Pathophysiology, diagnosis, and management of endometriosis

BMJ, Год журнала: 2022, Номер unknown, С. e070750 - e070750

Опубликована: Ноя. 14, 2022

Endometriosis affects approximately 190 million women and people assigned female at birth worldwide. It is a chronic, inflammatory, gynecologic disease marked by the presence of endometrial-like tissue outside uterus, which in many patients associated with debilitating painful symptoms. Patients endometriosis are also greater risk infertility, emergence fatigue, multisite pain, other comorbidities. Thus, best understood as condition variable presentation effects multiple life stages. A long diagnostic delay after symptom onset common, persistence recurrence symptoms despite treatment common. This review discusses potential genetic, hormonal, immunologic factors that lead to endometriosis, focus on current management strategies for gynecologists, general practitioners, clinicians specializing conditions higher risk. examines evidence supporting different surgical, pharmacologic, non-pharmacologic approaches treating presents an easy adopt step-by-step strategy. As multisystem disease, should ideally be offered personalized, multimodal, interdisciplinary approach. priority future discovery determining clinically informative sub-classifications predict prognosis enhance prioritization.

Язык: Английский

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Uterine bleeding: how understanding endometrial physiology underpins menstrual health

Nature Reviews Endocrinology, Год журнала: 2022, Номер 18(5), С. 290 - 308

Опубликована: Фев. 8, 2022

Язык: Английский

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Human embryo implantation

Development, Год журнала: 2023, Номер 150(10)

Опубликована: Май 15, 2023

Embryo implantation in humans is interstitial, meaning the entire conceptus embeds endometrium before placental trophoblast invades beyond uterine mucosa into underlying inner myometrium. Once implanted, embryo survival pivots on transformation of an anti-inflammatory bed, termed decidua, under homeostatic control natural killer cells. Here, we examine evolutionary context and elaborate remodelling after conception humans. We also discuss interactions between decidualising that regulate interstitial determine fitness. Together, this Review highlights precarious but adaptable nature process.

Язык: Английский

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Sexism in the management of bleeding disorders

Research and Practice in Thrombosis and Haemostasis, Год журнала: 2020, Номер 5(1), С. 51 - 54

Опубликована: Дек. 13, 2020

Sexism has been an issue in bleeding disorders for centuries. Women with have underrecognized and underdiagnosed. Those who are diagnosed often experience delays diagnosis feel that their symptoms dismissed or minimized. Several factors contribute to this sexism. Historically, the clinical research focus within disorder community on men hemophilia. Von Willebrand disease, a disease long recognized as affecting women, is much more common than hemophilia, yet significantly fewer resources devoted it. The lack of knowledge comfort patients health care providers regarding menstruation compounds issue, heavy menstrual one most seen women disorders. Stemming from universal stigmatization periods, results seeking care, addressing getting they deserve. Progress made, many organizations dedicating improving these women. road long, work needed ensure receive

Язык: Английский

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Association between menstrual cycle length and covid-19 vaccination: global, retrospective cohort study of prospectively collected data

BMJ Medicine, Год журнала: 2022, Номер 1(1), С. e000297 - e000297

Опубликована: Сен. 1, 2022

Objectives To identify whether covid-19 vaccines are associated with menstrual changes in order to address concerns about cycle disruptions after vaccination. Design Global, retrospective cohort study of prospectively collected data. Setting International users the tracking application, Natural Cycles. Participants 19 622 individuals aged 18-45 years lengths 24-38 days and consecutive data for at least three cycles before one covid (vaccinated group; n=14 936), those four over a similar time period (unvaccinated n=4686). Main outcome measures The mean change within was assessed by vaccination group menses length (mean first second dose vaccine subsequent cycle). Mixed effects models were used estimate adjusted difference between vaccinated unvaccinated. Results Most people (n=15 713; 80.08%) younger than 35 years, from UK (n=6222; 31.71%), US Canada (28.59%), or Europe (33.55%). Two thirds (9929 (66.48%) 14 936) received Pfizer-BioNTech (BNT162b2) vaccine, 17.46% (n=2608) Moderna (mRNA-1273), 9.06% (n=1353) Oxford-AstraZeneca (ChAdOx1 nCoV-19), 1.89% (n=283) Johnson & (Ad26.COV2.S). Individuals who had less day increase their cycles, compared not (0.71 (99.3% confidence interval 0.47 0.96) dose; 0.56 (0.28 0.84) dose). larger two doses (3.70 (2.98 4.42)). One vaccination, per (0.02 −0.10 0.14), but yet (0.85 0.24 1.46)) unvaccinated individuals. Changes did differ vaccine’s mechanism action (mRNA, adenovirus vector, inactivated virus). Menses unaffected Conclusions Covid-19 is small likely be temporary no length.

Язык: Английский

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Ovarian hormones-autophagy-immunity axis in menstruation and endometriosis

Theranostics, Год журнала: 2021, Номер 11(7), С. 3512 - 3526

Опубликована: Янв. 1, 2021

Menstruation occurs in few species and involves a cyclic process of proliferation, breakdown regeneration under the control ovarian hormones. Knowledge normal endometrial physiology, as it pertains to regulation menstruation, is essential understand disorders menstruation. Accumulating evidence indicates that autophagy endometrium, hormones, can result infiltration immune cells, which plays an indispensable role endometrium shedding, tissue repair prevention infections during In addition, abnormal levels, together with resulting dysregulated system function, are associated pathogenesis progression endometriosis. Considering its potential value target for treatment menstrual-related endometrium-related disorders, we review activity function menstrual cycles. The estrogen/progesterone-autophagy-immunity axis endometriosis also discussed.

Язык: Английский

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Premenstrual and menstrual changes reported after COVID-19 vaccination: The EVA project

Women s Health, Год журнала: 2022, Номер 18

Опубликована: Янв. 1, 2022

Menstrual disorders were not reported as a possible secondary effect in any of the clinical trials for SARS-CoV-2 vaccines.

Язык: Английский

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Menstrual cycle disturbances after COVID-19 vaccination

Women s Health, Год журнала: 2022, Номер 18

Опубликована: Янв. 1, 2022

After COVID-19 vaccination, women of reproductive age reported changes in their menstrual cycle.

Язык: Английский

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Current findings in endometrial microbiome: impact on uterine diseases

Reproduction, Год журнала: 2022, Номер 163(5), С. R81 - R96

Опубликована: Фев. 23, 2022

Microbiome or microbiota is essential to regulate many mammalian physiological processes, including reproduction. Like other organs tissues, the upper female reproductive tract used be considered as devoid of microorganisms; however, a non-infection-related bacterial community was discovered in uterus from humans and mammals, its composition related success. The dysbiosis endometrial associated with benign malign uterine diseases. Hence, this review addressed current knowledge about alterations their association common diseases, polyposis, endometriosis, myomatosis, hyperplasia, cancer. There specific endometrium most-analyzed However, constant finding consists reduced abundance Firmicutes Lactobacillus , while there an increased Proteobacteria (such Escherichia coli Enterococcus ), Bacteroidetes ( Prevotella for example), Actinobacteria (as Gardnerella contrast healthy endometrium. Besides, we discussed future usefulness components biomarkers diagnose diseases probable clinical outcomes. In addition, analyzed potential use probiotics since they could provide alternative complement existing therapies.

Язык: Английский

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Menstrual irregularities and vaginal bleeding after COVID-19 vaccination reported to v-safe active surveillance, USA in December, 2020–January, 2022: an observational cohort study

The Lancet Digital Health, Год журнала: 2022, Номер 4(9), С. e667 - e675

Опубликована: Авг. 9, 2022

BackgroundAnecdotal reports of menstrual irregularities after receiving COVID-19 vaccines have been observed in post-authorisation and post-licensure monitoring. We aimed to identify classify vaginal bleeding vaccination submitted a voluntary active surveillance system.MethodsThis observational cohort study included recipients vaccine who were aged 18 years older reported their health experiences v-safe, smartphone-based system for monitoring safety the USA, from Dec 14, 2020, Jan 9, 2022. Responses survey questions on reactions extracted, pre-trained natural language inference model was used free-text comments related menstruation response an open-ended prompt about any symptoms at intervals vaccination. Related responses further categorised into themes timing, severity, perimenopausal postmenopausal bleeding, resumption menses, other responses. examined associations between symptom theme respondent characteristics, including type dose number received, solicited local systemic reported, care sought.Findings63 815 respondents or which 62 679 female (1·0% 5 975 363 ≥18 years). Common identified timing (70 981 [83·6%] responses) severity (56 890 [67·0%] responses). Other menopausal (3439 [4·0%] menses (2378 [2·8%] Respondents submitting more likely seek than those themes.InterpretationReports heterogeneous are being although this is unable characterise relationship these Methods that leverage pretrained models interpret unsolicited signs offer promise initial evaluation unexpected adverse events potentially associated with use newly authorised licensed vaccines.FundingCenters Disease Control Prevention.

Язык: Английский

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