Avaliação da reserva ovariana, por meio da dosagem do hormônio antimulleriano, após escleroterapia alcoólica do endometrioma ovariano
Data
2023-05-29
Tipo
Dissertação de mestrado
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Introdução: Endometriose é uma doença ginecológica benigna, que acomete 6- 10% das mulheres em idade reprodutiva. A manifestação ovariana, denominada endometrioma, está presente em 17- 44% dessas pacientes. A infertilidade e a dor pélvica são sintomas comuns, que pioram a qualidade de vida das mulheres afetadas. O tratamento clínico medicamentoso é pouco eficaz nos endometriomas maiores que um centímetro. O tratamento cirúrgico é o mais indicado, sendo a cistectomia ovariana o procedimento cirúrgico padrão ouro. Entretanto, após a cistectomia, há diminuição da reserva ovariana nessas mulheres, que pode prejudicar a fertilidade. Portanto a busca por procedimento que possa reestabelecer a qualidade de vida e, também não prejudicar o futuro reprodutivo nos motivou a realizar este trabalho. Objetivo: Avaliar prospectivamente, por meio da dosagem do Hormônio Anti- Mulleriano (HAM), o comportamento da reserva ovariana, além da variação na intensidade da dor e taxa de recidiva dos cistos endometrióticos em pacientes submetidas ao procedimento de escleroterapia alcoólica. Métodos: Neste estudo prospectivo, 10 pacientes (com idade média de 30,5 anos), foram submetidas à escleroterapia alcoólica, como parte da terapêutica do ambulatório de Algia Pélvica e Endometriose, da UNIFESP, de maio de 2019 até janeiro de 2022. O diagnóstico foi baseado nos sintomas clínicos e exames de imagem. Para avaliar o impacto da reserva ovariana, o HAM sérico foi medido antes e 3 meses após o procedimento. O acompanhamento com ultrassonografia foi realizado 1 e 3 meses após a alcoolização. A comparação do HAM e tamanho dos endometriomas antes e depois foi realizada com software JAMOVI, através de testes pareados não paramétricos. A avaliação da qualidade de vida foi através do questionário Endometriosis Health Profile Questionnaire 30 (EHP-30) e escala visual analógica (EVA). Resultados: O tamanho médio do endometrioma variou de 5.56 cm ± 2.25 para 2.52 cm ± 1.79 com p < 0,001. Foi possível observar melhora em várias dimensões da qualidade de vida, analisadas pelo questionário EHP-30. Em relação ao score de dor houve uma diminuição de 49.91 pontos ± 19.31 para 7.96 pontos ± 5.79 (p < 0,001), indicando melhora desse sintoma. Não foi possível realizar a análise estatística em relação à variação dos níveis da medida do HAM sérico devido ao pequeno número de participantes. Conclusão: A escleroterapia alcoólica como tratamento para os endometriomas, resultou em melhora da dor, qualidade de vida e redução do tamanho dos cistos. Em relação à reserva ovariana, futuros trabalhos envolvendo número maior de pacientes, são necessários para assegurar a eficácia e segurança do método em relação à fertilidade.
Introduction: Endometriosis is a benign gynecological disease that affects 6- 10% women of reproductive age. The ovarian manifestation, called endometriomas, is present in 17-44% of these patients. Infertility and pelvic pain are common symptoms that worsen quality of life. Clinical drug treatment is ineffective in endometriomas larger than one centimeter. Surgical treatment is the most indicated, with ovarian cystectomy being the gold standard surgical procedure. However, after cystectomy, there is a decrease in the ovarian reserve in these women, which can greatly impair fertility. Therefore, the search for a procedure that can restore quality of life and also not harm the reproductive future motivated us to carry out this work. Objective: To prospectively evaluate, through the Anti-Mullerian Hormone (AMH) measurement, the behavior of the ovarian reserve, in addition, the variation in pain intensity, quality of life and recurrence rate of endometriotic cysts in patients undergoing alcoholic sclerotherapy. Methods: In this prospective study, 10 patients (mean age 30.5 years) underwent alcoholic sclerotherapy, as part of the therapy at the Pelvic Pain and Endometriosis outpatient clinic, UNIFESP, from May 2019 to January 2022. Diagnosis was based on clinical symptoms and imaging tests. To assess the impact of ovarian reserve, serum AMH was measured before and 3 months after the procedure. Follow- up with ultrasound was performed 1 and 3 months after alcoholization. The comparison of AMH and size of endometriomas before and after was performed with JAMOVI software, through non-parametric paired tests. Quality of life was assessed using the Endometriosis Health Profile Questionnaire 30 (EHP-30) questionnaire and Visual Analogue Scale (VAS). Results: The mean size of endometrioma has changed from 5.56 cm ± 2.25 to 2.52 cm ± 1.79 with p < 0.001. It was possible to observe improvement in several dimensions of quality of life, analyzed by the EHP-30 questionnaire. Regarding the pain score, there was a decrease from 49.91 points ± 19.31 to 7.96 points ± 5.79 with p < 0.001, indicating an improvement in this symptom. It was not possible to perform a statistical analysis regarding the variation in serum AMH measurement levels due to the small number of participants. Conclusion: Alcoholic sclerotherapy as a treatment for endometriomas has shown improving pain, quality of life and reducing the size of cysts. Regarding ovarian reserve, future randomized studies, with a greater number of patients, are necessary to ensure the effectiveness and safety of the method in relation to fertility.
Introduction: Endometriosis is a benign gynecological disease that affects 6- 10% women of reproductive age. The ovarian manifestation, called endometriomas, is present in 17-44% of these patients. Infertility and pelvic pain are common symptoms that worsen quality of life. Clinical drug treatment is ineffective in endometriomas larger than one centimeter. Surgical treatment is the most indicated, with ovarian cystectomy being the gold standard surgical procedure. However, after cystectomy, there is a decrease in the ovarian reserve in these women, which can greatly impair fertility. Therefore, the search for a procedure that can restore quality of life and also not harm the reproductive future motivated us to carry out this work. Objective: To prospectively evaluate, through the Anti-Mullerian Hormone (AMH) measurement, the behavior of the ovarian reserve, in addition, the variation in pain intensity, quality of life and recurrence rate of endometriotic cysts in patients undergoing alcoholic sclerotherapy. Methods: In this prospective study, 10 patients (mean age 30.5 years) underwent alcoholic sclerotherapy, as part of the therapy at the Pelvic Pain and Endometriosis outpatient clinic, UNIFESP, from May 2019 to January 2022. Diagnosis was based on clinical symptoms and imaging tests. To assess the impact of ovarian reserve, serum AMH was measured before and 3 months after the procedure. Follow- up with ultrasound was performed 1 and 3 months after alcoholization. The comparison of AMH and size of endometriomas before and after was performed with JAMOVI software, through non-parametric paired tests. Quality of life was assessed using the Endometriosis Health Profile Questionnaire 30 (EHP-30) questionnaire and Visual Analogue Scale (VAS). Results: The mean size of endometrioma has changed from 5.56 cm ± 2.25 to 2.52 cm ± 1.79 with p < 0.001. It was possible to observe improvement in several dimensions of quality of life, analyzed by the EHP-30 questionnaire. Regarding the pain score, there was a decrease from 49.91 points ± 19.31 to 7.96 points ± 5.79 with p < 0.001, indicating an improvement in this symptom. It was not possible to perform a statistical analysis regarding the variation in serum AMH measurement levels due to the small number of participants. Conclusion: Alcoholic sclerotherapy as a treatment for endometriomas has shown improving pain, quality of life and reducing the size of cysts. Regarding ovarian reserve, future randomized studies, with a greater number of patients, are necessary to ensure the effectiveness and safety of the method in relation to fertility.
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NEVES, Jaqueline da Silva. Avaliação da reserva ovariana, por meio da dosagem do hormônio antimulleriano, após escleroterapia alcoólica do endometrioma ovariano. 2023. 62 f. Dissertação (Mestrado em Ginecologia) – Escola Paulista de Medicina Universidade, Federal de São Paulo, São Paulo, 2023.