Dataset Information

The effect of transcervical endometrial resection on clinical symptoms related to intrinsic adenomyosis and junctional zone changes.

ABSTRACT:

Objectives

To assess the effect of transcervical endometrial resection on clinical symptoms related to histopathological findings of the junctional zone.

Study design

This prospective study took place at a university hospital. Premenopausal women suffering from abnormal uterine bleeding and/or pelvic pain and scheduled for transcervical endometrial resection were enrolled (n?=?112). Histopathological findings of the endomyometrial biopsies were categorized as follows: Adenomyosis of the inner myometrium (intrinsic adenomyosis): ? 2?mm myometrial invasion without contact to the basal endometrium, serrated junctional zone: > 3?mm myometrial invasion with contact to the basal endometrium and linear junctional zone: No or marginal myometrial invasion (? 3?mm) with contact to the basal endometrium. All study participants received a baseline and two follow-up questionnaires (6 and 18 months after surgery) regarding symptom severity, health-related quality of life and pelvic pain. Data regarding reintervention surgery was obtained from the National Database Patoweb. The rate of reintervention surgery and the improvement in symptom severity, health-related quality of life and pelvic pain were correlated to histopathological findings.

Results

Twenty-four patients had intrinsic adenomyosis, 31 had serrated junctional zone and 57 had linear junctional zone. Fifteen patients (13%) underwent reintervention surgery; three (20%) within 6 months, nine (60%) between 6-18 months and three (20%) > 18 months after transcervical endometrial resection. Reintervention surgery was more common in women with intrinsic adenomyosis compared to women without (33% (95% CI: 16-55) vs 8% (95% CI: 3-16)) (p-value: < .05). Nine patients (38%) with intrinsic adenomyosis were asymptomatic based on low symptom severity score, high health-related quality of life and no pelvic pain at 18 months follow-up. Patients with linear junctional zone had a higher improvement in symptom severity and health-related quality of life than patients with intrinsic adenomyosis or serrated junctional zone at 6 months follow-up after surgery (p-value < .05). However, there was no significant difference in pelvic pain reduction.

Conclusion

The effect of transcervical endometrial resection may depend upon the degree of junctional zone changes, and patients with intrinsic adenomyosis are more likely to undergo reintervention surgery than patients with either linear or serrated junctional zone. However, intrinsic adenomyosis may also be successfully treated with endometrial resection.

SUBMITTER: Rasmussen CK

PROVIDER: S-EPMC6687372 | biostudies-literature | 2019 Jul

REPOSITORIES: biostudies-literature

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Publications

The effect of transcervical endometrial resection on clinical symptoms related to intrinsic adenomyosis and junctional zone changes.

Rasmussen Christina K CK Hansen Estrid S ES Al-Mashadi Dahl Sham S Ernst Erik E Dueholm Margit M

European journal of obstetrics & gynecology and reproductive biology: X 20190430

<h4>Objectives</h4>To assess the effect of transcervical endometrial resection on clinical symptoms related to histopathological findings of the junctional zone.<h4>Study design</h4>This prospective study took place at a university hospital. Premenopausal women suffering from abnormal uterine bleeding and/or pelvic pain and scheduled for transcervical endometrial resection were enrolled (n = 112). Histopathological findings of the endomyometrial biopsies were categorized as follows: Adenomyosis ...[more]

PMID: 31404400

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Project description:ImportanceAdenomyosis is a common chronic gynecological disorder, and its treatment is an unmet need. New therapies need to be developed. Mifepristone is being tested for adenomyosis treatment.ObjectiveTo determine whether mifepristone is effective and safe for adenomyosis treatment.Design, setting, and participantsThis multicenter, placebo-controlled, double-blind randomized clinical trial was conducted in 10 hospitals in China. In total, 134 patients with adenomyosis pain symptoms were enrolled. Trial enrollment began in May 2018 and was completed in April 2019, and analyses were conducted from October 2019 to February 2020.InterventionsParticipants were randomized 1:1 to receive mifepristone 10 mg or placebo orally once a day for 12 weeks.Main outcomes and measuresThe primary end point was the change in adenomyosis-associated dysmenorrhea intensity, evaluated by the visual analog scale (VAS) after 12 weeks of treatment. Secondary end points included the change in menstrual blood loss, increased level of hemoglobin in patients with anemia, CA125 level, platelet count, and uterine volume after 12 weeks of treatment. Safety was assessed according to adverse events, vital signs, gynecological examinations, and laboratory evaluations.ResultsIn total, 134 patients with adenomyosis and dysmenorrhea were randomly assigned, and 126 patients were included in the efficacy analysis, including 61 patients (mean [SD] age, 40.2 [4.6] years) randomized to receive mifepristone and 65 patients (mean [SD] age, 41.7 [5.0] years) randomized to received the placebo. The characteristics of the included patients at baseline were similar between groups. The mean (SD) change in VAS score was -6.63 (1.92) in the mifepristone group and -0.95 (1.75) in the placebo group (P < .001). The total remission rates for dysmenorrhea in the mifepristone group were significantly better than those in the placebo group (effective remission: 56 patients [91.8%] vs 15 patients [23.1%]; complete remission: 54 patients [88.5%] vs 4 patients [6.2%]). All the secondary end points showed significant improvements after mifepristone treatment for menstrual blood loss, hemoglobin (mean [SD] change from baseline: 2.13 [1.38] g/dL vs 0.48 [0.97] g/dL; P < .001), CA125 (mean [SD] change from baseline: -62.23 [76.99] U/mL vs 26.89 [118.70] U/mL; P < .001), platelet count (mean [SD] change from baseline: -28.87 [54.30]×103/µL vs 2.06 [41.78]×103/µL; P < .001), and uterine volume (mean [SD] change from baseline: -29.32 [39.34] cm3 vs 18.39 [66.46] cm3; P < .001). Safety analysis revealed no significant difference between groups, and no serious adverse events were reported.Conclusions and relevanceThis randomized clinical trial showed that mifepristone could be a new option for treating patients with adenomyosis, based on its efficacy and acceptable tolerability.Trial registrationClinicalTrials.gov Identifier: NCT03520439.

Dataset Information

The effect of transcervical endometrial resection on clinical symptoms related to intrinsic adenomyosis and junctional zone changes.

Objectives

Study design

Results

Conclusion

Publications

The effect of transcervical endometrial resection on clinical symptoms related to intrinsic adenomyosis and junctional zone changes.

Similar Datasets

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