Journal of Endometriosis and Pelvic Pain Disorders

Chronic pelvic pain (CPP) is a common and variable condition often without standardised or effective treatment. A hysterectomy and/or oophorectomies alleviates CPP long term in some patients. Gonadotrophin releasing hormone analogues (GnRHa) induce a pseudo-menopausal state, mimicking some outcomes of these surgical procedures. This study aims to examine whether the use of pre-operative GnRHa can predict the pain outcome of patients undergoing hysterectomy and/or oophorectomies for CPP.

This is a retrospective cohort study at a tertiary university-affiliated hospital between 2010 and 2019 inclusive. Of 647 patients screened, 56 met the inclusion criteria of (i) pre-operative GnRHa prescription for pain management and (ii) proceeding to hysterectomy and/or oophorectomies. A positive pain response was considered either partial or complete pain relief.

All patients (N = 16) who had complete pain relief with GnRHa had complete pain resolution after surgery. Of the 25 patients who had partial resolution of pain with GnRHa, 22 (88.0%) had a positive pain response post-surgery. One patient reported no pain relief with either intervention. Pre-operative GnRHa had a sensitivity of 90.5% and specificity of 100% in predicting pain outcomes post hysterectomy and/or oophorectomies in this study.

Pre-operative GnRHa may be useful in patients with CPP to predict pain outcome after hysterectomy and/or oophorectomies.

To determine the incidence of autoimmunity in women with endometriosis and examine whether autoimmunity has any additional negative effects on ovarian reserve beyond the influence of endometriosis alone.

The study included women with endometriosis from January 2022 to January 2023. All enrolled patients underwent physical examinations and routine ultrasound checks. The diagnosis of endometriosis was established based on these assessments or confirmed by prior surgeries. Blood samples were collected from the participants, including measuring serum anti-Müllerian hormone (AMH) levels and an immunologic panel that comprised tests for anti-nuclear antibody profile, lupus anticoagulant antibody, and thyroid antibodies. A total of 104 patients were included in the analysis, divided into two groups based on the presence of autoimmune antibodies.

The study revealed 56 patients with negative test results (autoimmune (−) group) and 48 patients with at least one positive antibody (autoimmune (+) group), yielding an overall autoimmunity rate of 46%. Demographic parameters were comparable between the two groups. The autoimmune (+) group exhibited significantly lower levels of anti-Müllerian hormone, with respective interquartile ranges of 0.8 ng/ml (0.2–3.2) versus 1.7 ng/ml (0.6–4.8) in the autoimmune (-) group (p = 0.01).

The present study disclosed that almost half of the endometriosis patients tested positive for autoimmune antibodies. The observed rate of autoimmunity aligned with existing data. However, exploring the impact of autoimmune antibodies on ovarian reserve in endometriosis is a relatively new research avenue. This pilot study suggests that the presence of autoimmunity may have a more detrimental effect on ovarian reserve in endometriosis.

Matrix metalloproteinase-7 (MMP7) regulates pathogenesis of endometriosis by promoting cellular invasion and extracellular matrix remodeling. The present study aimed to understand whether single nucleotide polymorphism (SNP) of MMP7 promoter region at −181A/G can be a risk factor for development of endometriosis in eastern Indian population.

The case-control cohort included 130 women with endometriosis and 130 women without endometriosis from East Indian population. Polymorphism of MMP7 (rs11568818) at −181A/G was genotyped by polymerase chain reaction-restriction enzyme length polymorphism.

Our study did not identify MMP7 −181A > G promoter polymorphism as a risk factor for increased incidences of endometriosis. However, endometriosis patients having AG and AG + GG (pooled) genotypes showed increased susceptibility for developing severe endometriosis (p = 0.0485, OR: 2.864, 95% CI: 0.979–8.372 and p = 0.0428 OR: 2.848, 95% CI: 1.010–8.031 respectively) as compared to AA genotype. Endometriosis patients with GG genotype have faster disease development (5.65 ± 4.40 years, p = 0.0215) as compared to the endometriosis patients with AA genotype (8.71 ± 5.25 years).

Promoter polymorphism of MMP7 (−181A > G) is not a risk factor for increased incidences of endometriosis in eastern Indian women. However, endometriosis patients with MMP7-181G genotypes are susceptible to faster disease progression and developing severe endometriosis.

Despite recent progress in endometriosis treatments that modify the disease, pain continues to be the most significant symptom for many women suffering from endometriosis. Due to the role of inflammation and immune system abnormalities in the pathogenesis of endometriosis, this study aimed to determine the effectiveness of 10 mg prednisolone on pelvic pain management in women with Deep Infiltrative Endometriosis (DIE).

This randomized, double blind, placebo-controlled clinical trial study was conducted with 60 women (ages 18–45 years) diagnosed with DIE. The intervention group received two tablets of prednisolone (10 mg) along with Dienogest (2 mg) daily starting from the 10th day of the first menstrual period after the baseline visit for 12 weeks. The control group received one Dienogest tablet (2 mg) daily along with two placebo tablets following the same regimen as the intervention group. Primary outcomes included changes in pain scores for dysmenorrhea, dyspareunia, and dyschezia after the intervention, as well as the change in the size of endometriosis.

Dysmenorrhea and dyspareunia and dyschezia scores significantly decreased in both groups. However, the frequency of patients in the prednisolone group who experienced a reduction in dysmenorrhea and dyspareunia scores ⩾30% was statistically higher compared to the control group. While the percentage of patients showing reduced endometrium size was higher in the prednisolone group (58.3% vs 36.4%), this difference was not statistically significant (p = 0.15). No serious side effects were reported.

This clinical trial demonstrated that low-dose prednisolone provides a significant decrease in pain associated with DIE. Further trials will be warranted to confirm these findings.

Endometriosis remains a significant challenge to women’s health, with delays in diagnosis and suboptimal outcomes. This review aimed to consolidate recent findings and guide future strategies for improved detection, treatment, and patient care.

A literature review was conducted using the PubMed and Cochrane Library databases. We included studies published in 2023 or later that evaluated epidemiological data, diagnostic biomarkers, and therapeutic interventions. Particular attention was given to emerging modalities, such as artificial intelligence-driven diagnostics, novel hormonal treatments, and integrative care approaches.

Recent findings underscore the complex genetic and immunological factors that contribute to the progression of endometriosis. Symptom normalization and limited clinician awareness can lead to delayed diagnosis, which worsens patient outcomes. Biomarkers and advanced imaging techniques show promise for earlier detection but lack standardization and universal availability. Hormonal therapies remain the cornerstone of treatment, whereas surgical approaches offer symptomatic relief and fertility benefits, albeit with risks such as recurrence and potential ovarian reserve reduction. Moreover, mental and medical comorbidities further exacerbate disease burden and underscore the need for integrated healthcare. Innovative options, including neuromodulation, mTOR inhibitors, and integrative pain management methods, are being actively investigated. Socioeconomic and cultural disparities compose access challenges, emphasizing the importance of multidisciplinary, patient-centered management.

Major gaps remain in the early detection, comprehensive management, and equitable access for endometriosis. This review highlights the need for refined diagnostic tools, advanced treatment approaches, and integrated care strategies. Ongoing research and multidisciplinary collaboration are essential for improving patient outcomes and quality of life.

Pelvic pain of endometriosis often becomes refractory to standard pharmacological methods. For these patients, radiofrequency ablation (RFA) of Superior hypogastric plexus and Ganglion impar are effective alternative.

To compare efficacy of RFA of Superior Hypogastric Plexus versus RFA of both Superior hypogastric plexus and Ganglion impar.

This parallel group, open-label randomised controlled trial was conducted on 40 women with endometriosis based on particular inclusion and exclusion criteria at a tertiary care hospital. They were divided into two groups using random number table; Group A received RFA of Superior hypogastric plexus and Group B received RFA of Superior hypogastric plexus with Ganglion impar. Our study parameters were Visual Analogue Scale (VAS) for pain and short-form Endometriosis Health Profile (EHP-5) for quality of life. Data was taken at baseline, at 24 h, 1 week, 4 weeks and 12 weeks.

Significant (p < 0.05) improvement was noted in VAS and EHP-5 score in individual groups at all intervals. Group B has shown a better outcome of both parameters on all the follow-ups, but significant differences were noted at 24 h in the VAS score (p = 0.025) and at 1 week in the EHP-5 score (p = 0.040).

Both groups have shown significant improvement compared to baseline. However, significant improvement was noted in both the parameters on short term when Ganglion Impar is ablated along-with Superior Hypogastric Plexus.

To discuss the etiology, characteristics, and treatment strategies of metastatic clear cell carcinoma.

This study retrospectively reviews a case of metastatic clear cell carcinoma adjacent to the right lower abdominal rectus muscle, managed in the Department of Gastrointestinal Surgery at Hainan Provincial People’s Hospital, combined with an analysis and discussion of relevant literature from domestic and international sources.

A 54-year-old female patient was admitted with a palpable mass in the lower abdomen, approximately 10 cm × 9 cm × 8 cm in size. She had a history of cesarean section 20 years ago but no history of endometriosis. Preoperative diagnosis suggested an abdominal wall mass, and the patient underwent radical resection of the abdominal wall tumor with abdominal wall defect repair. During surgery, the mass was found beside the right rectus abdominis muscle in the lower abdominal wall, measuring approximately 10 cm × 9 cm × 8 cm. Intraoperative frozen pathology suggested metastatic clear cell carcinoma, with the presence of endometrial glands, stromal cells, and hemosiderin deposition, indicating malignant transformation of endometriosis.

This condition has a low preoperative detection rate, and early surgical treatment should be undertaken once the diagnosis is confirmed. For this patient, although there was no clear history of endometriosis, the malignant transformation of ectopic tissue may be one of the potential causes of metastatic clear cell carcinoma. Therefore, a comprehensive assessment of medical history and imaging studies should be strengthened before surgery.