapies for endometriosis include danazol, progestational agents, oral contraceptive agents, and gonadotropin-releasing hormone analogues which all function similarly in relieving pain. The new era of genomics promises to help characterize endometriosis and allow one to tailor therapies based on a woman's symptoms and reproductive goals.

Aromatase Inhibitors↗
PubMed2006

[Expression of heparanase and angiopoietin-2 mRNA in endometriosis].

OBJECTIVE: To investigate the relationship between heparanase (Hpa) and angiopoietin-2 (Ang-2) gene expression and the development of endometriosis (EM). METHODS: Expression of Hpa gene and Ang-2 mRNA in the eutopic and ectopic endometrium collected from 86 patients with endometriosis (EM group) and the normal endometrium from 30 women without endometriosis (control group) was determined by RT-PCR. RESULTS: (1) Hpa gene expression was detected in 53 ectopic endometrium and 47 eutopic endometrium specimens in the EM group and 8 normal endometrium specimens in the control group. There was no significant difference in Hpa gene expression between ectopic and eutopic endometrium in the EM group (P > 0.05). However, the Hpa gene expression in normal endometrium in the control group was significantly lower than that in ectopic and eutopic endometrium in the EM group (P < 0.05). (2) Ang-2 gene expression was detected in 61 ectopic endometrium and 56 eutopic endometrium specimens in the EM group and 10 normal endometrium specimens in the control group. There was no significant difference in Ang-2 gene expression between ectopic and eutopic endometrium in the EM group (P > 0.05), however, the Ang-2 positive rate in normal endometrium in the control group was significantly lower than that in ectopic and eutopic endometrium in the EM group (P < 0.05). (3) The expression of Hpa gene in stage III-IV endometriosis was significantly higher than that in stage I-II endometriosis (P < 0.05). (4) The difference of Ang-2 mRNA expression between stage III-IV and stage I-II endometriosis was not significant (P > 0.05). (5) The expression of Hpa gene was shown to be significantly correlated to the expression of Ang-2 gene in ectopic endometrium specimens from patients with endometriosis (P < 0.05). CONCLUSION: Hpa and Ang-2 genes are highly expressed in both ectopic and eutopic endometrium of patients with endometriosis. Over-expression of these two genes may play a role in the development and progression of endometriosis.

Adult↗
PubMed2006

[Association of tumor necrosis factors-beta gene polymorphism with endometriosis in women in Guangdong Province].

OBJECTIVE: To study the polymorphism of +252 site in intron 1 of tumor necrosis factor (TNF)-beta gene in relation to genetic susceptibility of endometriosis. METHODS: Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was employed to detect the polymorphism of +252 site in intron 1 of TNF-beta gene in 82 Chinese Han patients with endometriosis in Guangdong Province and 80 Han patients without endometriosis (control group), and the relation between TNF gene polymorphism and the risk of endometriosis was analyzed. RESULTS: The +252 site of TNF-beta allele and genotype distribution showed significant difference between endometriosis and control groups (Chi2=6.562, P<0.05; chi2=6.562, P<0.05), and relative risk of endometriosis in relation to allele A was increased by 1.793 fold. The risk of endometriosis was 3.33-fold higher in women of AA genotype than those of GG genotype (Chi2=6.562, P<0.05). CONCLUSIONS: Allele A in TNF-beta gene +252 site can significantly increase the relative risk of endometriosis in women in Guangdong, among which TNF-beta AA genotype might be one of the genetic susceptible factors for endometriosis.

Adult↗
PubMed2006

Evaluation of the effect of endometriosis on oocyte quality and endometrial environment by comparison of donor and recipient outcomes following embryo transfer in a shared oocyte program.

PURPOSE: To determine whether endometriosis has an effect on the uterine environment vs the oocyte itself. METHODS: A retrospective study comparing pregnancy outcome of infertile donors sharing oocytes with donor egg recipients according to whether the donor or recipient had endometriosis or not was carried out. RESULTS: There were 26 transfers from donors with endometriosis vs 144 in donors without endometriosis. The clinical and viable PRs and implantation rates were 42.9%, 38.1%, and 29.4% for the endometriosis group vs 60.9%, 51.9%, and 33.2%, respectively, for donors without endometriosis (p = NS). The clinical and viable PRs and implantation rates for donors with endometriosis per ET was 41.2%, 35.3%, and 20.4% vs 50.4%, 48.0% and 28.4% for donors without endometriosis, respectively (p = NS). CONCLUSIONS: Though no significant differences were found in donors with or without endometriosis in any parameters, there did appear to be a trend for lower PRs and implantation rates in women undergoing controlled ovarian hyperstimulation.

Adult↗
PubMed1991

Pharmacologic management of endometriosis.

The incidence, pathogenesis, staging, and treatment of endometriosis are reviewed, with an emphasis on pharmacologic management of this condition. Endometriosis--the presence of ectopic endometrial tissue--can be found in 15-25% of infertile women and may be found in 1-5% of all women between menarche and menopause. Although the pathogenesis of endometriosis is uncertain, the most tenable etiologic theory is a combination of celomic metaplasia and retrograde menstruation. Staging is based on the American Fertility Society classification scheme, with stage I being the mildest and stage IV the most severe form of the disease. The management of endometriosis depends on the extent of the disease, the severity of the symptoms, the age of the patient, and the patient's desire for future fertility. Treatment modalities include expectant management, surgery, induction of a pseudopregnancy state with hormonal therapy (e.g., oral contraceptives), or induction of a pseudomenopausal state. The induction of a pseudomenopausal state with the use of oral danazol gained widespread favor in the 1970s as the treatment of choice in patients with endometriosis, but therapy is often associated with unpleasant adverse effects. Gonadotropin-releasing hormone (GnRH) agonists may provide a safe and clinically effective alternative to danazol therapy in patients with endometriosis. Results of a multicenter study comparing nafarelin with danazol for treatment of endometriosis indicated no significant differences between treatment groups with respect to improvements in disease state and symptomatology. The most common adverse effect associated with nafarelin therapy is hot flashes. The GnRH agonist nafarelin is as effective as danazol or oral contraceptives for the treatment of endometriosis and causes fewer adverse reactions. GnRH agonists may replace danazol as the treatment of choice in patients with endometriosis.

Contraceptives, Oral↗
PubMed1989

[Endometriosis in light of laparoscopic examinations].

Laparoscopic examination was made in complete general anaesthesia by intubation modified by the H. Frangeheim technique. 491 laparoscopy examinations were analysed with respect to the frequency of endometriosis in the women examined, age when it appears and the relationship between diagnosis and routine laparoscopy. The women examined were divided in two groups, the basis of the division was the frequency of primary indications for laparoscopy in clinical suspicion of endometriosis. Group I consisted of 347 laparoscopies made due to various general indications, among them endometriosis suspected in 12 cases (3.4%). In this group all cases of clinical suspecting endometriosis were laparoscopically confirmed, besides endometriosis was found in 39 patients. Group II consisted of 144 laparoscopies, where suspicion of endometriosis was in 81 patients (56.3%) with primary indication. In this group clinical suspicions were confirmed in 49 patients (60.5%), besides endometriosis was found in 5 other patients examined because of their indications for laparoscopy. In the whole material of 491 laparoscopies, endometriosis was found in 105 women (21.4%). Thus one may conclude that endometriosis is a frequent disease of female genital organs, it can appear at any age of sexual maturity (the highest frequency between 26 and 35 years of age), its diagnosing depends only on routine laparoscopy in case of clinical suspicions of the disease.

Adult↗
PubMed1983

Appendectomy in the surgical treatment of endometriosis.

To address the question of when to perform an appendectomy in the surgical treatment of endometriosis, a series of 500 consecutive appendectomies was reviewed. In 104 patients with pelvic endometriosis who were undergoing appendectomy, the appendix was a relatively common (13%) extragenital site of endometriosis. Gross inspection of the appendix is not sufficient to exclude endometriosis, as 38% of appendices with histologic evidence of endometriosis had a normal appearance. Patient age and the severity of endometriosis do not appear to be risk factors for appendiceal involvement. No increased postoperative morbidity was demonstrated in 65 patients who had an appendectomy when compared with a similar group of 60 patients who did not have an appendectomy. The study supports 1) removal of the appendix in patients undergoing noninfertility surgery for endometriosis, as a high prevalence of occult endometriosis was observed in this group; and 2) excision of an abnormal appendix in patients with endometriosis during infertility surgery although appendectomy for occult involvement is not supported in this group.

Appendectomy↗
PubMed1994

Endometriosis impairs the efficacy of gamete intrafallopian transfer: results of a case-control study.

OBJECTIVE: To determine whether pelvic endometriosis impairs the efficacy of GIFT. DESIGN: Matched follow-up study. SETTING: University-based assisted reproduction program. PARTICIPANTS: Patients undergoing GIFT between 1987 and 1991. Cases had a primary diagnosis of endometriosis. Controls had no endometriosis and were matched with cases according to age, number of mature eggs transferred, and sperm grade. INTERVENTION: Gamete intrafallopian transfer was performed in all patients in an identical manner independent of their underlying diagnosis. MAIN OUTCOME MEASURES: Pregnancy and delivery rates. RESULTS: Of 114 laparoscopic egg retrievals performed in the endometriosis group, there were 37 pregnancies (32.5%) and 27 deliveries (23.7%). Of the 214 retrievals in the control group, there were 101 pregnancies (47.2%) and 76 deliveries (35.5%). Mantel-Haenszel estimates of relative risk indicated that endometriosis significantly impaired pregnancy and delivery rates. There was no statistically significant difference in pregnancy rates according to severity of disease among endometriosis cases. There was no statistically significant difference in pregnancy rates according to severity of disease among endometriosis cases. CONCLUSIONS: Our finding that GIFT pregnancy rates were lower in women with a primary diagnosis of endometriosis than in matched controls suggests that endometriosis is associated with reduced efficacy of GIFT.

Adult↗
PubMed1994

Endometriosis persisting after castration: clinical characteristics and results of surgical management.

OBJECTIVE: To identify the clinical characteristics and response to surgical treatment of endometriosis-associated pain in castrated women. METHODS: In a prospective, longitudinal observational study, 75 patients with previous castration had biopsy-proven endometriosis excised surgically. Anatomical characteristics of disease were studied using pelvic mapping and compared to the findings in non-castrated women with endometriosis. Preoperative and postoperative verbal analogue pain scales were used to gauge the response to excision of endometriosis. RESULTS: Patients treated surgically for endometriosis following castration were significantly older (37.8 +/- 8.1 versus 31.3 +/- 6.9 years, mean +/- standard deviation; 95% confidence interval [CI] 4.9-8.1) and slightly more likely to have intestinal involvement (risk ratio 1.3, 95% CI 0.94-1.8) than non-castrated endometriosis patients. Most had marked alleviation of pain after excision of endometriosis. CONCLUSIONS: Endometriosis can remain symptomatic after castration, with or without estrogen therapy. In such patients, there is a 33% frequency of intestinal involvement. At castration, consideration should be given to removal of invasive peritoneal and intestinal disease. Symptom improvement occurs in most patients after excision of endometriosis.

Adult↗
PubMed1994

Transforming growth factor-beta activity is increased in peritoneal fluid from women with endometriosis.

OBJECTIVE: To investigate the presence of transforming growth factor-beta in peritoneal fluid of women with and without endometriosis. METHODS: Fifty-two peritoneal fluid samples, obtained during laparoscopies performed for tubal ligation (n = 10), infertility (n = 38), or pain (n = 4), were examined for the presence of transforming growth factor-beta using the Mv1Lu cell growth inhibition assay. At laparoscopy, 26 women had endometriosis. The other 26 women had no endometriosis; 16 of them had infertility, and ten who had no pelvic pathology at tubal sterilization served as fertile controls. RESULTS: The concentration of transforming growth factor-beta was increased in the peritoneal fluid from women with endometriosis (11.4 +/- 3.3 ng/mL) compared to both the fertile control group without endometriosis (1.1 +/- 0.29 ng/mL) and the infertile control group without endometriosis (3.6 +/- 1.4 ng/mL). Twenty-five of the 52 women (48%) demonstrated levels of transforming growth factor-beta higher than 2 ng/mL. Patients with endometriosis were significantly more likely to have elevated concentrations of transforming growth factor-beta than were women without endometriosis (16 of 26, 61.5%, versus nine of 26, 34.6%). CONCLUSIONS: These findings demonstrate the presence of transforming growth factor-beta in peritoneal fluid. Elevated levels in women with endometriosis could be important in the pathophysiology of this disease.

Ascitic Fluid↗
PubMed1993

CA 125 levels measured in different phases of the menstrual cycle in screening for endometriosis.

OBJECTIVE: To examine variations in CA 125 levels during the three phases of the menstrual cycle in women with and without endometriosis. METHODS: One hundred infertile women were studied prospectively. CA 125 levels were measured during menses and during the follicular and luteal phases before diagnostic laparoscopy. Subjects were divided into four groups: no evidence of endometriosis (35 women), stage I endometriosis (30 women), stage II endometriosis (21 women), and stages III and IV endometriosis (14 women). RESULTS: In the endometriosis groups, there was a significant difference in the mean CA 125 levels drawn at menses and those drawn in the follicular phase. In patients with severe endometriosis, there was also a difference in the mean CA 125 levels drawn at menses and in the luteal phase. This finding led to the development of a screening test based on the ratio of CA 125 levels at menses to levels in the follicular phase. The test based on this ratio (with a cutoff of 1.5) had a sensitivity of 62.5% and specificity of 75%, compared with a sensitivity of 26.8% and specificity of 100% for the test based on a single CA 125 level drawn at menses (with a cutoff of 35 U/mL). CONCLUSIONS: CA 125 levels during menses are elevated compared with those during the follicular phase in patients with endometriosis. Screening tests based on the relationship of multiple CA 125 levels taken throughout the menstrual cycle were more sensitive for detection of endometriosis than tests based on a single CA 125 level.

Adult↗
PubMed1996

The cycle pregnancy rate is normal in baboons with stage I endometriosis but decreased in primates with stage II and stage III-IV disease.

OBJECTIVES: To test the hypothesis that fertility is reduced in baboons with endometriosis. DESIGN: Prospective controlled follow-up study. SETTING: Institute of Primate Research, Nairobi Kenya. SUBJECTS: Seventy-one baboons, including 34 controls (normal pelvis) and 37 animals with histologically proven endometriosis (16 spontaneous and 21 induced). Baboons with endometriosis had minimal (n = 9), mild (n = 14), moderate (n = 7), or severe (n = 7) disease. INTERVENTIONS: Seventy-one baboons were mated during 286 cycles. MAIN OUTCOME MEASURES: Cycle fecundity rate, cycle pregnancy rate, cycle abortion rate. RESULTS: Cycle pregnancy rate (excluding spontaneous abortions) was 15% (44/286) and was comparable between controls (19%, 20/104) and baboons with endometriosis (13%, 24/182). The cycle pregnancy rates were 24%, 10%, 7.5%, and 12.5% in animals with minimal, mild, moderate, and severe endometriosis, respectively. The cycle pregnancy rate was significantly lower in baboons with stage III-IV endometriosis (9%, 6/64) and with stage II disease (10%, 7/73) than in animals with stage I endometriosis (24%, 11/45) or in controls with a normal pelvis (19%). CONCLUSION: The normal cycle pregnancy rate in baboons with stage I endometriosis and the decreased cycle pregnancy rate in baboons with stage II and stage III-IV disease suggest that fertility decreases with the stage of endometriosis in baboons.

Abortion, Veterinary↗
PubMed2000

Gonadotrophin-releasing hormone analogues for pain associated with endometriosis.

BACKGROUND: Endometriosis is a common gynaecological condition that frequently presents with the symptom of pain. The precise pathogenesis (mode of development) of endometriosis is unclear but it is evident that endometriosis arises by the dissemination of endometrium to ectopic sites and the subsequent establishment of deposits of ectopic endometrium. The observation that endometriosis is rarely seen in the hypo-oestrogenic (low levels of oestrogen) post-menopausal woman led to the concept of medical treatment by induction of a pseudo-menopause using Gonadotrophin Releasing Hormone Analogues (GnRHas). When administered in a non-pulsatile manner (the pituitary is normally stimulated by pulses of natural GnRH and all analogues act on the pituitary at a constant level) their use results in down regulation (switching off) of the pituitary and a hypogonadotrophic hypogonadal state (low levels of female hormones due to non stimulation of the ovary). OBJECTIVES: To determine the effectiveness of Gonadotrophin Releasing Hormone analogues (GnRHas) in the treatment of the painful symptoms of endometriosis by comparing them with no treatment, placebo, other recognised medical treatments, and surgical interventions. SEARCH STRATEGY: The search strategy of the Menstrual Disorders and Subfertility review group (please see Review Group details) was used to identify all randomised trials of the use of GnRHas for the treatment of the painful symptoms of endometriosis. SELECTION CRITERIA: Trials were included if they were randomised, and considered the effectiveness of GnRHas in the treatment of the painful symptoms of endometriosis. DATA COLLECTION AND ANALYSIS: Twenty-six studies had data appropriate for inclusion in the review. The largest group (15 studies) compared GnRHas with danazol. There are 5 studies comparing GnRHas with GnRHas plus add-back therapy, 3 comparing GnRHa with GnRHa in a different form or dose, one compares them with gestrinone, one with the combined oral contraceptive pill, and one with placebo. Data was extracted independently by two reviewers. The authors of 11 studies have been contacted to clarify missing or unclear data. Only 4 have replied to date. Data on relief of pain, change in revised American Fertility Society (rAFS) scores, and side effects was collected. MAIN RESULTS: No difference was found between GnRHas and any of the other active comparators with respect to pain relief or reduction in endometriotic deposits. The side effect profiles of the different treatments were different, with danazol and gestrinone having more androgenic side effects, while GnRHas tend to produce more hypo-oestrogenic symptoms. REVIEWER'S CONCLUSIONS: There is little or no difference in the effectiveness of GnRHas in comparison with other medical treatments for endometriosis. GnRHas do appear to be an effective treatment. Differences that do exist relate to side effect profiles. Side effects of GnRHas can be ameliorated by the addition of addback therapy.

Danazol↗