Quality of life in endometriosis: evaluation of the Dutch-version Endometriosis Health Profile-30 (EHP-30)

The Dutch version of the Endometriosis Health Profile-30 (EHP-30) showed a high return rate and data completeness, low floor and ceiling effects, as well as good internal consistency, test-retest reliability and construct validity. The questionnaire is a reliable and valid instrument for the measurement of health-related quality of life in women with endometriosis.     

Patient Quality of Life and Symptoms after Surgical Treatment for Endometriosis

Study Objective

To assess the impact of surgical treatment of endometriosis on quality of life and pain over a 3-year period of postoperative follow-up.

Development of an endometriosis quality-of-life instrument: The Endometriosis Health Profile-30

OBJECTIVE: To describe a new disease-specific questionnaire with established measurement properties that addresses the dimensions of health-related quality of life considered important to women with endometriosis. METHODS: The Endometriosis Health Profile-30 was developed in three stages. Stage 1 included open-ended exploratory interviews with 25 women to generate the items on the questionnaire. Stage 2 was an 87-item questionnaire administered in a postal survey to identify the most salient dimensions of health-related quality of life. In stage 3, the reliability and validity of the questionnaire were evaluated. RESULTS: The final instrument contained a core questionnaire with 30 items and five scales: pain, control and powerlessness, emotional well-being, social support, and self-image. Six modular parts consisting of 23 questions were also developed and measured the areas of sexual intercourse, work, relationship with children, feelings about the medical profession, treatment, and infertility. All the scales achieved high internal reliability, with Cronbach's alpha coefficient ranging from 0.83 to 0.93 (core questionnaire) and 0.79 to 0.96 (modules). The intraclass correlation coefficients to evaluate the test-retest reliability were high (range 0.88-0.98, P <.001). Content validity was demonstrated as the questionnaire was developed from interviews of patients rather than existing literature and clinical scales. Construct validity was assessed by correlating the Endometriosis Health Profile-30 scales with the relevant Short Form-36 scales. High correlations for all comparisons were found (-0.41 to -0.73). CONCLUSION: The Endometriosis Health Profile-30 is a reliable, valid, patient-generated instrument to measure the health-related quality of life of women with endometriosis. Its application in various health care settings will provide new and valuable information on the effect of endometriosis on health-related quality of life from the patients' perspective.     

Long-Term Outcomes on Quality of Life in Women Submitted to Laparoscopic Treatment for Bowel Endometriosis

Study ObjectiveTo evaluate the long-term effects of laparoscopic surgery on quality of life in women with bowel endometriosis.DesignObservational prospective cohort study (Canadian Task Force classification II).SettingCentral Hospital of Santa Casa, Sao Paulo, Brazil.PatientsForty-five patients answered a short-form, 36-item, quality-of-life questionnaire (SF-36) at 3 different times.InterventionsBetween June 2007 and September 2008, patients underwent laparoscopic surgery to treat deep infiltrative endometriosis, with colorectal resection.Measurements and Main ResultsForty-five patients with bowel endometriosis were followed up from 2007 to 2012. Before surgery, all patients exhibited signs suggestive of bowel endometriosis at magnetic resonance imaging and transrectal ultrasound. The patients underwent laparoscopic surgery for resection of the endometriosis lesions, including colorectal resection. The patients completed the questionnaire before surgery (T0), at 12 (T12) and 48 (T48) months after surgery. The 8 items of the SF-36 questionnaire at the different time points of application were compared. For each domain attribute, a score of 0 to 100 was assigned, where 0 signified the worst quality of life, and 100 the best. Statistical analysis was performed using analysis of variance. If differences were detected, multiple comparisons were performed using the Tukey test. Analysis of each domain revealed improved quality of life when comparing the period before surgery with 12 and 48 months after surgery. There was a significant increase (p < .001) in the scores in all of the SF-36 domains when comparing T0 vs T12 and T0 vs T48, with higher average scores at T48 corresponding to the domains of physical functioning, role physical, and social functioning (scores of 85.56, 75.69, and 73.61, respectively).ConclusionLaparoscopic treatment of bowel endometriosis improved the long-term quality of life of patients.     

中草药对子宫内膜异位症患者术后生存质量影响的Meta分析

目的:系统评价中草药对子宫内膜异位症(EMs)患者术后生存质量的影响。方法:计算机检索Medline、EMBASE、The Cochrane Library、CNKI、中国生物医学文献数据库(CBM)、万方数据库。由2名研究者按照纳入与排除标准独立筛选文献、提取资料和评价文献质量后,采用Rev Man 5.2软件进行Meta分析。结果:共纳入7篇文献,共计644例患者。Meta分析结果显示,依据世界卫生组织生存质量简化量表(WHOQOL-BREF)评分,中草药干预能够改善患者术后的总体生存质量[SMD=0.19,95%CI(0.11,0.28),P0.000 1]。此外,依据研究中的量表EHP-30/5评分,中草药可能提高了EMs患者术后生存质量。结论:研究结果显示中草药可改善EMs患者术后总体生存质量,然而研究中所用量表不是EMs的专用量表,且由于目前相关研究的质量和数量尚不足,还不能提供足够证据说明中草药的干预效果,尚需更高质量研究以增强论证强度。     

Validation of the prolapse quality of life questionnaire (P-QOL) in a Turkish population

OBJECTIVE: To validate the Turkish translated version of the prolapse quality of life questionnaire (P-QOL). STUDY DESIGN: After establishing the test-retest reliability and internal consistency in a pilot study, 310 patients were enrolled in the study and general and subscale scores of the questionnaires were calculated. All participants underwent the International Continence Society (ICS) prolapse score (POP-Q). RESULTS: One hundred and forty-five (49.7%) women were symptomatic and 147 (50.3%) were asymptomatic. The level of missing data ranged from 0 to 2.2%. For the test-retest reliability, Spearman's rho was from 0.91 to 1.00 for all domains (p<0.001). The severity of P-QOL was strongly correlated with the vaginal examination findings among the symptomatic group (p<0.001). Items correlated with the objective vaginal examination findings. The total and domain scores for P-QOL of symptomatic and asymptomatic women were found to be statistically significant (p<0.001). CONCLUSION: The Turkish translated version of the P-QOL is reliable, consistent and valid instrument for assessing symptom severity, impact on quality of life in women with uterovaginal prolapse. It is easy to understand may be easily administered and self-completed by the women.     

Surgery for Endometriosis Improves Major Domains of Quality of Life: A Systematic Review and Meta-Analysis

Because surgery for endometriosis can involve severe complications, it is important to determine if the patient's quality of life (QOL) is indeed improved after surgery. A systematic review and meta-analysis, when appropriate, was conducted and included 38 studies that assessed the QOL using validated questionnaires administered before and after surgery. Results were grouped according to the type of endometriosis reported: all types endometriosis, deep infiltrative endometriosis (DIE), and bowel endometriosis. Quantitative analysis was performed on 17 homogeneous studies. Pooled response mean differences between the 36-Item and 12-Item Short Form Survey (SF-36 and SF-12) showed significant improvement in Mental Component Score (MCS) after surgery for all types of endometriosis (.21; 95% confidence interval [CI], .04–.38); significant improvement after surgical treatment for DIE in Vitality (.67; 95% CI, .41–.94), Social Functioning (.59; 95% CI, .18–.99), Role Emotional .49; 95% CI, .02–.97), Mental Health (.39; 95% CI, .03–.74), Physical Functioning (.93; 95% CI, .49–1.38), Bodily Pain (1.23; 95% CI, .47–1.99), General Health (.57; 95% CI, .02–1.12), MCS (.55; 95% CI, .10–1.00), and Physical Component Score (PCS; .73; 95% CI, .27–1.18); and significant improvement after surgery for bowel endometriosis for all 8 domains (Vitality [1.00; 95% CI, .56–1.43], Social Functioning [.97; 95% CI, .57–1.37], Role Emotional [1.17; 95% CI, .7–1.63], Mental Health [.94; 95% CI, .5–1.38], Physical Functioning [.74; 95% CI, .3–1.18], Role Physical [1.25; 95% CI, .75–1.76], Bodily Pain [1.39; 95% CI, .79–1.98], General Health [.84; 95% CI, 1.46–1.22]), MCS (.93; 95% CI, .47–1.40), PCS (.82; 95% CI, .40–1.23), and total score (1.15; 95% CI, .48–1.83). Only 1 study assessed patients with minimal disease and showed significant improvement in PCS (p?=?.002) and MCS (p <.001). This systematic review reveals that surgery for endometriosis resulted in overall improvement in most health domains of health-related QOL, with the greatest improvement found in the Bodily Pain domain.     

A retrospective review of patient-reported outcomes on the impact on quality of life in patients undergoing total abdominal hysterectomy and bilateral salpingo-oophorectomy for endometriosis

Objective

The Endometriosis Health Profile-30 (EHP-30), an endometriosis-specific health-related quality of life (HRQoL) questionnaire, forms part of our service evaluation of all women undergoing total abdominal hysterectomy and bilateral salpingo-oophorectomy for endometriosis in our reproductive medicine unit. We used the EHP-30 to investigate patient-reported outcomes in all patients undergoing this procedure.

Study design

Retrospective review of 16 women with endometriosis undergoing total abdominal hysterectomy and bilateral salpingo-oophorectomy for debilitating symptoms after other modalities of treatment had failed. Patients completed EHP-30 questionnaires before the operation and again three months after surgery.

Results

Total abdominal hysterectomy and bilateral salpingo-oophorectomy for endometriosis results in a significant improvement in HRQoL. The impact was greatest in the core domains – control and powerlessness, emotional wellbeing and social support. There was a 100% response rate for the core domains whereas in the modular domains, missing response rates ranged from 12.5% to 62.5%, with the percentage of missing data being greatest in the concern on infertility and relationship with children domains. Pain was significantly positively correlated with control and powerlessness, emotional wellbeing, work life and relationship with children. After multiple regression analyses, only control and powerlessness and emotional wellbeing were found to be predictive of pain. Additionally, changes in pain before and after total abdominal hysterectomy and bilateral salpingo-oophorectomy were significantly positively correlated with the changes in the core domains – control and powerlessness, emotional wellbeing and self image. After multiple regression analyses, change in pain was found to be predictive of ΔControl and powerlessness in our study subjects.

Conclusion

Total abdominal hysterectomy and bilateral salpingo-oophorectomy significantly improves HRQoL in patients debilitated by symptoms attributable to endometriosis and in whom other modalities of treatment have failed.     

The Effects of Gonadotropin-Releasing Hormone Agonist Combined with Add-Back Therapy on Quality of Life for Adolescents with Endometriosis: A Randomized Controlled Trial

Study Objective

Use of gonadotropin-releasing hormone agonists (GnRHa) to treat endometriosis can cause mood and vasomotor side effects. “Add-back therapy,” the combination of low-dose hormones, limits side effects but research is limited to adults. We sought to characterize quality of life (QOL) before treatment and to compare an add-back regimen of norethindrone acetate (NA) with conjugated estrogens (CEE) to NA alone for preventing side effects of GnRHa therapy in female adolescents with endometriosis.

Endometriosis doubles the risk of sexual dysfunction: a cross-sectional study in a large amount of patients

Introduction: Endometriosis affects several aspects of a woman’s life, including sexual function, but which specific aspects of sexual function remains unclear.

Methods: A cross-sectional study was performed involving 1001 women divided into two groups, according to the presence or absence of endometriosis. We assessed sexual function, anxiety and depression of patients and correlated these findings with symptoms, locations and types of endometriosis and the affected domains of sexual function. Eighteen completed the forms incorrectly, 294 women (29.9%) were excluded due to severe anxiety and depression. One hundred and six patients had symptoms that could have any relation to endometriosis, so they were also excluded. The final cohort was composed of 254 patients with endometriosis and 329 patients without the disease. Sexual function score was assessed using the female sexual quotient (FSQ); Beck inventories were used to assess anxiety and depression.

Results: Patients with endometriosis were affected in all phases of sexual response: desire, sexual arousal, genital–pelvic pain/ penetration and orgasm/ sexual satisfaction. In the overall assessment, 43.3% of patients with endometriosis had sexual dysfunction, while the population without endometriosis sexual dysfunction occurred in 17.6% of women.

Conclusions: Patients with endometriosis have more than twice sexual dysfunctions as compared to women without the disease.     

Pain scoring in endometriosis: entry criteria and outcome measures for clinical trials. Report from the Art and Science of Endometriosis meeting

Standardized entry criteria and outcome measures for clinical trials in endometriosis-related pain would facilitate the comparison of trial results and the production of systematic reviews, improving evidence-based practice in this area. This report summarizes the recommendations from an international meeting for these criteria.     

Cutoff score of the traditional Chinese version of the short form of the pelvic organ prolapse/urinary incontinence sexual questionnaire (PISQ-12)

ObjectiveThe short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) is a condition-specific instrument used to evaluate sexual function in women with pelvic floor disorders. The traditional Chinese version of the PISQ-12 (CVPISQ-12) has been validated, however the cutoff score has yet to be determined. The aim of this study is to establish the cutoff score for the CVPISQ-12 and analyze the risk factors for female sexual dysfunction.Material and methodsA sub-analysis of data involving sexually active women who sought consultation for pelvic floor disorders at a medical center in 2016. Based on the known cutoff value of Female Sexual Function Index, the cutoff score of the CVPISQ-12 was analyzed using receiver operating characteristic (ROC) curve analysis. Other assessments included 1-h pad test and incontinence-related questionnaires using the short forms of the Urogenital Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7).ResultsROC curve analysis showed a cutoff score of 32.5, with a sensitivity of 87% and specificity of 88%. The area under the ROC curve was 0.937 (p <0.001; 95% confidence interval: 0.895–0.979). The 1-h pad test (B = −0.266; p = 0.031), IIQ-7 (B = −0.378; p = 0.047) and age (B = −0.415; p = 0.001) were risk factors for sexual dysfunction in women with a score <32.5. However, age was the only significant risk factor for women with a higher score (B = −0.384; p = 0.035).ConclusionsA CVPISQ-12 score ≥32.5 suggested normal sexual function. For this patient group, age may be a more important factor associated with sexual function than pelvic floor disorders.     

Endometriosis in Italy: From cost estimates to new medical treatment

Endometriosis is defined as the presence of endometrial-like tissue outside the uterus, which induced a chronic inflammatory reaction. The data collected from Italy showed that around 3 million women are affected by endoemtriosis and the condition was predominantly found in women of reproductive age (50% of women were in the 29–39 age range), only 25% of women were asymptomatic. The associated symptoms can create an impact in general physical, mental, and social well-being. Endometriosis is associated with severe dysmenorrhea, deep dyspareunia, chronic pelvic pain, ovulation pain, cyclical, or perimenstrual symptoms, with or without abnormal bleeding, infertility, and chronic fatigue. The annual cost for hospital admission can be estimated to be in a total around 54 million euros. The average time for right diagnosis is around 9 years still today and it follows a long and expensive diagnostic search. Therapies can be useful to relieve and sometimes solve the symptoms, encourage fertility, eliminate endometrial lesions, and restore the anatomy of the pelvis. For medical therapy, several different preparations (oral contraceptives, progestogenics, gestrinone, danazol, and GnRHa) and new options (GnRH antagonists, aromatase inhibitors, estrogen receptor beta agoinist, progesterone receptor modulators, angiogenesis inhibitors, and COX-2 selective inhibitors) are available.     

Effectiveness of intracavitary monopolar dielectric radiofrequency in women with endometriosis-associated pain: A case series

Backgroundand Purpose: Endometriosis-associated pain is the main cause of chronic pelvic pain in women. Endometriosis has a significant negative impact across different domains of patients’ quality of life. This study aimed to evaluate the efficacy of an intracavitary application of monopolar dielectric radiofrequency in women with endometriosis-associated pain.Patient presentationFive women with endometriosis received 25 sessions of an intracavitary application of monopolar dielectric radiofrequency within three months. Outcomes, including quality of life, sex interference (Endometriosis Health Profile [EHP]-30 + section C), myofascial pain syndrome (myofascial trigger points), pain intensity (Visual Analogue Scale), frequency and referral pattern, pressure pain thresholds, allodynia and neuropathic pain (modified DN4), were examined both during and outside menses, after intervention and six months later.ResultsClinically meaningful improvements were achieved by most participants regarding pelvic pain intensity, abdominal sensitivity, and myofascial pain of the pelvic floor.ConclusionThis study lays the foundation for future in-depth research, suggesting that monopolar dielectric radiofrequency could be helpful in improving the symptomatology and quality of life of women with endometriosis, also in patients who are unresponsive to medical and/or surgical treatments, or who cannot undergo them in the short term.     

Factors Associated with Severity of Irritable Bowel Syndrome Symptoms in Patients with Endometriosis

Objective

This study sought to examine factors associated with severity of irritable bowel syndrome (IBS) by using the Birmingham IBS symptom scale in patients presenting with endometriosis to a tertiary referral centre.

Translation and validation of the Taiwanese SarQoL,a quality of life questionnaire specific to sarcopenia

BackgroundThe Sarcopenia Quality of Life (SarQoL) questionnaire has been translated into various languages. This study validated the Taiwanese version of the SarQoL (SarQoL-TW) questionnaire.MethodsForward–backward translation was conducted, along with a test of the prefinal version of the translated questionnaire. To validate the psychometric properties of the questionnaire, 50 older adults with sarcopenia and 50 older adults without sarcopenia completed the SarQoL-TW, the Short Form12 Health Survey (SF-12), and the EQ-5D-3L questionnaire. Participants with sarcopenia were asked to complete the SarQoL-TW questionnaire once more after 2 weeks. Validating the psychometric properties of the SarQoL-TW questionnaire involved assessing its discriminative power, internal consistency, construct validity, test–retest reliability, and potential floor and ceiling effects.ResultsThe SarQoL-TW questionnaire was translated without major difficulties. The psychometric analysis revealed that older adults with sarcopenia scored significantly lower on the SarQoL-TW, both overall and in some of the domains. The Cronbach's alpha of 0.846 indicated high internal consistency. The SarQoL-TW questionnaire correlated well with similar constructs on the SF-12 and EQ-5D-3L for convergent validity and correlated weakly with distinct domains for divergent validity, confirming its favorable construct validity. The test–retest reliability was excellent (intraclass correlation coefficient: 0.970). Neither floor nor ceiling effects were observed.ConclusionThe SarQoL-TW questionnaire is a reliable and valid questionnaire, useful for assessing quality of life in older adults with sarcopenia in clinical practice and research.     

尿失禁影响问卷简表的引进和人群验证

目的 引进和验证尿失禁影响问卷简表(IIQ-7),并探讨其在中国人群中的信度与效度.方法 对IIQ-7英文原版进行中文简体版本的译制;选取74例尿失禁患者填写IIQ-7中文简体版、健康调查简表(SF-12)并行1 h尿垫实验,分析IIQ-7中文简体版的信度和效度.结果 (1)IIQ-7中文简体版的信度分析显示,Cronbach α系数为0.824(P<0.01);组内相关性分析显示,重测信度的组内相火系数为0.749(P<0.01).(2)IIQ-7中文简体版的效度分析显示,IIQ-7中文简体版得分与SF-12得分呈负相关(Spearman相关系数为-0.570,P<0.01),与1 h尿垫实验结果 呈正相关(Spearman相关系数为0.461,P<0.01),与尿失禁病程呈正相关(Spearman相关系数为0.235,P<0.05).因子分析显示,IIQ-7中文简体版提取因子成分与问卷的理论结构基本相符.结论 IIQ-7中文简体版在中国人群中具有较高的信度和效度,适用于在中国人群中对尿失禁患者的生命质量进行评价.

Abstract：

Objective To study reliability and validity of incontinence impact questionnaire short form (IIQ-7) in the Chinese population. Methods IIQ-7 form was translated into Chinese; 74 patients with urinary incontinence completed the IIQ-7 simplified Chinese version and short-form 12-item health survey (SF-12) questionnaires. The urinary incontinence patient also ran a 1 hour pad test. Then, reliability and validity of those forms were analyzed. Results The Cronbach's alpha of IIQ-7 simplified Chinese version was 0. 824 (P <0. 01). The intra-class correlation coefficient of IIQ-7 simplified Chinese version was 0. 749 (P < 0.01) . IIQ-7 simplified Chinese version scores were negatively correlated with SF-12 scores (Spearman correlation coefficient: - 0. 570, P < 0. 01) , IIQ-7 simplified Chinese version scores were positively correlated with 1 hour pad test (Spearman correlation coefficient: 0.461, P < 0. 01) , IIQ-7 simplified Chinese version scores were also positively correlated with the course of disease (Spearman correlation coefficient: 0. 235 , P < 0. 05) . Factor analysis of IIQ-7 simplified Chinese version showed good construct validity. Conclusions The simplified Chinese version of IIQ-7 has higher reliability and validity in the Chinese population. They are highly recommended for clinical treatment and research.     

Macrophage Scavenger Receptor(s) and Oxidatively Modified Proteins in Endometriosis

Objective: To determine whether cultured human peritoneal macrophages have functional scavenger receptor(s) and whether activation of macrophages in endometriosis may involve an increase in scavenger receptor activity.

Design: A controlled clinical study comparing peritoneal fluid (PF) macrophages of women with endometriosis and controls without endometriosis.

Setting: Women undergoing laparoscopic evaluation and treatment in a tertiary medical center.

Patient(s): Twenty-one women undergoing evaluation for pelvic pain or infertility and 10 women undergoing elective laparoscopic tubal ligation.

Intervention(s): None.

Main Outcome Measure(s): Evidence for functional macrophage scavenger receptor and evidence of ligands for the scavenger receptor in PF.

Result(s): Peritoneal macrophages of women with endometriosis degrade significantly more endothelial cell-low density lipoprotein (EC-LDL) and copper-oxidized LDL (Cu-LDL) than native LDL. Macrophages of women with endometriosis also incorporate more labeled oleic acid into cholesteryl ester in the presence of oxidized LDL (Ox-LDL) than in the presence of native LDL. Western blot analysis demonstrates the presence of adducts between lipid peroxidation products and proteins in PF of patients with and without endometriosis. The PF of women with endometriosis competes with labeled Ox-LDL for uptake by mouse peritoneal macrophages in a dose-dependent manner.

Conclusion(s): We demonstrate for the first time that human macrophages have functional scavenger receptor(s) and that activation of macrophages in endometriosis involves an increase in scavenger receptor activity. Two lines of evidence indicate the presence of ligands for the scavenger receptor in PF.