Depression in women with endometriosis with and without chronic pelvic pain Laparoscopic Surgery for Severe Rectovaginal Endometriosis Compromising the Bowel: A Prospective Cohort Study. Randomized Trial of Laparoscopically Assisted Versus Open Colorectal Resection for Endometriosis: Morbidity, Symptoms, Quality of Life, and Fertility The burden of endometriosis: costs and quality of life of women with endometriosis and treated in referral centres. Depressive symptoms, anxiety, and quality of life in women with pelvic endometriosis. [Treatment of endometriosis with dienogest: preliminary report]. Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries. Human issues and medical economics of endometriosis. Three- vs. six-month GnRH-agonist therapy. Effectiveness of complementary pain treatment for women with deep endometriosis through Transcutaneous Electrical Nerve Stimulation (TENS): randomized controlled trial. Hormonal suppression treatment or dietary therapy versus placebo in the control of painful symptoms after conservative surgery for endometriosis stage III-IV. A randomized comparative trial. Add-back therapy in the treatment of endometriosis-associated pain. Detailed analysis of a randomized, multicenter, comparative trial of dienogest versus leuprolide acetate in endometriosis. Letrozole and norethisterone acetate in colorectal endometriosis. The effects and effectiveness of laparoscopic excision of endometriosis: a prospective study with 2-5 year follow-up. Quality of life after segmental resection of the rectosigmoid by laparoscopy in patients with deep infiltrating endometriosis with bowel involvement. Long-term effectiveness of presacral neurectomy for the treatment of severe dysmenorrhea due to endometriosis. Quantification of endometriosis-associated pain and quality of life during the stimulatory phase of gonadotropin-releasing hormone agonist therapy: a double-blind, randomized, placebo-controlled trial. Deep dyspareunia and sex life after laparoscopic excision of endometriosis. When sex is not on fire: a prospective multicentre study evaluating the short-term effects of radical resection of endometriosis on quality of sex life and dyspareunia. Laparoscopic excision of endometriosis: a randomized, placebo-controlled trial. Migraine in women with chronic pelvic pain with and without endometriosis. Clinical and quality-of-life outcomes after fertility-sparing laparoscopic surgery with bowel resection for severe endometriosis. Prolonged gonadotropin-releasing hormone agonist treatment of symptomatic endometriosis: the role of cyclic sodium etidronate and low-dose norethindrone "add-back" therapy.
Aim . The aim of the study is to compare the prevalence of depression in women surgically diagnosed with endometriosis according to the presence or absence of pelvic pain . Methods . This cross‐sectional prospect i ve study evaluated 100 women receiving care at the Out patients ’ Clinic for Endometriosis , Department of Obstetrics and Gynecology , Universidade Estadual de Campinas ( UNICAMP ) , Campinas , São Paulo , Brazil , equally divided into two groups : one suffering from chronic pelvic pain and the other pain‐free .  The Beck Depression Inventory  was used in order to measure depression . Results . Depression was detected in 86 and 38 % of the women with and without chronic pelvic pain , respectively . Complaints of depression , such as somatic concerns , work inhibition , dissatisfaction , and sadness , were observed at a significantly higher rate in the group with pain . A sensation of failure was the only variable observed more frequently in the pain‐free group . Conclusions . Depression is highly prevalent in women with endometriosis , especially those with pelvic pain . Careful evaluation can identify women with depression who may benefit from treatment STUDY OBJECTIVE Endometriosis can affect 10 % of women at reproductive age . Of those , 5.3 % to 12 % will have endometriosis affecting the bowel . Although outcomes after surgery for severe endometriosis affecting the bowel have previously been studied and have shown improvement in generic quality of life indices and sexual function , few studies have evaluated bowel function or symptoms specific to endometriosis . Our aim was to determine the quality of life after radical excision of rectovagina endometriosis compromising the bowel . DESIGN Single-center prospect i ve cohort study ( Canadian Task Force classification II-2 ) . SETTING Specialist referral center for the management of advanced endometriosis . PATIENTS Women with severe rectovaginal endometriosis compromising the bowel . INTERVENTIONS Comparison of preoperative data with a 2- , 6- , and 12-month follow-up was made for consecutive patients who underwent surgery for endometriosis with bowel involvement . The main outcome measures were quality of life using the Endometriosis Health Profile 30 and EuroQol-5 dimension question naires . Bowel symptoms were measured using the Gastrointestinal Quality of Life Index . Dysmenorrhea , dyspareunia , dyschezia , and chronic pain were measured using a visual analogue scale . To compare preoperative and postoperative scores , a Freidman test was performed followed by a preoperative and 12-month postoperative Wilcoxon signed-rank test . A Mann-Whitney U test was used to compare the results between those who had pelvic clearance and those who did not . MEASUREMENTS AND MAIN RESULTS In total , 137 patients had surgery , of which 100 completed follow-up to 12 months . The serious perioperative and postoperative complication rate was 7.3 % . The results show significant improvement in almost all variables measured ( p < .01 ) . At 12 months patients who had a pelvic clearance ( hysterectomy with bilateral salpingo-oophorectomy ) had significantly less pain with better bowel function . Additionally , they had higher quality of life scores and greater satisfaction with their treatment . There was no significant difference between any postoperative variables tested regardless of the type of bowel surgery . CONCLUSION Severe rectovaginal endometriosis compromising the bowel can be treated surgically with experienced combined gynecologic and colorectal input with a low serious complication rate . Surgery by an experienced multidisciplinary team results in significant improvement in pain , sexual function , and quality of life up to 1 year postoperatively . Pelvic clearance improves outcome and patients should be counseled accordingly . There is no difference in outcome between the types of bowel surgery undertaken as long as all visible/palpable endometriosis is removed Objective : We report the first r and omized trial of laparoscopically assisted versus open colorectal resection for endometriosis focusing on perioperative complications , improvement in symptoms , quality of life , and fertility . Summary of Background Data : Bowel endometriosis is one of the most severe forms of endometriosis . Although laparoscopically assisted surgery is a vali date d technique for colorectal cancer , there are serious concerns about its appropriateness for endometriosis in young women wishing to conceive because it is almost invariably a traumatic procedure . Methods : We conducted a noninferiority trial and r and omly assigned 52 patients with colorectal endometriosis to undergo laparoscopically assisted or open colorectal resection .  The median follow-up was 19 months . The primary end point was improvement in dyschesia . Results : Overall , a significant improvement in digestive symptoms ( dyschesia P < 0.0001 , diarrhea P < 0.01 , and bowel pain and cramping P < 0.0001 ) , gynecologic symptoms ( dysmenorrhea P < 0.0001 and dyspareunia P < 0.0001 ) , and general symptoms ( back pain P = 0.001 and asthenia P = 0.0001 ) was observed . No difference in the symptom delta values and quality of life was noted between the groups . Median blood loss was lower in the laparoscopic group ( P < 0.05 ) . Total number of complications was higher in the open surgery group ( P = 0.04 ) , especially grade 3 ( P = 0.03 ) . Pregnancy rate was higher in the laparoscopic group ( P = 0.006 ) , and the cumulative pregnancy rate was 60 % . Conclusion : Our findings support that laparoscopy is a safe option for women requiring colorectal resection for endometriosis . Moreover , laparoscopy offers a higher pregnancy rate than open surgery with similar improvements in symptoms and in quality of life BACKGROUND This study aim ed to calculate costs and health-related quality of life of women with endometriosis-associated symptoms treated in referral centres . METHODS A prospect i ve , multi-centre , question naire-based survey measured costs and quality of life in ambulatory care and in 12 tertiary care centres in 10 countries . The study enrolled women with a diagnosis of endometriosis and with at least one centre-specific contact related to endometriosis-associated symptoms in 2008 . The main outcome measures were health care costs , costs of productivity loss , total costs and quality -adjusted life years . Predictors of costs were identified using regression analysis . RESULTS Data analysis of 909 women demonstrated that the average annual total cost per woman was € 9579 ( 95 % confidence interval € 8559-€10 599 ) . Costs of productivity loss of € 6298 per woman were double the health care costs of € 3113 per woman . Health care costs were mainly due to surgery ( 29 % ) , monitoring tests ( 19 % ) and hospitalization ( 18 % ) and physician visits ( 16 % ) . Endometriosis-associated symptoms generated 0.809 quality -adjusted life years per woman . Decreased quality of life was the most important predictor of direct health care and total costs . Costs were greater with increasing severity of endometriosis , presence of pelvic pain , presence of infertility and a higher number of years since diagnosis . CONCLUSIONS Our study invited women to report re source use based on endometriosis-associated symptoms only , rather than drawing on a control population of women without endometriosis . Our study showed that the economic burden associated with endometriosis treated in referral centres is high and is similar to other chronic diseases ( diabetes , Crohn 's disease , rheumatoid arthritis ) . It arises predominantly from productivity loss , and is predicted by decreased quality of life OBJECTIVE To assess depressive symptoms , anxiety and quality of life in women with pelvic endometriosis . STUDY DESIGN A prospect i ve study of 104 women diagnosed with pelvic endometriosis . The  Beck Depression Inventory ( BDI ) and the Hamilton Rating Scale for Depression ( HAM-D ) were used to evaluate depressive symptoms ; the  Spielberger State-Trait Anxiety Inventory ( STAI )  and the  Hamilton Rating Scale for Anxiety ( HAM-A )  to evaluate anxiety symptoms ;  and the  short ( 26-item ) version of the World Health Organization Quality Of Life instrument ( WHOQOL-BREF )  to  evaluate quality of life .  RESULTS Of the patients evaluated , 86.5 % presented depressive symptoms ( mild in 22.1 % , moderate in 31.7 % , and severe in 32.7 % ) and 87.5 % presented anxiety ( minor in 24 % and major in 63.5 % ) . Quality of life was found to be subst and ard . Age correlated positively with depressive symptoms , as determined using the BDI ( P=0.013 ) and HAM-D ( P=0.037 ) . There was a positive correlation between current pain intensity and anxiety symptoms , as assessed using the STAI ( state , P=0.009 ; trait , P=0.048 ) and HAM-A ( P=0.0001 ) . The complaints related to physical limitations increased in parallel with the intensity of pain ( P=0.017 ) . There was an inverse correlation between duration of treatment and quality of life ( P=0.017 ) . There was no correlation between psychiatric symptoms and endometriosis stage . CONCLUSIONS A rational approach to endometriosis should include an evaluation of the emotional profile and quality of life . That approach would certainly reduce the functional damage caused by the endometriosis AIM OF THE STUDY Influence of two hormonal therapies ( GnRH agonist -- leuprolein acetate and a new progestin -- dienogest ) on symptoms of endometriosis in patients with different clinical grade of disease . MATERIAL AND METHODS 34 women with endometriosis confirmed by laparoscopy and histology were included into the study . Patients were r and omized and divided into two therapeutic groups . One group was treated with dienogest and the second with leuprolein acetate during 6 month of study . The intensification of pain was assessed with Visual Analog Scale ( VAS ) and pelvic symptoms scale before , during ( 3 month ) and after therapy . Dyspareunia was assessed with pelvic symptoms scale before , during ( 3 month ) and after therapy . Frequency of adverse effects was assessed in 1 , 3 and 6 month of therapy . Emotional state , bone density and basic serum parameters were assessed before and after therapy . RESULTS AND CONCLUSIONS Dienogest as well as leuprolein acetate decreased pelvic pain and dyspareunia . There were no differences between these influences . Dienogest did not reveal and rogenic activity ( did not reveal activity nor intense seborrheic lesions , nor hirsutism , nor voice tone ) . Dienogest did not reveal hot flashes . Bleeding ( caused by dienogest therapy ) did not influence hematologic indices nor affected the patients ' decision on preterm end of treatment OBJECTIVE To assess the impact of endometriosis on health-related quality of life ( HRQoL ) and work productivity . DESIGN Multicenter cross-sectional study with prospect i ve recruitment . SETTING Sixteen clinical centers in ten countries . PATIENT(S ) A total of 1,418 premenopausal women , aged 18 - 45 years , without a previous surgical diagnosis of endometriosis , having laparoscopy to investigate symptoms or to be sterilized .  INTERVENTION(S ) None . MAIN OUTCOME MEASURE(S ) Diagnostic delay , HRQoL , and work productivity . RESULT ( S ) There was a delay of 6.7 years , principally in primary care , between onset of symptoms and a surgical diagnosis of endometriosis , which was longer in centers where women received predominantly state-funded health care ( 8.3 vs. 5.5 years ) . Delay was positively associated with the number of pelvic symptoms ( chronic pelvic pain , dysmenorrhoea , dyspareunia , and heavy periods ) and a higher body mass index . Physical HRQoL was significantly reduced in affected women compared with those with similar symptoms and no endometriosis . Each affected woman lost on average 10.8 hours ( SD 12.2 ) of work weekly , mainly owing to reduced effectiveness while working . Loss of work productivity translated into significant costs per woman/week , from US$ 4 in Nigeria to US$ 456 in Italy . CONCLUSION ( S ) Endometriosis impairs HRQoL and work productivity across countries and ethnicities , yet women continue to experience diagnostic delays in primary care . A higher index of suspicion is needed to expedite specialist assessment of symptomatic women . Future research should seek to clarify pain mechanisms in relation to endometriosis severity OBJECTIVE To project the efficacy and economic consequence of short-term intranasal gonadotropin-releasing hormone agonist ( GnRH-a ) for diagnosis of and therapy for endometriosis . STUDY DESIGN Multicenter , placebo-controlled clinical trials of GnRH-a comparing three vs. six months of treatment , three months of retreatment and three months of postoperative treatment for the symptoms and signs of laparoscopically diagnosed endometriosis . RESULTS The reduction in symptoms and signs of endometriosis was similar at the end of three months to the relief at six months . Retreatment was as effective as initial treatment , and the return of symptoms after laparoscopic surgery plus postoperative treatment for three months was delayed by approximately 18 months as compared to surgery alone . The projected charges for the surgical approaches ( laparoscopy or minilaparoscopy ) to diagnosis and therapy were 50 - 60 % greater than those for the medical approach . CONCLUSION GnRH-a administration for three months could be a cost-effective approach to the presumptive diagnosis and treatment of endometriosis among women with chronic pelvic pain OBJECTIVE Evaluate TENS effectiveness as a complementary treatment of chronic pelvic pain and deep dyspareunia  in women with deep endometriosis . STUDY DESIGN This r and omized controlled trial was performed in a tertiary health care center , including twenty-two women with deep endometriosis undergoing hormone therapy with persistent pelvic pain and /or deep dyspareunia . This study was registered in the Brazilian Record of Clinical Trials ( ReBEC ) , under n RBR-3rndh6 . TENS application for 8 weeks followed a r and omized allocation into two groups : Group 1 - acupuncture-like TENS ( Frequency : 8Hz , pulse duration : 250μs ) - VIF ( n=11 ) and Group 2 - self-applied TENS ( Frequency : 85Hz , pulse duration : 75μs ) ( n=11 ) . The intensity applied was " strong , but comfortable " . We evaluated patients before and after treatment by the use of the Visual Analogue Scale , Deep Dyspareunia Scale and Endometriosis Quality of Life Question naire . We used the Wilcoxon and Mann-Whitney tests to compare before and after treatment conditions . RESULTS Despite the use of hormone therapy for 1.65±2.08 years , the 22 women with deep endometriosis  sustained pelvic pain complaints ( VAS=5.95±2.13 and 2.45±2.42 , p<.001 ) and /or deep dyspareunia ( DDS=2.29±0.46 and 1.20±1.01 , p=.001 ) . We observed significant improvement for chronic pelvic pain , deep dyspareunia and quality of life by the use of TENS . Both application types of TENS were effective for improving the evaluated types of pain . CONCLUSIONS Both re sources ( acupuncture-like TENS and self-applied TENS ) demonstrated effectiveness as a complementary treatment of pelvic pain and deep dyspareunia , improving quality of life in women with deep endometriosis regardless of the device used for treatment OBJECTIVE To evaluate the effectiveness for the outcomes of endometriosis-related pain and quality of life of conservative surgery plus placebo compared with conservative surgery plus hormonal suppression treatment or dietary therapy . DESIGN R and omized comparative trial . SETTING University hospital . PATIENT(S ) Two hundred twenty-two consecutive women who underwent conservative pelvic surgery for symptomatic endometriosis stage III-IV ( r-AFS ) . INTERVENTION(S ) Six months of placebo ( n = 110 ) versus GnRH-a ( tryptorelin or leuprorelin , 3.75 mg every 28 days ) ( n = 39 ) or continuous estroprogestin ( ethynilestradiol , 0.03 mg plus gestoden , 0.75 mg ) ( n = 38 ) versus dietary therapy ( vitamins , minerals salts , lactic ferments , fish oil ) ( n = 35 ) . MAIN OUTCOME MEASURE(S ) Painful symptoms ( visual analogue scale score ) and quality -of-life endometriosis-related symptoms ( SF-36 score ) at 12 months ' follow-up . RESULT ( S ) Patients treated with postoperative hormonal suppression therapy showed less visual analogue scale scores for dysmenorrhoea than patients of the other groups . Hormonal suppression therapy and dietary supplementation were equally effective in reducing nonmenstrual pelvic pain . Surgery plus placebo showed significative decrease in dyspareunia scores . Postoperative medical and dietary therapy allowed a better quality of life than placebo . CONCLUSION ( S ) Postoperative hormonal suppression treatment or dietary therapy are more effective than surgery plus placebo to obtain relief of pain associated with endometriosis stage III-IV and improvement of quality of life OBJECTIVE To determine the efficacy of GnRH analogue plus add-back therapy compared with GnRH analogue alone and estroprogestin in patients with relapse of endometriosis-associated pain . DESIGN R and omized , controlled study . SETTING University hospital . PATIENT(S ) One hundred thirty-three women with relapse of endometriosis-related pain after previous endometriosis surgery . INTERVENTION(S ) Forty-six women were treated with GnRH analogue plus add-back therapy , 44 women were given GnRH analogue alone , and 43 women received estroprogestin , for 12 months . MAIN OUTCOME MEASURE(S ) Pain evaluation by a visual analogue scale , quality of life in treated patients according to the SF-36 question naire , and occurrence of adverse effects , including bone mass density loss , at pretreatment , after 6 months of treatment , at the end of treatment ( 12 months ) , and 6 months after discontinuation of treatment . RESULT ( S ) Patients treated either with GnRH analogue alone or GnRH analogue plus add-back therapy showed a higher reduction of pelvic pain , dysmenorrhea , and dyspareunia than patients treated with oral contraceptive , whereas patients treated with add-back therapy showed a better quality of life , as assessed with the SF-36 question naire , and adverse effects rate than the other two groups . CONCLUSION ( S ) Add-back therapy allows the treatment of women with relapse of endometriosis-associated pain for a longer period , with reduced bone mineral density loss , good control of pain symptoms , and better patient quality of life compared with GnRH analogue alone or oral contraceptive OBJECTIVE To analyze the secondary efficacy and safety outcomes from a recent trial comparing dienogest ( DNG ) with leuprolide acetate ( LA ) in women with endometriosis . METHODS A 24-week , open-label , r and omized , multicenter study of DNG versus LA  in women with endometriosis-related pain was assessed for outcomes such as responder rates ( using predefined thresholds of pain relief ) , changes in single symptoms/signs and sum scores from the Biberoglu and Behrman ( B&B ) scale , clinical laboratory parameters , and measures of quality of life . RESULTS Dienogest was non-inferior to LA for treatment response using all predefined thresholds of pain relief and provided equivalent improvements in B&B symptoms and signs . No clinical ly relevant changes in laboratory parameters were observed during DNG treatment , whereas estrogen levels decreased in the LA group . Compared with LA , DNG was associated with pronounced improvements in specific quality -of-life measures . CONCLUSION The analyses provide supportive evidence that the efficacy of DNG is equivalent to that of LA for treating endometriosis symptoms , with specific quality -of-life benefits and a favorable safety profile OBJECTIVE Up to now limited attention has been given to the medical treatment of bowel endometriosis . This study evaluates the efficacy of aromatase inhibitors and norethisterone acetate in treating pain and gastrointestinal symptoms caused by bowel endometriosis . STUDY DESIGN This prospect i ve pilot study included six women with colorectal endometriosis ; all women had intestinal nodules infiltrating at least the muscularis propria of the bowel and did not have a stenosis of the bowel lumen > 60 % ; the patients suffered from pain and intestinal symptoms . The study subjects received letrozole ( 2.5 mg/day ) and norethisterone acetate ( 2.5 mg/day ) continuously for 6 months . The presence and intensity of symptoms were evaluated before starting the treatment , and after 3 and 6 months of treatment . RESULTS The double-drug regimen improved pain , non-menstrual pelvic pain , deep dyspareunia , dyschezia , symptoms mimicking diarrhoea-predominant irritable bowel syndrome , intestinal cramping , abdominal bloating and passage of mucus in the stools , and 67 % of the patients declared that the treatment improved their gastrointestinal symptoms . CONCLUSIONS The administration of letrozole and norethisterone acetate reduces pain and gastrointestinal symptoms of women with colorectal endometriosis , particularly when patients suffer from symptoms mimicking diarrhoea-predominant irritable bowel syndrome BACKGROUND This study investigates the outcomes for women up to 5 years after laparoscopic excision of endometriosis . METHODS In this prospect i ve observational cohort study , 254 women with chronic pelvic pain were referred to two units specializing in minimal access surgical management of endometriosis . Of these , 216 women underwent surgical assessment and 176 were confirmed to have endometriosis .  Question naires and visual analogue scale ( VAS ) scores for dysmenorrhoea , non-menstrual pelvic pain , dyspareunia and dyschesia as well as quality of life instruments ; the EQ-5Dindex and  EQ-5Dvas  ,  Short-Form 12 ( SF-12 ) and  sexual activity question naires were completed pre-operatively . Intra-operative details of revised American Fertility Society ( rAFS ) stage , site of disease , associated tests , duration of surgery and complications were noted . Follow-up was performed by postal question naire and chart review . For women who had further surgery , rAFS stage , site of disease , other procedures and histology were all recorded . RESULTS Pain scores were all significantly reduced at 2 - 5 years for dysmenorrhoea ( median VAS baseline versus follow-up 2 - 5 years ) ; 9 versus 3.3 ( P < 0.0001 ) , non-menstrual pelvic pain 8 versus 3 ( P < 0.0001 ) , dyspareunia 7 versus 0 ( P < 0.0001 ) and dyschesia 7 versus 2 ( P < 0.0001 ) . Quality of life was improved for the EQ-5Dindex ( P = 0.008 and the EQ-5Qvas ( P = 0.03 ) and for sexual function with pleasure ( P = 0.001 ) and habit ( P = 0.012 ) being improved and discomfort being decreased ( P = 0.001 ) . The chance of requiring further surgery as determined by the Kaplan-Meier survival curve was 36 % . A rAFS score of > 70 was predictive of requiring further surgery ( P = 0.03 ) . Of women who had further surgery , endometriosis was found histologically in 68 % . CONCLUSIONS Laparoscopic excision of endometriosis significantly reduces pain and improves quality of life for up to 5 years . The probability of requiring further surgery is 36 % . Return of pain following laparoscopic excision is not always associated with clinical evidence of recurrence STUDY OBJECTIVE To estimate the quality of life of patients undergoing laparoscopic resection of a segment of the rectosigmoid for the treatment of deep infiltrating endometriosis with bowel involvement . DESIGN Prospect i ve application of the SF-36 Health Status Question naire to 151 women before and 1 year after surgical intervention ( Canadian Task Force Design Classification II ) . SETTING Department of Obstetrics and Gynecology , University of São Paulo Medical School , and Samaritano Hospital , São Paulo , Brazil . PATIENTS A total of 151 women ( mean age 34.05 ± 5.65 years ) with deep infiltrating endometriosis underwent resection of a segment of the rectosigmoid by laparoscopy between 2002 to 2009 . INTERVENTIONS All the patients had historical data collected and underwent clinical examination and transvaginal ultrasonography with prior bowel preparation for resection of a segment of the rectosigmoid by laparoscopy indicated for patients with symptoms ( pelvic pain ) with 1 or more lesions of more than 3 cm in length or multifocal lesions . MEASUREMENTS AND MAIN RESULTS Wilcoxon signed rank test verified differences between the degrees of the symptoms and the SF-36 scores before and 1 year after laparoscopic treatment . There was a significant improvement ( p < .001 ) in all pain-related symptoms , as well as a significant increase ( p < .001 ) in scores in all the SF-36 domains and in the sum of the components comprising both physical and mental health . CONCLUSION Laparoscopic segmental resection of the rectosigmoid fulfills its essential objective of treating endometriosis with bowel involvement and improving patients ' QoL to a significant extent STUDY OBJECTIVE To assess the long-term effectiveness of presacral neurectomy ( PSN ) in women with severe dysmenorrhea due to endometriosis treated with conservative laparoscopic surgical intervention .  DESIGN R and omized , controlled trial ( Canadian Task Force classification I ) . SETTING University-affiliated department of obstetrics and gynecology . PATIENTS One hundred forty-one sexually active women of reproductive age . INTERVENTION Conservative laparoscopic surgery without ( group A ) or with ( group B ) PSN . MEASUREMENTS AND MAIN RESULTS At entry and 24-months after surgical procedures , cure rates ; frequency and severity of dysmenorrhea , dyspareunia , and chronic pelvic pain ; and quality of life were evaluated . At follow-up visit , the cure rate was significantly ( P<0.05 ) higher in group B ( 83.3 % ) than in group A ( 53.3 % ) . The frequency and severity of dysmenorrhea , dyspareunia , and chronic pelvic pain were significantly ( P<0.05 ) lower in both groups compared with baseline values , and only severity was significantly ( P<0.05 ) lower in group B. A significant ( P<0.05 ) improvement in quality of life was observed after surgery in both groups and was significantly ( P<0.05 ) increased in group B compared with group A. CONCLUSION PSN improves long-term cure rates and quality of life in women treated with conservative laparoscopic surgery for severe dysmenorrhea due to endometriosis OBJECTIVE The purpose of this study was a quantification of changes in endometriosis-associated  pain and quality of life during the stimulatory phase of gonadotropin-releasing hormone agonist therapy . STUDY DESIGN One hundred twenty women with significant endometriosis-associated pain participated in a 1-month double-blind , r and omized , placebo-controlled trial . Pain was measured at baseline and at 2 and 4 weeks with  visual analog scales  and the Endometriosis Symptom Severity score . Quality of life was measured with the SF-36 instrument . Group means and SEMs were calculated . Paired t tests were used after determination of data normality . RESULTS Compared with placebo-treated control subjects women treated with gonadotropin-releasing hormone agonist had a statistically ( P < . 0001 ) and clinical ly significant temporary increase in pain and a concomitant decrease in quality of life . CONCLUSION The stimulatory phase of gonadotropin-releasing hormone agonist therapy is associated with an increase in endometriosis-associated pain and a decrease in quality of life BACKGROUND Among subjects with endometriosis and deep dyspareunia ( DD ) , those with endometriosis of the uterosacral ligament ( USLE ) have the most severe impairment of sexual function . This study examines the effect of laparoscopic excision of endometriosis on DD and quality of sex life . METHODS This observational cohort prospect i ve study included 68 women with endometriosis suffering DD ( intensity of pain > or= 6 on a 10-cm visual analogue scale ) . Patients underwent laparoscopic full excision of endometriosis .  Following surgery , they were asked to use nonhormonal contraception devices . Before surgery , at 6- and at 12-month follow-up , patients answered a self-administered question naire based on the Sexual Satisfaction Subscale of the Derogatis Sexual Functioning Inventory . RESULTS At 6- and 12-month follow-up , women with and without USLE had significant improvement in DD .  Subjects with USLE reported increased variety in sex life , increased frequency of intercourse , more satisfying orgasms with sex , relaxing more easily during sex and being more relaxed and fulfilled after sex . Similar improvements were observed among women without USLE ; however , for some variables statistical significance was not reached . CONCLUSIONS Surgical excision of endometriosis improves not only DD but also the quality of sex life OBJECTIVE The aim of the current study was to evaluate the effect of surgical removal of endometriosis on dyspareunia , sexual function , quality of sex life and interpersonal relationships . STUDY DESIGN A question naire-based multicentre prospect i ve study was conducted in six tertiary referral centres in Austria and Germany . Ninety-six patients with histologically proven endometriosis and dyspareunia were included . Before surgery and averagely 10 months postoperatively ( range 9 - 12 months ) , the Female Sexual Function Index ( FSFI ) and the Female Sexual Distress Scale ( FSDS ) were used to screen women 's sexuality . Additionally , we evaluated psychological parameters and pain intensity during/after sexual intercourse via a self-administered question naire . RESULTS Pain scores measured via NAS during/after intercourse decreased significantly after surgery . Frequencies of interrupted sexual intercourse , feelings of guilt towards the partner , being afraid of pain before/during sexual intercourse and feelings of being a burden for the relationship also decreased significantly in patients with peritoneal endometriosis and deep infiltrating endometriosis . Interestingly , sexually related personal distress did not improve in women with peritoneal endometriosis/vaginal resection , but improved in cases of deep infiltrating endometriosis ( DIE ) . CONCLUSION Radical laparoscopic excision of endometriosis offers an effective treatment option and offers a significant improvement in dyspareunia and quality of sex life OBJECTIVE To examine the effect on pain and quality of life for women with all stages of endometriosis undergoing laparoscopic surgery  compared with placebo surgery . DESIGN A r and omized , blinded , crossover study . SETTING A tertiary referral unit in a district general hospital . PATIENT(S ) Thirty-nine women with histologically proven endometriosis completed the 12-month study . INTERVENTION(S ) Women were r and omized to receive initially either a diagnostic procedure ( the delayed surgical group ) or full excisional surgery ( the immediate surgery group ) . After 6 months , repeat laparoscopy was performed , with removal of any pathology present . MAIN OUTCOME MEASURE(S ) The end points were changes from baseline values of visual analogue pain scores , vali date d quality -of-life instruments ( EQ-5D and SF-12 ) , and sexual activity question naire scores . Patients and assessors of outcomes were blinded to the treatment-group assignment . RESULT ( S ) Significantly more of the 39 women operated on according to protocol reported symptomatic improvement after excisional surgery than after placebo : 16 of 20 ( 80 % ) vs. 6 of 19 ( 32 % ) ; chi(2)(1 ) = 9.3 . Other aspects of quality of life were also significantly improved 6 months after excisional surgery but not after placebo .  Progression of disease at second surgery was demonstrated for women having only an initial diagnostic procedure in 45 % of cases , with disease remaining static in 33 % and improving in 22 % of cases . Nonresponsiveness to surgery was reported in 20 % of cases . CONCLUSION ( S ) Laparoscopic excision of endometriosis is more effective than placebo at reducing pain and improving quality of life . Surgery is associated with a 30 % placebo response rate that is not dependent on severity of disease . Approximately 20 % of women do not report an improvement after surgery for endometriosis OBJECTIVE To examine the prevalence of migraine in women with chronic pelvic pain with and without endometriosis . DESIGN Prospect i ve study of headache , pelvic pain , and quality of life before laparoscopic surgery for pelvic pain . Endometriosis was diagnosed pathologically . Headaches were classified as migraine or non-migraine using International Headache Society criteria . SETTING Clinical research hospital . PATIENT(S ) 108 women in a clinical trial for chronic pelvic pain ( NCT00001848 ) . INTERVENTION(S ) Laparoscopy to diagnose endometriosis , assessment by neurologist to assess headaches . MAIN OUTCOME MEASURE(S ) Prevalence of migraine and other headaches in women with chronic pelvic pain with or without endometriosis . Headache frequency , severity and relationship to pelvic pain and endometriosis . RESULT ( S ) Lifetime prevalence of definite or possible migraine was 67 % of women with chronic pelvic pain . An additional 8 % met criteria for possible migraine . Migraine was no more likely in women with endometriosis than those without . Women with the most severe headaches had a lower quality of life compared with those with pelvic pain alone . CONCLUSION ( S ) Migraine headache is common in women with chronic pelvic pain , regardless of endometriosis , and contributes to disability in those with both conditions . The strong association suggests a common pathophysiology STUDY OBJECTIVE To describe the effect of fertility-sparing laparoscopic excision of endometriosis and bowel resection on clinical and quality -of-life outcomes . DESIGN Prospect i ve observational cohort study ( Canadian Task Force classification II-2 ) . SETTING Australian tertiary referral center for the surgical treatment of endometriosis . PATIENTS Seven consecutive patients with known endometriosis involving the bowel . INTERVENTION Laparoscopic resection of all endometriosis , including laparoscopic bowel resection with end-to-end anastomosis with or without temporary ileostomy . MEASUREMENTS AND MAIN RESULTS Preoperative and 12-month postoperative data were collected by use of visual analogue scores for dysmenorrhea , nonmenstrual pelvic pain , dyspareunia , and dyschezia . Vali date d research tools ( SF12 , EuroQOL , and Sexual Activity Question naire ) also assessed quality of life . Reduction in median pain scores at baseline was demonstrated and at 12 months after operation for dysmenorrhea 71 ( interquartile range 43 - 85 ) versus 5 ( 0 - 10 ) ; p=.028 , nonmenstrual pelvic pain 74 ( 48 - 85 ) versus 11 ( 0 - 18 ) ; p=.046 , dyspareunia 66 ( 0 - 98 ) versus 5 ( 0 - 8 ) ; p=.080 , and dyschezia 48 ( 20 - 64 ) versus 20 ( 0 - 40 ) ; p=.173 . All measures of quality of life were improved at 12 months after surgery , although not reaching statistical significance because of the small sample size . All three women wishing to conceive after operation have been successful , result ing in three live births at term . There were few complications associated with this surgery . CONCLUSION Fertility-sparing laparoscopic excision of endometriosis with bowel resection results in improvements in all aspects of pain and quality of life . Results appear to parallel published data for conservative resection of endometriosis not involving bowel . For women with severe endometriosis involving bowel , this surgical treatment provides a viable alternative to pelvic clearance and successfully maintains fertility OBJECTIVE To examine the safety and efficacy of combining cyclic sodium etidronate and low-dose norethindrone with a long-acting GnRH agonist ( GnRH-a ) for prolonged therapy of symptomatic endometriosis . DESIGN Prospect i ve r and omized open label study . SETTING Tertiary care university-affiliated reproductive medicine program . PATIENTS Nineteen regularly cycling women with laparoscopically diagnosed symptomatic endometriosis and 18 regularly cycling untreated controls without endometriosis . INTERVENTIONS All patients received a depot preparation of the GnRH-a leuprolide acetate IM monthly for 48 weeks . Group I patients ( n = 10 ) received supplemental sodium etidronate cycled with calcium carbonate as well as 2.5 mg norethindrone daily . Group II patients ( n = 9 ) received only supplemental 10 mg norethindrone daily . Group III volunteers ( n = 18 ) were untreated and followed for bone density changes . MAIN OUTCOME MEASURES Disease extent at follow-up laparoscopy ; pain , vasomotor , and vaginal symptom scores ; bone mineral density ( serial dual-energy roentgenogram absorptiometry scans ) ; serum estrogens , lipids , and glucose and insulin response to glucose challenge . RESULTS Painful symptoms and extent of endometriosis were reduced in both treatment groups . Despite maintenance of a chronically hypoestrogenic state for 48 weeks , no changes in bone density over time or in comparison to group III untreated controls were noted . Similarly , no evidence of significant vasomotor symptoms were reported in either treatment group . However , adverse changes over time in circulating low-density lipoprotein ( LDL ) cholesterol and apolipoprotein A1 levels as well as the ratio of high-density lipoprotein to LDL were noted only in group II . CONCLUSIONS The combination of cyclic sodium etidronate and low-dose norethindrone with a long-acting GnRH-a served to safely prolong medical therapy of symptomatic endometriosis . Clinical efficacy was preserved while prophylaxis against significant hypoestrogenic side effects was achieved
Surgery and the use of drugs provided reduced pain scores in patients with endometriosis but nevertheless exhibit disadvantages , such as risk of recurrence and side effects , respectively .
However , improved quality of life in these patients has been obtained with the use of conventional treatment
Endometriosis is a chronic gynecological disease characterized by sustained painful symptoms that are responsible for a decline in the quality of life of sufferers .
Conventional treatment includes surgical and pharmacological therapy aim ing at reducing painful symptoms .
This study aim ed to evaluate pain levels in women with endometriosis , focusing on the influence of conventional treatment in controlling this variable .
Treatment of endometriosis is , therefore , a challenge for gynecologists and patients , as they must select the best therapeutic approach for this disease .