Valentina Lucia La Rosa

Impact of endometriosis on quality of life and psychological well-being

Abstract The aim of this work is to propose a brief comment about the impact of endometriosis on quality of life and psychological well-being of women affected.

Peroxisome Proliferator-Activated Receptor Modulation during Metabolic Diseases and Cancers: Master and Minions

The prevalence of obesity and metabolic diseases (such as type 2 diabetes mellitus, dyslipidaemia, and cardiovascular diseases) has increased in the last decade, in both industrialized and developing countries. This also coincided with our observation of a similar increase in the prevalence of cancers. The aetiology of these diseases is very complex and involves genetic, nutritional, and environmental factors. Much evidence indicates the central role undertaken by peroxisome proliferator-activated receptors (PPARs) in the development of these disorders. Due to the fact that their ligands could become crucial in future target-therapies, PPARs have therefore become the focal point of much research. Based on this evidence, this narrative review was written with the purpose of outlining the effects of PPARs, their actions, and their prospective uses in metabolic diseases and cancers.

Anxiety and depression in patients with endometriosis: impact and management challenges

Endometriosis is one of the most common gynecological diseases and affects ~10% of women in reproductive age. The most common clinical signs of endometriosis are menstrual irregularities, chronic pelvic pain (CPP), dysmenorrhea, dyspareunia and infertility. Symptoms of endometriosis often affect psychological and social functioning of patients. For this reason, endometriosis is considered as a disabling condition that may significantly compromise social relationships, sexuality and mental health. Considering this point, the aim of this narrative review is to elucidate the impact of anxiety and depression in the management of women with endometriosis. Psychological factors have an important role in determining the severity of symptoms, and women who suffer from endometriosis report high levels of anxiety, depression and other psychiatric disorders. In addition, endometriosis is one of the most important causes of CPP; women with endometriosis suffer from a wide range of pelvic pain such as dysmenorrhea, dyspareunia, nonmenstrual (chronic) pelvic pain, pain at ovulation, dyschezia and dysuria. Several studies have underlined the influence of CPP on quality of life and psychological well-being of women with endometriosis. Data suggest that the experience of pelvic pain is an important component of endometriosis and may significantly affect emotive functioning of affected women. It has been demonstrated that high levels of anxiety and depression can amplify the severity of pain. Further studies are needed to better understand the relationship between psychological factors and perception of pain. Treatment of endometriosis may be hormonal or surgical. Surgery is the primary treatment for more severe forms of endometriosis. There are few data in the literature about the influence of psychological factors and psychiatric comorbidities on the effectiveness of treatments. It is important to evaluate the presence of previous psychiatric diseases in order to select the most appropriate treatment for the patient.

Etiology, pathophysiology and biomarkers of interstitial cystitis/painful bladder syndrome

PurposeInterstitial cystitis/painful bladder syndrome (IC/PBS) is a chronic pain syndrome and a chronic inflammatory condition prevalent in women that leads to urgency, sleep disruption, nocturia and pain in the pelvic area, to the detriment of the sufferer’s quality of life. The aim of this review is to highlight the newest diagnostic strategies and potential therapeutic techniques.MethodsA comprehensive literature review was performed on MEDLINE, PubMed, and Cochrane databases gathering all literature about “Interstitial cystitis” and “Painful Bladder Syndrome”. Visual analogue scales, epidemiological strategies, pain questionnaires and similar techniques were not included in this literature survey.ResultsThe etiology, exact diagnosis and epidemiology of IC/PBS are still not clearly understood. To date, its prevalence is estimated to be in the range of 45 per 100,000 women and 8 per 100,000 men, whereas joint prevalence in both sexes is 10.6 cases per 100,000. There are no “gold standards” in the diagnosis or detection of IC/PBS, therefore, several etiological theories were investigated, such as permeability, glycosaminoglycans, mast cell, infection and neuroendocrine theory to find new diagnostic strategies and potential biomarkers.ConclusionDue to the fact that this disease is of an intricate nature, and that many of its symptoms overlap with other concomitant diseases, it could be suggested to classify the patients with emphasis on the phenotype, as well as their symptom clusters, to tailor the diagnostic and management choices according to the observed biomarkers.

Hysteroscopic Morcellation of Submucous Myomas: A Systematic Review

Hysteroscopic surgery is the actual gold standard treatment for several types of intrauterine pathologies, including submucous myomas (SMs). To date, the availability of Hysteroscopic Tissue Removal systems (HTRs) opened a new scenario. Based on these elements, the aim of this article is to review the available evidence about HTRs for the management of SMs. We included 8 papers (3 prospective studies and 5 retrospective studies). A total of 283 women underwent intrauterine morcellation of SM: 208 were treated using MyoSure and 75 using Truclear 8.0. Only 3 articles reported data about procedures performed in outpatient/office setting. Only half of the included studies included type 2 SMs. HTRs significantly reduced operative time compared to traditional resectoscopy in some studies, whereas others did not find significant differences. Despite the availability of few randomized controlled trials and the cost of the instrument, according to our systematic review, the use of HTRs seems to be a feasible surgical option in terms of operative time and complications. Nevertheless, the type of SM still remains the biggest challenge: type 0 and 1 SMs are easier to manage with respect to type 2, reflecting what already is known for the “classic” hysteroscopic myomectomy.

Psychopharmacotherapy in Pregnancy and Breastfeeding.

Importance Fifteen percent to 20% of pregnant women suffer from mental disorders, and 86% of them are not treated due to potential teratogenic risks for the fetus. Several drugs seem to be safe during pregnancy but knowledge regarding risks of antenatal exposure to drugs is still limited. Objective The aim of this article is to provide a review of literature, data, and a clinical guideline concerning the treatment and management of mental disorders during pregnancy and lactation. Evidence Acquisition Bibliographical research was carried out using Medline and Pubmed (from 2005 until 2015) and articles, books and Websites were consulted. Results Regarding antidepressants, only paroxetine seems to lead to an increased risk of malformations, whereas fluoxetine, fluvoxamine, sertraline, citalopram, escitalopram and venlafaxine do not appear to increase this risk. The use of duloxetine is associated with an increased risk of miscarriage during pregnancy but not with an increased risk of adverse events, such as birth defects. There is no clear evidence of malformation risk associated with the use of antipsychotics, whereas a risk associated with pregnancy and newborn outcome has been detected. All mood stabilizers are associated with risks of birth defects and perinatal complications. Conclusions and Relevance Taking psychoactive drugs is possible during pregnancy, but it is important to consider various effects of the drugs. Future research should focus on prospective and longitudinal studies with an adequate evaluation of confounding variables. This should be followed by long-term studies to obtain accurate measures of child development. Target Audience Obstetricians and gynecologists, family physicians Learning Objectives After completing this activity, the learner should be better able to identify the main categories of psychiatric drugs used during pregnancy and breastfeeding, discuss side effects for the mother and the newborn associated with these drugs, and use the most appropriate drug according to different clinical situations.

Comment on: “Effect on Sexual Function of Patients and Patients' Spouses After Midurethal Sling Procedure for Stress Urinary Incontinence: A Prospective Single Center Study”

Dear Editor, We read with great interest the article by Ko et al.1 about sexual function in women with stress urinary incontinence (SUI) and in their partners after midurethal sling procedure. We agree that SUI is an adverse factor for sexual function of women affected and that urinary symptoms negatively influence sexual activity within the couple.2–4 For this reason, it is important to investigate the effects of treatments for SUI on sexual function of both women and their partners. Although we appreciate the reported methodology, we take the opportunity to point out several elements that would let us further realize the results of this study. First, the sample is very small, so we believe that it would have been more appropriate to use a larger sample in order to obtain more reliable results. Second, nonsurgical interventions such as behavioral modification and pelvic floor exercises (PFEs) with or without biofeedback, or pharmacologic therapy can be used instead of the sling procedure, especially in primary cases of SUI. For this reason, we would like to know why the authors have not also considered this type of patient in their study. Moreover, the average age of the sample (46.7) is lower than that reported in other studies on this topic and the body mass index of the women enrolled is low. According to our opinion, these data could influence the results of the study especially because obesity correlates with more severe symptoms and worse outcomes in patients with SUI.5 Finally, we believe that the authors could use other nonspecific and specific questionnaires such as the Pelvic Floor Distress Inventory (PFDI-20) and the Pelvic Floor Impact Questionnaire (PFIQ-7) or the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ12) that has been used in other studies on this topic.3,4 In conclusion, according to these data and based on our experience, we strongly suggested for future studies on this topic use larger samples, to consider also nonsurgical treatments and pharmacologic therapy for SUI and, last but not least, to take into account variables such as age or BMI that could influence the validity of the results.

Psychology of infertility and assisted reproductive treatment: the Italian situation

Abstract The aim of this work is to propose a brief comment about the role of psychology in the cases of infertility and assisted reproductive treatments with particular reference to the Italian situation.

Do miRNAs Play a Role in Fetal Growth Restriction? A Fresh Look to a Busy Corner

Placenta is the crucial organ for embryo and fetus development and plays a critical role in the development of fetal growth restriction (FGR). There are increasing evidences on the role of microRNAs (miRNAs) in a variety of pregnancy-related complications such as preeclampsia and FGR. More than 1880 miRNAs have been reported in humans and most of them are expressed in placenta. In this paper, we aimed to review the current evidence about the topic. According to retrieved data, controversial results about placental expression of miRNAs could be due (at least in part) to the different experimental methods used by different groups. Despite the fact that several authors have demonstrated a relatively easy and feasible detection of some miRNAs in maternal whole peripheral blood, costs of these tests should be reduced in order to increase cohorts and have stronger evidence. In this regard, we take the opportunity to solicit future studies on large cohort and adequate statistical power, in order to identify a panel of biomarkers on maternal peripheral blood for early diagnosis of FGR.

Fertility preservation in women with gynaecologic cancer: the impact on quality of life and psychological well-being

Abstract The aim of this article is to propose a brief commentary about the impact of gynaecologic cancer treatments on the reproductive capacity of affected women and the importance of the fertility preservation treatments to improve quality of life and psychological well-being. The experience of gynaecologic cancer and treatment affects sexual function and psychological well-being of patients. Therefore, the preservation of reproductive potential is central to quality of life. Despite the importance of fertility preservation for cancer survivors’ quality of life and psychological well-being, there is still little information about these treatments. We suggest that further studies about the impact on quality of life and psychological outcomes of fertility preservation counselling and fertility preservation treatments should be conducted.