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Objective: To compare the effects of dienogest and a combined oral contraceptive pill (COCP) after laparoscopic surgery on pain and quality of life in women with severe endometriosis. Methods: A randomized double‐blind pilot study was conducted from March 2018 to March 2020 in women with severe endometriosis confirmed by laparoscopic surgery. A total of 108 patients who had undergone laparoscopic surgery received dienogest, COCP, or placebo daily for 6 months. Primary and secondary outcomes were compared between the three groups. Results: Treatment with dienogest or COCP was associated with improved self‐reported pain after 6 months of treatment, as evidenced by significantly lower scores for pelvic pain and dyspareunia compared with placebo (P < 0.05). Significant differences in overall quality of life score were observed over 6 months in the dienogest, COCP, and placebo groups (mean difference 22.00, 23.45, and 6.45 points, respectively; P < 0.001). Post‐hoc analysis revealed a significant difference in overall quality of life score between the placebo group and the dienogest (P < 0.001) and COCP groups (P = 0.004). Conclusion: Postoperative administration of dienogest or COCP reduced endometriosis‐associated pain and improved quality of life in women with severe endometriosis. Clinical trials registration: https://en.irct.ir/trial/43070. Synopsis: Postoperative administration of dienogest or the combined oral contraceptive pill is an effective treatment with few adverse effects, reduced endometriosis‐associated pain, and improved quality of life. [ABSTRACT FROM AUTHOR]

Background. The present study was designed to verify the accuracy of the noninvasive biomarkers enolase/Cr, CA125, and CA19-9 as a clinical diagnostic tool for the detection of endometriosis. Methods. A cross-sectional study was performed at Rasool-e-Akram Hospital affiliated to Iran University of Medical Sciences, Tehran, Iran, from April 2015 to April 2018. Eighty-six women were scheduled to undergo laparoscopy due to chronic pelvic pain, infertility, pelvic mass, and abnormal uterine bleeding. Serum and urine samples of all patients were collected preoperatively. Serum levels of CA125 and CA19-9, and urine levels of enolase-1 were measured. Serum levels of CA125 and CA19-9 were determined by the electrochemiluminescence method (ECL). Urinary enolase-1 was measured by the ELISA method. Result. Serum levels of CA125 and CA19-9 were significantly higher in the endometriosis group than in controls (p < 0.001 , p = 0.004 , respectively). Levels of enolase I and enolase/Cr were higher in patients with endometriosis, but the differences were not statistically significant. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of combined enolase/Cr, CA125, and CA19-9 were 65%, 66.6%, 71%, and 60.1%, respectively. The positive likelihood ratio (PLR) and negative likelihood ratio (NLR) of combined enolase/Cr, CA125, and CA19-9 was 1.94 and 0.52, respectively. The area under the ROC curve for enolase / Cr + CA 125 + CA 19 − 9 was 0.675 (95% confidence interval 0.573-0.710). Conclusion. The present study revealed that concurrent measurement of enolase-1, CA125, and CA19-9 might be a valuable noninvasive test for the identification of endometriosis. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effects of laparoscopic cystectomy on serum anti-Müllerian hormone (AMH) level as a marker of ovarian reserve in patients with endometrioma.Methods: A prospective observational study enrolled patients aged younger than 40 years who were referred to a tertiary center in Tehran, Iran, between January 1, 2013 and December 31, 2014 to undergo laparoscopic cystectomy for ovarian endometriomas at least 30 mm in diameter, or regardless of size for patients with infertility, dysmenorrhea, dyspareunia, or dyschezia. Baseline and 6-month post-operative AMH levels were compared.Results: Data from 70 patients were included in the analyses. Among patients with unilateral endometriomas, lower pre-operative AMH levels were observed in patients with endometriomas at least 50 mm in diameter (P=0.027), whereas cyst size was not associated with differences in pre-operative AMH level in patients with bilateral endometriomas (P=0.227). Across the entire study population, post-operative AMH levels were lower than the baseline (P=0.008). Greater post-operative decreases in AMH were associated with bilateral cysts compared with unilateral cysts (P=0.046), cysts being at least 50 mm in diameter among patients with unilateral cysts (P=0.028), and both cysts being at least 50 mm in diameter among patients with bilateral cysts (P=0.025).Conclusion: Laparoscopic cystectomy was associated with post-operative decreases in serum AMH, particularly with bilateral involvement and endometriomas at least 50 mm in diameter. [ABSTRACT FROM AUTHOR]

Purpose: Recent studies indicated that there is a high density of small nerve fibers in the functional layer of the endometrium in women with endometriosis and that it can be used as a marker to detect endometriosis. In this study, the efficacy assessment of small nerve fibers' density as a diagnostic marker was compared in patients with and without endometriosis.Methods: In this study, women with history of pelvic pain and/or infertility who were candidates for laparoscopy or laparotomy in Rassoul hospital (2007-2009) were enrolled. Histological sections of endometrial tissue were prepared from endometrial biopsy from women with endometriosis (n = 12) (1) and without endometriosis (n = 15) (2). Protein gene product 9.5 and neurofilament were evaluated as marker from endometrial biopsies by immunohistochemical methods.Results: There was no statistically significant difference between two groups according to age, body mass index. Nerve fibers were detected in all endometrial biopsies from all women with endometriosis but detected only in three women without endometriosis. The mean density of nerve fibers was 2.2 ± 4.7 mm(-2) in group without endometriosis and) 13.1 ± 3.3 (in group with endometriosis (p < 0.001). Women with endometriosis had significantly higher nerve fiber density in comparison with women without endometriosis.Conclusions: Our findings indicated that endometrial biopsy for detecting density of nerve fibers by usage of protein gene product 9.5, provided a reliable marker for diagnosis of endometriosis. [ABSTRACT FROM AUTHOR]

Background. Recently, it has been suggested that microbial infections play a role in the pathogenesis of endometriosis. One of the most commonly suggested infections associated with the pathogenesis of endometriosis is human papillomavirus (HPV) infection. The present study is aimed at evaluating the prevalence, types, and risk factors for HPV infection in women with endometriosis and at investigating the association of upper and lower genital tract involvement with HPV and the severity of endometriosis. Methods. This cross-sectional study was conducted on 81 patients with endometriosis, referred to Rasool Akram Medical Complex in Tehran, Iran, for laparoscopic surgery. The patients' demographic, clinical, and anthropometric data were extracted from their medical records, as well as interviews. The stage of disease was scored based on the revised American Society for Reproductive Medicine (rASRM) classification. The HPV-positive and HPV-negative cases were compared using the chi-square test for categorical variables and Student t -test for continuous variables. Results. Twenty (24.69%) out of 81 women with endometriosis were infected with HPV (nine cases of pelvic HPV, nine cases of vaginal HPV, and two cases of both pelvic and vaginal HPV). The HPV-infected women had a significantly lower infertility rate (15% vs. 45.9%; P = 0.014). The VAS scores for dysmenorrhea and dyspareunia were relatively the same in the two groups (P > 0.05). HPV 6 and HPV 11 were the most common types of HPV, reported in 35% and 30% of endometriosis cases, respectively. Conclusion. The prevalence of HPV was 24.69%, and low-risk genotypes were dominant. No significant association was found between HPV and the severity of endometriosis. [ABSTRACT FROM AUTHOR]

Ovarian fibromas are the most common benign solid ovarian tumors, which are often difficult to diagnose preoperatively. Ovarian fibromas, especially in bilateral cases, may be cases of Gorlin-Goltz syndrome (GGS), a rare autosomal dominant disorder with predisposition to basal cell carcinomas (BCCs) and other various benign and malignant tumors. This case report describes a 25 year-old female with GGS, bilateral ovarian fibroma, endometriosis and septated uterus, which was referred to the Gynecology Clinic of Rasoul-e-Akram Hospital in October 2016. This patient had facial asymmetry due to recurrent odontogenic keratocysts. In young cases of ovarian fibromas as reported here, conservative surgical management can preserve ovarian function and fertility. These patients must be followed up by a multidisciplinary team and submitted to periodic tests. [ABSTRACT FROM AUTHOR]

Background: Endometriosis is a chronic disease mostly affecting women at reproductive age. Some evidence suggests that surgery of ovarian endometrioma may have a detrimental effect on ovarian reserve. The aim of this study was to evaluate the changes of serum antimullerian hormone (AMH) levels in patients with endometrioma after cystectomy. Methods: A prospective study was performed at Nikan hospital on 58 patients with endometrioma who underwent laparoscopic cystectomy. Of them, 30 had unilateral endometrioma and 28 had bilateral endometrioma. Complete excision was done, pelvic endometriosis implants as well as deep infiltrative endometriosis was resected. Sutures were made for the closure of ovarian parenchyma and bleeding control. We did not use any hot energy devices such as cautery on ovaries for ablation, coagulation or resection of endometrioma. Serum AMH levels were measured preoperatively, 3, 9, and 15 months postoperatively. Results: Serum AMH levels decreased significantly from the preoperative sample (2.98 ± 2.47 ng/ml) to 3 months after laparoscopy (1.07 ± 1.06 ng/ml), then gradually increased 9 months (1.47 ± 1.16 ng/ml) and 15 months (1.95 ± 1.85 ng/ml) after surgery, without returning to the preoperative levels during the follow-up time of study. Conclusion: There is a fluctuation pattern in AMH levels from preoperative to 15-month follow-up after endometrioma surgery using only suture for ovarian hemostasis. Firstly, there is decline in AMH level 3 months after surgery, then an increasing trend was observed gradually up to 15 months after surgery. Controlled studies are needed to compare the effects of various cystectomy methods on the ovarian reserve after endometrioma surgery [ABSTRACT FROM AUTHOR]