Effects of simvastatin in prevention of pain recurrences after surgery for endometriosis (original) (raw)
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Acta obstetricia et gynecologica Scandinavica, 2015
To evaluate the efficacy of dienogest + estradiol valerate (E2V) and gonadotrophin-releasing hormone analogue (GnRH-a) in reducing recurrence of pain in patients with chronic pelvic pain due to laparoscopically diagnosed and treated endometriosis. Multi-center, prospective, randomized study. Three university departments of obstetrics and gynecology in Italy. Seventy-eight women who underwent laparoscopic surgery for endometriosis combined with chronic pelvic pain. Post-operative administration of dienogest + E2V for 9 months (group 1) or GnRH-a monthly for 6 months (group 2). A visual analogue scale was used to test intensity of pain before laparoscopic surgery at 3, 6 and 9 months of follow up. A questionnaire to investigate quality of life was administered before surgery and at 9 months of follow up. The visual analogue scale score did not show any significant differences between the two groups (p = 0.417). The questionnaire showed an increase of scores for all women compared with...
The Journal of Obstetrics and Gynecology of India, 2018
Objective To compare the efficacy and safety of dienogest (DNG) with depot leuprolide acetate (LA) in patients with recurrent pelvic pain following laparoscopic surgery for endometriosis. Design Prospective randomized trial. Setting Zagazig University hospitals, Egypt. Patients Two hundred and forty-two patients with recurrent pelvic pain following laparoscopic surgery for endometriosis. Intervention Dienogest (2 mg/day, orally) or depot LA (3.75 mg/4 weeks, intramuscularly) for 12 weeks. Main Outcome Measures A visual analogue scale was used to test the intensity of pain before and after the end of treatment. Results There was highly significant reduction in pelvic pain, back pain and dyspareunia in both groups with mean of difference in dienogest group (28.7 ± 5.3, 19.0 ± 4.3 and 20.0 ± 3.08 mm, respectively) and in LA group (26.2 ± 3.01, 19.5 ± 3.01 and 17.9 ± 2.9 mm, respectively). The most frequent drug-related adverse effects in
Simvastatin protects against the development of endometriosis in a nude mouse model
Journal of Clinical …, 2009
Context: Endometriosis is a common condition associated with infertility and pelvic pain in women. Recent in vitro studies have shown that statins decrease proliferation of endometrial stroma (ES) and inhibit angiogenesis. Objective: The aim was to evaluate effects of simvastatin on development of endometriosis in a nude mouse model. Methods: Proliferative phase human endometrial biopsies were obtained from healthy donors and established as organ cultures or used to isolate ES cells. To establish endometriosis in the nude mouse, endometrial tissues were maintained in 1 nM estradiol (E) for 24 h and subsequently injected into ovariectomized nude mice. Mice (n ϭ 37) were treated with E (8 mg, SILASTIC capsule implants; made in author laboratory) alone or with E plus simvastatin (5 or 25 mg/kg ⅐ d) for 10 d beginning 1 d after tissue injection (from three donors). Mice were killed and examined for disease. Effects of simvastatin on matrix metalloproteinase-3 (MMP-3) were evaluated in cultures of ES cells. Primary Outcome: The number and size of endometriotic implants were measured. Results: Simvastatin induced a dose-dependent decrease of the number and size of endometrial implants in mice. At the highest dose of simvastatin, the number of endometrial implants decreased by 87%, and the volume by 98%. Simvastatin also induced a concentration-dependent decrease in MMP-3 in the absence and presence of inflammatory challenge (using IL-1␣). Conclusions: Simvastatin exerted a potent inhibitory effect on the development of endometriosis in the nude mouse. Mechanisms of action of simvastatin may include inhibition of MMP-3. The present findings may lead to the development of novel treatments of endometriosis involving statins.
Journal of Minimally Invasive Gynecology, 2011
Study Objective: To evaluate continuous (CON) compared with cyclic (CYC) administration of combined oral estroprogestins for 6 months after laparoscopic excision of ovarian endometriomas associated with pain. Design: Multicenter, prospective, randomized trial (Canadian Task Force classification I). Setting: Tertiary care university hospitals. Patients: Fifty-seven women aged 18 to 40 years with ovarian endometriomas associated with moderate to severe pelvic pain who underwent laparoscopic excision of the disease. Interventions: Patients were randomized to receive postoperative estroprogestins for 6 months, administered as either a CON or CYC regimen. Measurements and Main Results: At 3, 6, 12, and 24 months postoperatively, patients were evaluated for recurrence of endometriomas (defined as cysts .3 cm in greatest diameter) using ultrasonography, for recurrence of pain using a visual analog scale, and for patient satisfaction. After a minimum follow-up of 12 months (mean, 22 months), at intent-to-treat analysis, no endometrioma recurrence was observed in the CON group, whereas there was recurrence in 1 patient (4%) in the CYC group. Pain recurred in 5 and 9 patients, respectively (17% vs 32%; p 5 .23). Compared with pretreatment values, pain scores improved in both groups, with no significant difference between the 2 groups. Most patients in both groups were either satisfied or very satisfied, with no significant difference between treatment groups. However, compared with the CYC group, significantly more patients in the CON group experienced moderate to severe adverse effects, and therapy was discontinued (41% vs 14%; p 5 .03). Conclusions: Although both regimens were equally effective insofar as postoperative pain and recurrence of endometrioma, when compared with the CYC regimen, the CON regimen seems to be associated with significantly more adverse effects and discontinuation rates.
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2011
To investigate factors that might influence the recurrence of both painful symptoms and endometriotic lesions following laparoscopic treatment of endometriosis. Study design: Retrospective cohort study in a University teaching hospital. We reviewed data from patients referred for laparoscopy between March 1993 and November 2007. We selected women who were followed up throughout Transvaginal-ultrasound (TV-US) after a first conservative laparoscopy for endometriosis. After laparoscopy, all patients were followed up according to an internal protocol: a standard gynaecologic examination, the assessment of painful symptoms and a TV-US scan that were repeated at 3, 6, and 12 months, and subsequently on a yearly basis. Sixteen factors were assessed by univariable and multivariable Cox proportional hazards models to evaluate their associations with recurrence of endometriotic lesions and pain related-endometriosis. Results: 401 women were enrolled. A total of 154 (38.4%) experienced moderate or severe pain after laparoscopy; endometriotic lesions were observed by TV-US in 74 (18.4%) patients. In the multivariable model, age at menarche, severity of chronic pelvic pain (CPP) and dysmenorrhoea prior to surgery were significant risk factors for recurrence/occurrence of pain. Age at the first laparoscopy, stage of disease, pre-operative severity of CPP, and pregnancy were predictive factors of the recurrence for such lesions. Conclusion: The severity of CPP prior to the first laparoscopy showed the only significant factor in the overall prediction of recurrence of pain and endometriotic lesions. Patients with severe CPP at the time of their first surgery might represent a subgroup of women with a more aggressive form of endometriosis.
Fertility and Sterility, 2011
Objective: To compare efficacy of the levonorgestrel-releasing intrauterine system (LNG-IUS; Mirena) with depot GnRH analogue (GnRH-a; gosareline acetate; Zoladex) on endometriosis-related chronic pelvic pain (CPP) in patients with severe endometriosis during 12 months. Design: Prospective, randomized, controlled study. Setting: The reproductive endocrinology unit of a tertiary, research and education hospital. Patient(s): Forty women with severe endometriosis (revised The American Fertility Society [AFS] classification >40) and endometriosis-related CPP and control groups were enrolled in the study. Intervention(s): The patients were treated with either LNG-IUS (n ¼ 20) or GnRH-a (n ¼ 20). The GnRH-a dose was repeated every 4 weeks for 24 weeks. Main Outcome Measure(s): Scores of CPP were evaluated using a visual analogue scale (VAS) and total endometriosis severity profile (TESP). Result(s): The TESP score decreased in the LNG-IUS group at first, third, and sixth month follow-up visits, whereas at the 12th month follow-up visit, the TESP scores were increased to values similar to pretreatment values. Although the VAS score had no significant alteration during the follow-up period in the LNG-IUS group, the GnRH-a group showed a significant decrease in the VAS score and TESP score at the end of 1 year. The LNG-IUS treatment showed a lower patient satisfaction. Conclusion(s): Both treatment modalities showed comparable effectiveness in the treatment of CPP-related endometriosis.
Indonesian Journal of Obstetrics and Gynecology, 2019
Objective : To evaluate the correlation between the American Society of Reproductive Medicine (ASRM) score in endometriosis and severity pelvic pain in a group of women with endometriosis. Methods : A total of 131 patients with pelvic pain who: conduct laparoscopy for diagnosis and therapy of endometriosis, have pain symptoms>3 months, and absence of pelvic anomalies. Dysmenorrhea, deep dyspareunia, dyschezia, dysuria, and chronic pelvic pain were evaluated using a 10-point visual analogue scale. The data was collected by assessing the medical record, and retrospective analysis was performed. Disease stage according to the American Society of Reproductive Medicine, the presence of adhesion, lesion type (Deep Infi ltrating Endometriosis (DIE) or without DIE), and severity of pain symptoms were analysed by Spearman analysis. Different VAS between DIE vs non DIE group was analysed by Mann-Whitney analysis. Results : Stage IV endometriosis accounts for 79.4%. Based on the macroscopic appearance, ovarian endometriosis accounts for 92.4%, peritoneal endometriosis 82.4%, DIE was 40.5%, and adenomyosis was 19.1%. There was signifi cant correlation between total ASRM, ovarian endometriosis, peritoneal lesion, Douglas pouch obliteration, adnexal adhesion score and VAS dysmenorrhea (r=0.303; 0.187; 0.203; 0.278; 0.266, p<0.05). There was signifi cant VAS difference of DIE vs non DIE group; the difference was on dyspareunia (5.18±2.4 and 4.58±1.0, p<0.001] and dyschezia [5.28±2.2 and 4.86±0.7,p<0.001] Conclusions : There was a positive correlation between ovarian endometriosis score and severity of dysmenorrhea. There was also a difference in the degree of endometriosisassociated pain between DIE and non DIE group.
Fertility and Sterility, 2010
Objective: To identify prognostic factors for pain and endometrioma recurrence after complete laparoscopic excision of endometrioma(s). Design: Prospective observational study. Setting: Tertiary care university hospital. Patient(s): One-hundred sixty-six consecutive women affected by uni-or bilateral ovarian endometrioma(s). Intervention(s): Laparoscopic conservative treatment of endometriosis. Main Outcome Measure(s): Patient demographic characteristics, surgical findings, and surgical results were prospectively recorded. Postoperative follow-ups were carried out every 3 months to identify pain and/or endometrioma recurrence for a minimum of 3 years. Result(s): Dysmenorrheal, dyspareunia, and chronic pelvic pain recurred in 14.5%, 6%, and 5.4% of women, respectively. Prior surgery for endometriosis, adhesion extension, and use of ovarian stimulation drugs (OSD) were unfavorable prognostic factors for pain symptoms. Ovarian endometrioma recurred in 9.6% of cases; negative factors were prior surgery for endometriosis, OSD, pelvic adhesions, and high American Society for Reproductive Medicine disease scores. Postoperative pregnancy showed a significant protective effect on pain and disease recurrences. Conclusion(s): Prior surgery, presence of adhesions, and ovulation drugs are negative prognostic factors. Pregnancy has a protective effect on disease and pain recurrence. (Fertil Steril Ò 2010;93:716-21.