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伴有或不伴有子宫腺肌病的深部浸润型子宫内膜异位症患者的生活质量、性生活质量及疼痛症状评估以及灵活延长联合口服避孕药方案的影响:一项前瞻性观察性研究的结果

Assessment of Quality of Life, Sexual Quality of Life, and Pain Symptoms in Deep Infiltrating Endometriosis Patients With or Without Associated Adenomyosis and the Influence of a Flexible Extended Combined Oral Contraceptive Regimen: Results of a Prospective, Observational Study.

作者信息

Alcalde Ana María, Martínez-Zamora María Ángeles, Gracia Meritxell, Ros Cristina, Rius Mariona, Castelo-Branco Camil, Carmona Francisco

机构信息

Gynaecology Department, Institute Clinic of Gynaecology, Obstetrics and Neonatology, Hospital Clinic, Universitat de Barcelona, Institut d`Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.

Gynaecology Department, Institute Clinic of Gynaecology, Obstetrics and Neonatology, Hospital Clinic, Universitat de Barcelona, Institut d`Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.

出版信息

J Sex Med. 2022 Feb;19(2):311-318. doi: 10.1016/j.jsxm.2021.11.015. Epub 2021 Dec 31.

Abstract

BACKGROUND

The quality of life of women with deep infiltrating endometriosis (DIE) is impaired and may improve with combined oral contraceptives (COCs).

AIM

To compare the overall and sexual quality of life of patients diagnosed with DIE with or without associated adenomyosis (AD) with that of healthy controls and determine the influence of a COC containing 2 mg dienogest/30 μg ethinyl estradiol on these aspects.

METHODS

We enrolled 42 women diagnosed with DIE; 31 diagnosed with DIE + AD by transvaginal ultrasound, and 39 non-AD/DIE controls. All patients were interviewed regarding pain symptoms (dysmenorrhea, dyspareunia, dyschezia, and dysuria), heavy menstrual bleeding using the Pictorial Blood Loss Assessment Chart, quality of life using the Short Form-36 questionnaire (SF-36), and sexual quality of life using the Sexual Quality of Life-Female questionnaire (SQOL-F) and the Brief Profile of Female Sexual Function (B-PFSF) before starting COCs and after 12 months of treatment.

OUTCOMES

There was significant improvement in overall and sexual quality of life after treatment in DIE and DIE + AD patients.

RESULTS

Non-AD/DIE controls showed significantly higher scores in the B-PFSF, the SQOL-F and the SF-36 questionnaires (P < .05) at baseline versus the other groups. DIE + AD patients showed poorer quality of sexual life and greater intensity in pain symptoms compared with DIE patients. After 12 months of treatment, there was a significant improvement in overall and sexual quality of life in the DIE and DIE + AD groups, with improvement in sexual quality of life being slightly greater in DIE + AD patients compared with DIE patients. Pain symptoms also decreased in both groups.

CLINICAL IMPLICATIONS

Patients with DIE + AD showed greater impairment in overall and sexual quality of life compared with patients with isolated DIE which seems to improve with a COC containing 2 mg dienogest/30 μg ethinyl estradiol.

STRENGTHS & LIMITATIONS: Strengths include the long-term follow up, assessment of the impact of two associated conditions, and administration of the same COC in all patients. Limitations include the relatively small sample size, and the fact that we did not assess the effectiveness of a flexible extended COC regimen containing 2 mg dienogest/30 μg ethinyl estradiol since the groups were different at baseline.

CONCLUSION

Patients diagnosed with DIE with or without AD have a decreased quality of life which may improve with a COC containing 2 mg dienogest/30 μg ethinyl estradiol. Further research is needed to confirm our results. Alcalde AM, Martínez-Zamora MÁ, Gracia M, et al. Assessment of Quality of Life, Sexual Quality of Life, and Pain Symptoms in Deep Infiltrating Endometriosis Patients With or Without Associated Adenomyosis and the Influence of a Flexible Extended Combined Oral Contraceptive Regimen: Results of a Prospective, Observational Study. J Sex Med 2022;19:311-318.

摘要

背景

深部浸润型子宫内膜异位症(DIE)女性的生活质量受损,联合口服避孕药(COC)可能会改善这种情况。

目的

比较诊断为DIE伴或不伴子宫腺肌病(AD)的患者与健康对照者的总体生活质量和性生活质量,并确定含2mg地诺孕素/30μg炔雌醇的COC对这些方面的影响。

方法

我们纳入了42名诊断为DIE的女性;31名经阴道超声诊断为DIE+AD,39名非AD/DIE对照者。所有患者在开始服用COC前和治疗12个月后,就疼痛症状(痛经、性交痛、排便困难和排尿困难)、使用图片失血评估图评估的月经量过多、使用简短健康调查问卷(SF-36)评估的生活质量以及使用女性性生活质量问卷(SQOL-F)和女性性功能简要概况(B-PFSF)评估的性生活质量接受访谈。

结果

DIE和DIE+AD患者治疗后的总体生活质量和性生活质量有显著改善。

结果

在基线时,非AD/DIE对照者在B-PFSF、SQOL-F和SF-36问卷中的得分显著高于其他组(P<.05)。与DIE患者相比,DIE+AD患者的性生活质量较差,疼痛症状强度更大。治疗12个月后,DIE组和DIE+AD组的总体生活质量和性生活质量有显著改善,与DIE患者相比,DIE+AD患者的性生活质量改善略大。两组的疼痛症状也有所减轻。

临床意义

与孤立性DIE患者相比,DIE+AD患者的总体生活质量和性生活质量受损更严重,含2mg地诺孕素/30μg炔雌醇的COC似乎可改善这种情况。

优点和局限性

优点包括长期随访、评估两种相关疾病的影响以及所有患者使用相同的COC。局限性包括样本量相对较小,以及由于各组在基线时不同,我们未评估含2mg地诺孕素/30μg炔雌醇的灵活延长COC方案的有效性。

结论

诊断为DIE伴或不伴AD的患者生活质量下降,含2mg地诺孕素/30μg炔雌醇的COC可能会改善这种情况。需要进一步研究来证实我们的结果。阿尔卡德AM、马丁内斯-萨莫拉MÁ、格拉西亚M等。伴有或不伴有子宫腺肌病的深部浸润型子宫内膜异位症患者的生活质量、性生活质量和疼痛症状评估以及灵活延长联合口服避孕药方案的影响:一项前瞻性观察性研究的结果。《性医学杂志》2022;19:311-318。

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