Journal of Endometriosis and Pelvic Pain Disorders

Dienogest (DNG) is a fourth-generation progestin used frequently for medical treatment of endometriosis. dienogest has been known as an effective treatment in alleviating pain, preventing recurrence, and enhancing the quality of life in patients. Considering the contradictory results regarding the side effects of DNG, such as the risk of decreasing bone mineral density, physiologic disorder, menometroraghy, and its effects in the treatment of endometriosis, this study was conducted to assess the efficacy and side effects of DNG 2 mg daily for 24 weeks in Iranian women with endometriosis.

Before and 24 weeks after starting treatment with DNG, lumbar and pelvic bone mineral density (BMD) was measured. Changes in the severity of dysmenorrhea and dyspareunia and side effects were recorded using a visual analog scale.

The change in the investigated variables before and after the intervention was compared using chi-square and paired t-test. The mean age of the patients was 35.42 ± 4.76 years. Following the intervention, Dysmenorrhea and dyspareunia were significantly decreased (p < 0.001). Total pelvic and vertebra BMD did not change substantially after the intervention, except for L1, which was significantly reduced after treatment (0.37 ± 0.96–0.22 ± 0.89; p = 0.01).

The results of this study suggested that 24 weeks of treatment with DNG had no significant adverse effect on BMD. On the other hand, the use of DNG in endometriosis patients was associated with improvement in dysmenorrhea and dyspareunia scale.

Pelvic floor disorders are common and debilitating conditions affecting women. This study aims to determine the prevalence of pelvic floor disorders among Ethiopian women and to identify associated risk factors.

This systematic review and meta-analysis was conducted in accordance with PRISMA guidelines. Primary studies were identified through electronic searches of Google Scholar, HINARI, MEDLINE, and PubMed.

A total of 23 papers meeting the inclusion criteria were included in this systematic review and meta-analysis of pelvic floor disorders. Sixteen studies were used for the pooled prevalence analysis. In Ethiopia, the pooled prevalence of pelvic floor disorders was 22% (95% confidence interval (CI) = 16, 28). The following factors were found to be associated with pelvic floor disorders: age at first delivery under 20 years (pooled odds ratio (POR) = 5.08, 95% CI = 3.1, 8.33), multiparity (POR = 4.23, 95% CI = 2.9, 6.16), age 40 years or older (POR = 3.67, 95% CI = 2.21, 6.11), carrying heavy objects (POR = 3.73, 95% CI = 2.98, 4.68), chronic cough (POR = 4.68, 95% CI = 2.21, 9.94), instrumental-assisted vaginal delivery (POR = 3.7, 95% CI = 2.45, 5.57), menopause (POR = 3.62, 95% CI = 2.53, 5.18), history of chronic constipation (POR = 3.37, 95% CI = 2.25, 5.02), prolonged labor (POR = 4.63, 95% CI = 2.56, 8.38), and sphincter damage (POR = 3.93, 95% CI = 1.85, 8.32).

Pelvic floor disorders represent a major but often overlooked health issue for Ethiopian women, with substantial implications for their well-being. Addressing these disorders requires coordinated efforts in prevention, early diagnosis, and management, as well as broader social and health system changes to reduce stigma and improve access to care.

Although physical activity is recommended as a therapeutic approach for endometriosis, there is limited evidence on the interaction between endometriosis and skeletal muscle health and function.

The participant was diagnosed with stage II endometriosis via laparoscopic surgery in 2020. She was undergoing treatment with Dienogest. The study spanned nine consecutive weeks, during which we assessed both functional and structural skeletal muscle parameters, including muscle stiffness, maximal strength, and muscular fatigue outcomes. Saliva samples were collected to analyze estradiol and cortisol concentrations at rest, immediately after, and 30 min following the fatiguing protocol.

Resting estradiol concentrations were within the expected range with a mean value of 2.48 pg/mL (±1.24). estradiol levels did not change significantly following the fatiguing protocol [F (2, 16) = 0.113, p = 0.893, η_p² = 0.014]. A significant negative relationship between estradiol concentrations and muscle stiffness, both in a relaxed (r = –0.68, p = 0.044) and contracted state (r = –0.763, p = 0.017) was evident.

Mean resting cortisol concentrations were 5.87 nmol/L (±2.18), and significantly decreased after the fatiguing protocol [F (2, 16) = 18.2, p < 0.001, η_p² = 0.695]. Pearson’s correlation showed a significant positive association between cortisol concentrations and eccentric peak torque (r = 0.723, p = 0.028).

A diminished hormonal response to physical strain was evident. From these results, we propose the hypothesis that the function of the hypothalamic-pituitary-adrenal (HPA) axis may be impaired following prolonged stress. Muscle stiffness of M. rectus femoris was negatively influenced by estradiol concentrations. Hence, estradiol may modulate muscle stiffness, potentially independent of the underlying pathology.

Endometriosis is a condition of chronic inflammation. Data imply an association with severe autoimmune spectrum. This paper analyses the relationship between autoimmune co-morbidities and phenotypes such as the more severe forms of disease, and assesses how well immunological markers may predict advanced disease.

This case-control study included 100 women of reproductive age who had endometriosis verified by laparoscopy. Based on the presence of autoimmune diseases, such as antiphospholipid syndrome (APS), rheumatoid arthritis (RA), autoimmune thyroid disorders (ATD), systemic lupus erythematosus (SLE), and type 1 diabetes mellitus (T1D), participants were divided into the study group (n = 40) and the control group (n = 60).

Patients with autoimmune comorbidities had a higher proportion of advanced-stage disease (stage IV; 70.0% and 5.0%; p < 0.01), especially those with antiphospholipid syndrome (APS) and type-1 diabetes mellitus. The prevalence of deep infiltrating endometriosis was also higher in the autoimmune group (p = 0.03). Autoimmunity was an independent predictor of stage IV endometriosis (AUC = 0.832). For APS, the association was very strong (OR: 48.9; p < 0.001), and similarly for T1DM (OR: 57.0; p = 0.002). Correlation analysis further showed that advanced disease is positively and significantly correlated with APS, RA, and ATD (all p < 0.001).

The current study has emphasized that a pronounced relation exists between endometriosis and autoimmune disorders. Utilization of autoimmune screening tests can contribute to a better diagnosis and personalized treatment of endometriosis.

Among individuals with endometriosis, pelvic floor physical therapy (PFPT) is a recommended treatment, despite limited clinical evidence. This study aimed to evaluate whether PFPT is efficacious in patients with endometriosis, both before and after surgical intervention when surgery was performed.

An anonymous online cross-sectional survey was administered to participants through convenience sampling (March 2024 to March 2025) to understand the self-reported efficacy of PFPT as a treatment for endometriosis before and after surgery. Measures included sociodemographics, Patient Global Impression of Change (PGIC) scores, and satisfaction scores.

Among our 198 participants, 83.8% had undergone excision or ablation surgery. Of the 165 responses, 9.7% of patients had completed PFPT before surgery, 40.6% had completed PFPT after surgery, and 49.7% had participated in both before and after surgery. The average PGIC scores were 4.8 before surgery and 5.1 after surgery, indicating no change or minimal improvement in symptoms of endometriosis pain. Satisfaction scores were also relatively low, averaging 5.8 before surgery and 6.5 after surgery, indicating minimal satisfaction. Additionally, 33.1% and 32.4% reported worsening of symptoms or no change before and after surgery, respectively. On average, participants required 5.6 PFPT sessions to first notice improvement in symptoms after surgery. Comorbidities, including adenomyosis (45.3%), migraines (68.7%), Ehlers-Danlos Syndrome (22.0%), and vulvodynia (24.7%), were highly prevalent, suggesting the need for more tailored approaches to care.

Based on self-reported results, PFPT is a minimally effective and potentially harmful treatment, defined as worsening of symptoms, for those with endometriosis, regardless of surgery.

Ovarian Remnant Syndrome (ORS) is a rare but clinically significant condition where ovarian tissue persists after oophorectomy. This retained tissue remains functional, potentially leading to complications such as chronic pelvic pain, cyst formation, hormonal activity and ureteric obstruction. ORS is particularly challenging in patients with severe pelvic adhesions, endometriosis or a history of multiple gynaecologic surgeries.

A 39-year-old woman with a history of total abdominal hysterectomy with ovarian preservation for early cervical cancer (FIGO 1A1) presented several years later with pelvic pain, which initially responded to GnRH analogues. Later, she underwent laparoscopic bilateral salpingo-oophorectomy and was discharged on Tibolone. After 8 weeks, she presented to A&E with severe pain. Imaging revealed 5 cm cystic mass compressing the distal ureter, leading to moderate hydronephrosis. Ureteric stenting was performed, and Tibolone was discontinued. Hormonal studies confirmed premenopausal levels, diagnosing ovarian remnant syndrome (ORS). She subsequently underwent robotic oophorectomy with ureteric shaving. Histology confirmed endometriosis. However, postoperative persistence of the ovarian remnant cyst, ureteric stricture and hydronephrosis resulted in eventual nephrostomy after stent removal. She ultimately underwent robotic ureteroneocystostomy with ICG-guided ureteric identification.

This case highlights the challenges of managing recurrent ORS with ureteric involvement. Robotic surgery with ICG guidance was crucial in enhancing surgical precision and preserving renal function.

Pelvic floor muscle (PFM) exercises are commonly prescribed to women with endometriosis-associated pelvic pain (EAPP) but the feasibility and effects of different PFM protocols remain unknown.

To evaluate the feasibility and acceptability of conducting a randomised controlled trial (RCT) comparing PFM contraction-plus-relaxation (PFMC + R) and PFM relaxation-only (PFMR) protocols combined with mindfulness in women with EAPP, and to explore changes in pelvic pain and PFM morphometry.

An 8-week hybrid intervention of PFMC + R or PFMR with mindfulness was evaluated in a feasibility RCT. Primary outcomes were feasibility and acceptability; secondary outcomes were EAPP symptoms and PFM morphometry.

Of 95 participants assessed for eligibility, 45 were randomised to PFMC + R (n = 23) or PFMR (n = 22). The PFMC + R group had higher retention (86% vs 63%) and acceptability rates (82% vs 63%), and greater improvements in pelvic pain (mean difference (MD) = −2.80, 95% confidence interval (CI) −4.22, −1.45), dyspareunia (MD = −2.43, 95% CI: −3.90, −1.03), anorectal angle (MD = 3.61, 95% CI: 2.52, 9.48) and levator hiatus (MD = 0.34, 95% CI: 0.14, 0.63) at rest than the PFMR group.

The PFMC + R protocol was more feasible and acceptable than the PFMR protocol and demonstrated greater improvements in EAPP symptoms and PFM morphometry. Larger studies are needed to verify these findings.

The Australian New Zealand Clinical Trials Registry, registration number: ACTRN12622001393741, trial registry URL).

To systematically evaluate the epidemiology, diagnostic modalities, and treatment strategies for urinary tract endometriosis (UE), with the goal of informing evidence-based clinical practice.

A comprehensive search of PubMed, Ovid, Embase, MEDLINE, and the Cochrane Library was conducted from January 1976 to March 2023. The protocol was registered with INPLASY (INPLASY202420054). Original studies reporting clinical, diagnostic, or therapeutic aspects of urinary tract endometriosis (UE) involving the bladder, ureter, kidney, or urethra were included, while reviews, editorials, and duplicate publications were excluded. Three reviewers independently screened articles, extracted relevant data, and categorized findings by site of involvement and diagnostic or treatment modality. A narrative synthesis of the results was performed.

A total of 137 studies were included. Bladder endometriosis was the most common subtype (80%–85%), followed by ureteral involvement (9%–23%). MRI and transvaginal ultrasound showed the highest sensitivity and specificity for diagnosis. Minimally invasive surgery, particularly robotic-assisted laparoscopy, was associated with favorable outcomes and lower recurrence rates.

UE is a rare and underdiagnosed manifestation of deep infiltrating endometriosis. Early recognition with appropriate imaging and multidisciplinary surgical planning improves outcomes. Larger prospective studies are needed to inform standard guidelines.

Endometriosis is a common gynecological condition that in sporadic cases can mimic an ovarian malignancy. We report a unique case of endometriosis characterized by massive hemorrhagic ascites and a mass-like plaque on the uterine surface. Atypical endometriosis is recognized as a potential precursor to ovarian malignancies.

A 51-year-old woman with no significant medical history presented with abdominal pain, massive ascites and abnormal findings on ultrasound and CT. This, together with an elevated CA-125 level pre-operatively raised suspicion for ovarian malignancy. Diagnostic laparoscopy with frozen section biopsy was executed and the uterus and adnexa were removed. The final diagnosis however revealed an atypical presentation of endometriosis.

This case highlights a rare manifestation of endometriosis that closely mimics ovarian malignancy. Clinicians should consider this differential diagnosis when encountering similar presentations.

Endometriosis, a chronic inflammatory disease often beginning in adolescence, significantly impacts quality of life. Delayed diagnosis contributes to prolonged suffering, educational disruption, and high healthcare costs. Promoting menstrual health education in schools may aid early recognition and intervention. This study aimed to implement and evaluate Endo-Teach, a menstrual health and endometriosis education program for seventh and eighth grade students, assessing its effectiveness in improving their understanding of endometriosis.

The implementation of the teaching package Endo-Teach, developed by a group of specialists at the certified endometriosis center of the Bern University Hospital, Switzerland, was evaluated using a voluntary questionnaire distributed before and after the class.

Within a total collective of 177 students, the mean age was 14.37 years. Awareness of endometriosis among adolescents was initially low (30.4%). Just over half (50.6%) of female adolescents reported having very painful menstruation; 54.5% of the adolescents reporting very painful period or insecurity about it needed to take pain medication, and 23.6% missed school regularly due to menstrual pain. The teaching package was evaluated as clear (96.5%) and educative (97.7%).

The teaching package Endo-Teach in its actual form is a valid option to promote awareness of menstrual health and endometriosis in secondary schools. In Switzerland, the prevalence of severe menstrual pain in secondary-school students, including the use of pain medication and school absenteeism, is high, whereas awareness of endometriosis is low. This shows that offering age-appropriate educational measures in a broader context is important to reduce the burden of the disease.