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A disorder with estrogen dependency comprising of inflammatory lesions outside the uterus, causing pain and inflammation in pelvis and affecting women of reproductive age with infertility and post reproductive age is endometriosis. Endometriosis is viewed as public health issue with a major impact on quality of life of women. Medically advanced computational and chemical treatments are available to treat the progression of the disease by diagnostic imaging, clinical examinations, imaging and laparoscopy often leading to immediate surgery. A warrantable rethinking on the diagnosis and management of endometriosis is to be assessed and medical treatments should be considered as first-line option for therapeutic relief for endometriosis by suppressing the systemic estrogen levels providing desirable efficacy and safety, prior to performing endometriosis surgery. The aim of this review is to describe natural products, hormonal and non-hormonal compounds that suppress the progression of endometriosis. Various herbal, conventional and traditional therapies are investigated to treat gynecological disease, endometriosis. The information in this paper include various studies assessing the use of novel treatments in addition to the herbal and hormonal products in the endometriosis therapy. Most of the studies involved were in scrutinizing the pharmacological activity profiles of various sources of drugs in endometriosis treatment, hormonal drugs involved suppression and regulation of various hormones along with various factors like anti-inflammatory, anti-oxidant, anti-proliferative and apoptotic, anti-angiogenic, anti-invasive, immunomodulatory, and estrogen modulating activity. However, novel drugs and medicinal plants are also reviewed here to draw attention to the molecules of drugs that target at multiple points for rational therapeutic treatment of endometriosis.

Introduction Investigating the epidemiology of endometriosis in women of Arab ancestry, in the context of regionally important environmental and genetic effects, will provide us with a better understanding on the endometriosis phenome across different populations. Under the following initiative, the Middle Eastern Women Research Association: the MAR’A project, the study aimed to investigate for the first time in women of Arab ancestry: (1) Associations of symptomatology, risk factors, phenotypic profile, and comorbidities with endometriosis (2) Assess the impact of endometriosis on health-related quality of life (HRQoL), work productivity, activity impairment, physical activity, and diagnostic delay (3) Conduct a candidate gene association study (CGAS) on variants in wingless-type MMTV integration site family member 4 (WNT4) and the Vezatin (VEZT) in women with endometriosis. Method The MAR’A Project is a case-control study with multiple hospital and population-based sites across the United Arab Emirates, between August 2018 and August 2019. In total, 2,610 (518 endometriosis cases; 2092 controls) premenopausal women, aged 18-50 years, without a previous surgical diagnosis of endometriosis and self-reported ethnically Arab, were recruited. The study design of a case-control study compared incident endometriosis cases (n=518) with the following two comparison groups to evaluate potential risk factors: (1) ascertainment criteria (hospital controls (n=1251) vs. population controls (n=841)); and (2) symptomatic criteria (symptomatic controls (n=1331) vs. asymptomatic controls (n=761)). A subset of the samples (100 endometriosis cases and 100 hospital controls) was selected for the CGAS. Standardized, validated questionnaires, basic anthropometric measurements and saliva samples were collected from consenting participants. Results (1) Women with endometriosis had a lower BMI and WHRadjBMI, reported a higher frequency of pain phenotypes (dysmenorrhea, chronic pelvic pain, dysuria, and dyschezia) with greater severity, earlier age of symptom onset, and higher pain catastrophizing score, in comparison to controls. Similar to the Western population studies, women with endometriosis had earlier age at menarche, shorter menstrual cycle, heavier menstrual flow, and longer duration of menstrual phase. Women with endometriosis had a higher frequency of miscarriages, ectopic pregnancy, preterm birth, and emergency caesarean section. (2) The average diagnostic delay was 11.61 years, with single women experiencing 15.81 years of diagnosis delay. HRQoL scores were significantly impaired in women with endometriosis, for both the Physical and Mental Composite Scores, affecting work productivity and activity impairment. (3) A significant association was observed for SNP rs12320196 (OR=1.60 (95% CI: 1.05, 2.45), p=0.027) intronic to the VEZT gene, and SNPs rs12037376 (OR=1.89 (95% CI: 1.06, 3.37), p=0.029) and rs3820282 (OR=1.90 (95% CI: 1.05, 3.46), p=0.033) intronic to the WNT4 gene. Conclusion This study provided novel findings of the clinical presentation and risk factors of endometriosis among Arab women from a combined hospital and population-based sites. Along with the presence, duration and severity of the pain phenotypes, adverse reproductive outcomes, and comorbidities, Arab women experience among the highest diagnostic delay of endometriosis. Social exacerbation and cultural factors may influence management of endometriosis-associated pain, leading to psychological distress and significant impacts on HRQoL. Further research must be conducted among Arab women to improve early diagnosis and provide culturally sensitive clinical care.

Abstract Shimotsuto is a traditional Japanese Kampo medicine used to treat gynecological diseases, such as irregular menstruation, in addition to oversensitivity to cold and chilblains. Part of the pharmacological actions of shimotsuto is traditionally considered to be exerted by an improvement effect of the blood and the circulatory system. Multiple ingredients (e.g., catalpol and paeoniflorin) contained in shimotsuto have been reported to have pharmacological activities on the blood and circulatory system, and thus been considered to contribute to the pharmacological actions of shimotsuto. However, it remains unclear whether the ingredients can be absorbed into the body following oral administration of shimotsuto. The aim in the present study was to specify shimotsuto ingredient absorbed into the systemic circulation in rats. Seven candidate active ingredients (catalpol, paeoniflorin, albiflorin, ligustilide, senkyunolide A, butylphthalide, and ferulic acid) in plasma after oral administration of shimotsuto were quantified by targeted liquid chromatography–tandem mass spectrometry (LC–MS/MS) analysis. This study also performed nontargeted LC–MS/MS analysis of plasma following administration of constituent crude drugs of shimotsuto to find extensively blood-absorbed ingredients of shimotsuto. Among detected peaks in the nontargeted analysis, two peaks could be identified as bergapten and 8-debenzoylpaeoniflorin, subsequently their concentrations in shimotsuto-treated rat plasma were quantified. These pharmacokinetic studies indicated that catalpol showed the highest plasma concentration following administration of shimotsuto, followed by 8-debenzoylpaeoniflorin. This study suggests that all nine ingredients are absorbed into the blood following oral administration of shimotsuto and possibly contribute to its pharmacological action. Graphic abstract

Endometriosis is a benign gynecological disease, which significantly impairs fertility. However, the contribution of specific hormonal parameters to the proper diagnosis of endometriosis in infertility states has not been adequately determined. The aim of this study was to compare ant-Mullerian hormone (AMH), prolactin and estradiol concentrations between infertile women with and without endometriosis, as well as to estimate the effect of endometrioid heterotopia on ovarian reserve.In this cross-sectional study, mean baseline serum AMH, prolactin and estradiol levels were assessed in infertile women with and without endometriosis. Descriptive statistics are presented in the form of arithmetic mean ± standard deviation (SD). The comparison of indicators was performed by using parametric (Seventy-two infertile women with endometriosis (group A; mean age: 32 ± 4.3 years) and 77 infertile women without endometriosis (group B; mean age: 32.4 ± 3.7 years) were studied. Mean baseline prolactin concentrations were higher in group A (16.9 ± 5.7 ng/mL) compared with group B (15 ± 4.3 ng/mL;Infertile women with endometriosis demonstrated higher prolactin and lower AMH concentrations, compared with infertile women without endometriosis. The highest prolactin and the lowest AMH concentrations were observed in patients with ovarian endometriomas.

Genital endometriosis (GE) is a widespread gynecological disease which requires its further pathogenesis investigation and search for new effective treatments. The known data of oxytocin receptor presence in endometrioid heterotopy smooth muscle cells give some grounds to assume oxytocin participation in the pathogenesis of endometriosis. The present study objective was to evaluate oxytocin level in peripheral blood (PB) in patients with endometriosis associated pain syndrome and to estimate the efficacy of oxytocin receptor inhibitors (IOXTR) administration based on animal endometriosis model.The basic group comprised 61 patients with endometriosis associated pain syndrome, while 21 patients formed the control group. VAS, MPQ, and BBS objective tests were applied for pain syndrome evaluation. Oxytocin level in PB was measured by immunoenzyme method. After confirmation of endometriosis experimental model formation in rats and further randomization, a daily IOXTR intra-abdominal injection was performed in a dose of 0.35 mg/kg/24 h in the basic group (Oxytocin level in PB was authentically higher in patients with GE compared to the control: 51.45 (35.54-62.76) pg/mL and 27.64 (23.23-34.12) pg/mL, respectively (The obtained results confirm the oxytocin role in the pathogenesis of endometrioid associated pain syndrome. The high efficacy of IOXTR administration based on animal model of surgically induced endometriosis allows viewing this method as a perspective therapy.

This study was oriented to assess surgical outcomes, feasibility, and safety of Robotic-assisted Single-Site Hysterectomy and bilateral salpingo-oophorectomy (RSSH/BSO) performed for sexual reassignment compared to indications for the benign gynecologic disease. The present trial is a retrospective analysis of a prospectively collected database. After the exclusion of 3 patients with endometrial cancer on histological specimens, 112 subjects were considered for final analysis: 60 transgender men (TM) and 52 cisgender women (CW). There is a statistical difference in surgical time (total operative time p = 0.0152, docking p = 0.0011, console time p = 0.0001, and anesthesia time p = 0.0061) between TM and CW. Other than in TM, a significant difference in uterine volume (p = 0.0001), Body Mass Index (p = 0.0169), and previous comorbidity (p = 0.0001) was reported. There are no differences in conversion rate, the decrease in hemoglobin and blood loss, hospital stay, intra- and postoperative complications between the two groups. RSSH for sex reassignment appears to be a safe, viable, and cost-effective option with a significant decrease in surgical time compared to other indications for benign disease. In addition, the benefit of this scar-less surgical procedure appears to be more evident in TM’s due to the absence of traditional surgical stigmata.

Endometriosis is a widespread gynecological disease, which affects reproductive-aged women. An accurate diagnosis is critical to develop a more comprehensive treatment strategy for endometriosis than is currently available. This article provides an overview of current data on the value of radiation techniques for the diagnosis of external genital and extragenital endometriosis, deep infiltrating endometriosis, and adenomyosis. The necessity of using a systematic approach to examine the pelvis in women with suspected endometriosis is shown, modern terms and methods of measurement being given to describe ultrasound picture of endometriosis.

Endometriosis is a common gynecological disease affecting up to 10% of women at reproductive age. Prior combined studies implied that MYH8 mutations might exist in endometriosis. Here, 152 Han Chinese samples with ovarian endometriosis were analyzed for the presence of MYH8 mutations. Two heterozygous missense mutations in the MYH8 gene, c.1441A C (p.I481L) and c.4057G A (p.E1353K), were identified in our samples. These mutations were neither found in public databases nor detected in our 485 Han Chinese control women without endometriosis. The p.I481L-mutated sample belonged to 34-year-old, who had slightly elevated serum CA 125 (42.09 U/mL); while the sample with p.E1353K mutation belonged to 25 years old, who had a markedly increased serum CA125 (89.86 U/mL). The evolutionary conservation analysis results suggested that these MYH8 mutations caused highly conserved amino acid substitutions among vertebrate species. Both the mutations were predicted to be 'disease causing' by MutationTaster and SIFT programs. In addition, no association was observed between MYH8 mutations and the available clinical data. In summary, the present study identified two novel potential pathogenic mutations in the MYH8 gene in samples with ovarian endometriosis for the first time, implying that MYH8 mutations might play a positive role in the pathogenesis of endometriosis.

Women at the National Institute of Child Health and Human Development (NICHD) are charging the institute9s outgoing scientific director with 10 years of sex discrimination. They say geneticist Constantine Stratakis oversaw a disproportionate decrease in the number of women leading experiment-running labs at the institute, and that he dismantled research on gynecological disease affecting adult women at the institute9s Bethesda, Maryland, campus. Between 2013 and 2019, at least eight female professionals at NICHD filed equal employment opportunity complaints charging Stratakis with sex discrimination, age discrimination, or both. Stratakis denies all the claims, saying he elevated institute women into leadership positions and actively recruited women including three new gynecologists focused on disease in children and teens. In June, he is set to take a new job as executive director of the Research Institute of the McGill University Health Centre.

Endometriosis is a gynecological disease characterized by pain and infertility. The diagnosis is very often made during the infertility work-up, together with other reproductive diseases and uterine disorders. A retrospective cohort study was conducted on infertile women with clinical or ultrasound suspect of endometriosis, undergoing an ultrasound (US) evaluation by a team of expert sonographers (

Background Sanjie Zhentong capsule (SZC) offers excellent effect in treating adenomyosis (AM), which is a common and difficult gynecological disease in the clinic. However, the systematic analysis of its mechanism has not been carried out yet and further studies are needed to reveal the role of SZC. Methods A systematic network pharmacology analysis was conducted by integrating construction of SZC compound database and AM target database, prediction of potential active compounds and targets by molecular docking combined with compound-target prediction graph (CTPG), protein-protein interaction (PPI) analysis, Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis. Then, the anti-inflammation experiments in vitro were performed by investigating SZC and the representative compounds regulating nitric oxide (NO), interleukin-6 (IL-6), and interleukin-10 (IL-10). Results Our findings show that SZC mainly treated AM by stimulating 28 core targets through 30 key potential active compounds, and affecting 4 crucial pathways. The treatment was associated with inflammation reaction, hormone regulation, cell adhesion, proliferation, and angiogenesis. Additionally, SZC achieved the anti-inflammatory activity by the cooperation of the compounds through inhibiting NO and IL-6, both promoting and inhibiting IL-10. Conclusion This study investigated the anti-inflammatory activity of SZC based on a systematic analysis of SZC remedying AM, which was revealed to be one of the essential mechanisms. These findings will provide valuable guidance for further research of the SZC treatment of AM, and help improve the comprehension of SZC pharmacological basis as well as AM pathogenesis.

Endometriosis (EM) is an estrogen-dependent, frequent benign gynecological disease, which reduces the quality of life in EM patients. Propofol regulates the apoptosis of EM. miR-9-5p is decreased i...

Background: Preoperative anemia affects perioperative outcomes and often causes fatigue and psychological disorders. Therefore, anemia should be treated before a patient undergoes surgery. Ninjin’yoeito (NYT), a Japanese Kampo medicine composed of ginseng and Japanese angelica root with the other 10 herbs, is administered for anemia, fatigue and anxiety; however, there are a few reports that have prospectively examined the effects of NYT before surgery for gynecological diseases. Hence, we tended to investigate its efficacy and safety.Methods: In this open-label randomized trial, women with gynecological diseases accompanied by preoperative anemia (defined as Results: 40 patients were enrolled of whom 30 patients were finally analyzed after allocating 15 to each group. There was no difference in the characteristics between both groups. Hb significantly increased in both groups (iron supplementation group, 9.9 ± 0.8 g/dL vs. 11.9 ± 1.6 g/dL; NYT group, 9.8 ± 1.0 g/dL vs. 12.0 ± 1.0 g/dL); the difference in the elevations in Hb between both groups was statistically insignificant (P = 0.72). Contrarily, CFS (17.9 ± 10.2 vs. 8.1 ± 5.2) and VAS-A (56 mm (50–70) vs. 23 mm (6–48)) scores were significantly decreased only in the NYT group and these changes were greater in the NYT group (∆CFS, P = 0.015; ∆VAS-A, P = 0.014). Liver dysfunction occurred in one patient of the NYT group.Conclusions: For treating preoperative anemia in women with gynecological conditions, NYT administration along with iron supplementation safely and efficiently improved the preoperative anemia, fatigue and anxiety.Trial registration: jRCT1051190012 (28/April/2019, retrospectively registered).

Dingkun Dan (DKD), a reputable traditional Chinese medicine formula, has been used to treat gynecological diseases and showed significant clinical effects since ancient times. However, the application and development of DKD are seriously hampered by the unclear active substances. Structural characterization of compounds absorbed in vivo and their corresponding metabolites is significant for clarifying the pharmacodynamic material basis. In this study, an integrated strategy using ultra-performance liquid chromatography, coupled with quadrupole time-of-flight mass spectrometry and UNIFI™ software, was used to identify prototypes and metabolites after oral administration of DKD in rats. As a result, a total of 261 compounds, including 140 prototypes and 121 metabolites, were tentatively characterized in rat plasma, urine, and feces. The metabolic pathways of prototypes have been studied to clarify their possible transformation process in vivo. Moreover, an in vitro metabolism study was applied for verifying the metabolites under simulating the metabolic environment in vivo. This first systematic metabolic study of DKD is important for elucidating the metabolites and metabolic pathways and could provide a scientific basis for explaining the integrative mechanism in further pharmacology study.

Endometriosis is a chronic gynecological disease that impacts more than 176 million women worldwide, having a strong impact on psychological morbidity. This study aimed to evaluate the contribution of psychological morbidity, in women with endometriosis, taking into consideration the duration of the couple’s relationship and the duration of the disease and also examine whether women’s sexual satisfaction had an impact on their psychological morbidity (actor effect) and on their sexual partners’ psychological morbidity (partner effect) and vice versa. Participants were 105 women and their partners, who answered the Hospital Anxiety and Depression Scale (HADS), Couple Satisfaction Index (CSI-4) and the Global Measure of Sexual Satisfaction (GMSEX). The results revealed a direct effect between the perception of symptom severity, marital satisfaction, and women’s psychological morbidity. Sexual activity and the presence of infertility had an indirect effect on the relationship between sexual satisfaction, diagnosis duration, and psychological morbidity, respectively. Finally, women’s sexual satisfaction had a direct effect on their own and partner’s marital satisfaction that predicted less psychological morbidity, in each. Thus, multidisciplinary interventions focused on the couple’s sexual and marital relationship, as well as illness representations, are needed to promote psychological well-being in this population.

The human body is inhabited by a large and complex network of commensal and predatory eukaryotic viruses and bacteriophages collectively termed the virome. Despite being the most abundant and genetically diverse biological entities on the planet, the impact of viruses on human health especially within the female reproductive tract (FRT) remains under-studied. To better appreciate current knowledge regarding the dynamic role of viruses in FRT health and disease, in this review we highlight the known constituents of the FRT virome, transkingdom interactions within the FRT and their influence on gynecological disease. A better understanding of the FRT virome may pave the way toward improved outcomes in gynecological, reproductive, and neonatal health.

Endometriosis is a chronic gynecological disease that affects approximately 1 in 10 women of reproductive age. Symptoms of severe pelvic pain, infertility, fatigue, and abnormal menstruation can cause significant negative effects on an individual’s physical and mental health, including interactions with their family, friends, and health care providers. Stigma associated with endometriosis has been under-studied and is rarely discussed in current literature. Herein, this paper aims to provide a brief overview of published literature to explore and establish the plausibility of stigma as a driver of suboptimal psychosocial well-being and diagnostic delay among individuals living with endometriosis. We present the clinical characteristics and physical and mental health consequences associated with endometriosis, highlight several theoretical constructs of stigma, and review the limited studies documenting women’s lived experiences of endometriosis-related stigma. To mitigate harmful effects of this phenomenon, we recommend increasing efforts to assess the prevalence of and to characterize endometriosis-related stigma, implementing awareness campaigns, and developing interventions that combat the multidimensional negative effects of stigma on timely care, treatment, and quality of life for individuals living with endometriosis.

Study question Is there consensual clinical practices about fertility preservation (FP) for benign gynecological diseases BGD)? Summary answer A consensus study using the modified Delphi method identified 28 consensual practices concerning oocyte vitrification for fertility preservation in women with benign gynecological disease. What is known already Clinical Practical international guidelines are still published in oncology for offering standardized information and care for adults and children with cancer. Recently, the ESHRE Female Fertility Preservation Guideline Development Group published recommendations for healthcare professionals involved in fertility preservation for post-pubertal women and transgender adolescents and young adults. However, benign gynecological indications weren’t distinctly individualized of malignant conditions. There’s a lack of large cohort studies assessing the risks and outcome of FP for benign gynecological diseases. Healthcare professionals need consensus for defining the “good” indications of FP for benign gynecological diseases that could impair fertility. Study design, size, duration A steering group composed by 14 healthcare professionals and a patient representative with lived experience of endometriosis identified 42 potential practices concerning fertility preservation for benign gynecological disease. Then, 114 key stakeholders including various healthcare professionals (n = 108) and patient representatives(n = 6) were asked to answer at two rounds of a modified Delphi via an online survey from February to September 2020. Participants/materials, setting, methods Participants had to score 42 items for the first round and 31 for the second round using a nine-point Likert scale. These statements were distributed into five categories: Information to deliver to age-reproductive women with a BGD (n = 9), technical aspect of fertility preservation for BGD (n = 6), indications of FP for endometriosis (n = 13), indications of FP for none-endometriosis BGD (n = 10), idiopathic diminished ovarian reserve in the absence of gynecologic and endocrinologic diseases (n = 4). Main results and the role of chance Survey response of stakeholders was 75% (86 out of 114) for the round 1 and 87% (75 out of 86) for the round 2. Consensus recommendations were achieved for 28 items, and no consensus between stakeholders was achieved in the remaining items. Stakeholders rated the importance of an age-specific information concerning the risk of diminished ovarian reserve after surgery and the necessity to inform about the benefice/ risk balance of oocyte vitrification, in particular about the chance of live-birth according to the age at the time of oocyte vitrification. They endorsed oocyte vitrification as the reference FP technique for those benign indications. Experts rejected to determine lower and upper age limits in women for fertility preservation. FP shouldn’t be offered in rAFS stages I and II endometriosis without endometriomas. Limitations, reasons for caution Experts were only French native speakers from France, and Belgium. It would have been interesting to conduct this survey with experts from other continents. Wider implications of the findings: At our knowledge, we present here the first guideline s focusing on FP in women with BGD, following a designed scientific Delphi procedure. These guidelines could be useful for gynecologists to better inform women with benign gynecological diseases about the indication or not to offer a FP procedure. Trial registration number Not applicable

Uterine disease is a disease that generally attacks female reproduction. Most women know a disease that is in their womb when the disease is declared severe or so-called advanced stage. With this expert system, it is hoped that human uterine diseases can be detected early and can minimize the occurrence of more dangerous diseases. The method used in this expert system is the Dempster Shafer calculation method. This expert system works by entering the symptoms experienced by the patient after which the system will work according to the calculations determined by the expert who entered the knowledge base. The result of this research is to build an expert system for diagnosis of gynecology using a website-based dempster shafer. This website can be used as the use of technology so that it can be used to diagnose uterine diseases precisely and accurately, so that people with gynecological diseases are handled more quickly from an early age.

Endometriosis (EM) is a common gynecological disease characterized by endometrial-like tissue outside the uterine cavity. We report a case of intramedullary EM, a rare condition with only seven similar cases reported until today. MRI showed a mass-like lesion within the spinal canal at the L1-L2 levels and the histological and immunohistochemical features were characteristic of intraspinal endometriosis (IEM). A review of the relevant literature and a comparison between our case and seven other similar cases were made. Intraspinal EM must be recognized as a potential cause of periodic neurological signs and symptoms in young and middle-aged women. Timely intervention and appropriate management can result in control of the disease and an improvement in neurological functions.

Polycystic ovary syndrome (PCOS) is a gynecological disease manifested in polycystic ovarian morphology, oligo/ anovulation, hyperandrogenism, hirsutism, alopecia, and acne. PCOS affects 5–10 % of women of reproductive age. The first histological description of polycystic ovaries was made by Antonio Vallisneri. Then, Kronid Fedorovich Slavyanskiy, for the first time, described the clinical picture of PCOS, and Sergey Kuzmich Lesnoy proposed ovary wedge resection for surgical treatment. Irving Stein and Michael Leventhal studied the PCOS symptom complex and provided the recommendations on its diagnosis and treatment to restore normal menstrual cycle and fertility in such patients.