The purpose of this study is to determine whether endometriosis and adenomyosis are progressive diseases, in terms of symptoms (pain, abnormal uterine bleeding and infertility), anatomical lesions size, and recurrences. We also aimed to address molecular questions on immune dialogues between ectopic lesions and the eutopic endometrium, auto-immunity in endometriosis and adenomyosis and the role of the microbiota in their respective pathophysiologies.
Endometriosis and adenomyosis are benign gynecological conditions which affect more than 10% of women, that typically cause pain and / or infertility, thereby exerting a negative impact on the patients' quality of life. Although the pathogenesis of endometriosis and adenomyosis are controversial, both diseases are defined by the presence of endometrial tissue outside the uterine cavity. Endometriosis is a heterogeneous disease, with three phenotypes: superficial peritoneal endometriosis (SUP), ovarian endometrioma (OMA), and deep infiltrating endometriosis (DIE) The most widely accepted pathophysiological hypothesis for endometriosis is that of the implantation of ectopic endometrial cells following peritoneal reflux. Endometriosis can be associated with adenomyosis, also heterogeneous, characterized by the infiltration of endometrial tissue into the myometrium, presenting different forms: diffuse, focal or cystic. Due to diseases heterogeneity, the diagnosis of endometriosis and adenomyosis is difficult and affected patients are subject to a long delay for appropriate management. We hypothesize that the disease may be progressive in terms of symptoms (pain, abnormal uterine bleeding and infertility), anatomical lesions and recurrences. Furthermore, highlighting specific clinical and molecular markers would shorten the diagnostic time.
Study Type
OBSERVATIONAL
Enrollment
5,300
Port Royal, hospital cochin
Paris, France
RECRUITINGPain scores (analog visual scale), quantification of uterine bleeding (number of towels or tampon/day/month) and live birth rates
Composite outcome
Time frame: 10 years
Changes in lesions or recurrences to imaging performed during the gynaecological follow-up of the patient
Time frame: 10 years
Pain scores (analog visual scale), quantification of uterine bleeding (number of towels or tampon/day/month) and live birth rates
Time frame: 1 year
Pain scores (analog visual scale), quantification of uterine bleeding (number of towels or tampon/day/month) and live birth rates
Time frame: 3 years
Pain scores (analog visual scale), quantification of uterine bleeding (number of towels or tampon/day/month) and live birth rates
Time frame: 5 years
Pain scores (analog visual scale), quantification of uterine bleeding (number of towels or tampon/day/month) and live birth rates
Time frame: 7 years
Delays between the onset of symptoms and post-operative or radiological histological diagnosis with specialized imaging (transvaginal ultrasound, endorectal ultrasound, magnetic resonance imagingI
Time frame: 10 years
meeting specific criteria for endometriosis and adenomyosis lesions
Time frame: 10 years
Association between clinical parameters of interrogation and clinical examination and the presence of endometriosis.
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Time frame: 10 years
Association between clinical parameters of interrogation and clinical examination and the presence of adenomyosis.
Time frame: 10 years
Association between clinical data and the occurrence of the disease
Time frame: 10 years
Creating a score on clinical diagnosis
Time frame: 10 years
- Evaluation of individualized management: comparison between different management strategies on pain scores (analog visual scale), pregnancy-conception desire delay, live birth rate
Time frame: 10 years
Serum dosage of circulating antibodies before and after surgical treatment of lesions
Time frame: 10 years
Metabolic pathway exploration in adenomyosis lesions
Time frame: 10 years
Study of the presence of autoantibodies in cases of endometriosis and adenomyosis
Time frame: 10 years
Establish a genotype/phenotype correlation of the disease (endometriosis and adenomyosis)
Time frame: 10 years
To study the natural history of deep endometriosis lesions and analysis of focused invasion processes, epithelio-mesenchymatous transitions, and fibrogenesis using molecular biology techniques
Time frame: 10 years
Characterization of the microbiota in urine and vaginal samples.
Time frame: 10 years