"I feel reassured, but there is no guarantee." How do women with a future childbearing desire respond to active surveillance of cervical intraepithelial neoplasia grade 2? A qualitative study.

INTRODUCTION: In Denmark, women with a future childbearing desire diagnosed with cervical intraepithelial neoplasia grade 2 (CIN2) are recommended active surveillance instead of excisional treatment. However, we have limited and contradictory knowledge about how active surveillance of CIN2 may affect women emotionally. The aim of this study was to explore thoughts and emotional responses in women undergoing active surveillance of CIN2 and to explore how active surveillance may affect women's future childbearing desire. MATERIAL AND METHODS: This qualitative study was conducted in the gynecological outpatient clinic, the Department of Obstetrics and Gynecology, Gødstrup Hospital, Denmark. Women of childbearing age undergoing active surveillance with colposcopy, biopsy and smear every 6 months due to CIN2 were eligible for enrollment. In-depth semi-structured interviews were conducted. The interviews were audiotaped and transcribed verbatim. A thematic analysis was performed using a phenomenological approach. RESULTS: A total of 20 women were included. All women experienced nervousness and anxiety when they were diagnosed with CIN2 initially. Their main concern was whether they had cancer. Most women carried on with their everyday lives with only minor occasional worries about CIN2, often prompted just before check-up. However, some women were particularly nervous and found the period between check-ups frustrating and challenging. Women did not want to postpone their plans for pregnancy because of CIN2, but experienced the worries and check-ups associated with active surveillance as disruptive elements in their family planning. Women preparing for fertility treatment had their startup unnecessarily delayed due to active surveillance of CIN2, as clinical guidelines were inconsistent across subspecialties. Various factors influenced women's emotional well-being: life circumstances, information needs, and mental and physical discomfort during colposcopic examination. CONCLUSIONS: Women felt that worries and check-ups due to active surveillance of CIN2 were disrupting elements in their family planning, although they did not affect their every-day life. Some women, however, were particularly anxious, demonstrating the importance of including women's experiences and preferences in clinical counseling. The fact that fertility treatment was delayed due inconsistent guidelines across subspecialties, suggests a need for a revision of current guidelines.

Increased IL-25 levels in the peritoneal fluid of patients with endometriosis.

Previous studies have indicated a higher prevalence of allergic disease among women with endometriosis. It is already well established that type 1 allergies develop in a Th2 cytokine environment. Recent studies have shown, however, that IL-25 induces a Th2 development of naive T lymphocytes and is central in the Th2 response. The aim of this case-control study was to investigate the presence of IL-25 in the peritoneal fluid of women suffering from endometriosis. PF was obtained both from women undergoing laparoscopic surgery due to endometriosis (25 cases) and from women wanting sterilisation (19 controls). IL-25 levels were then investigated by ELISA. Women with endometriosis showed significantly higher levels of IL-25 in their PF (p=0.019) compared to controls. IL-25 levels did not correlate with the stage of endometriosis. Both Th2-cells and mast cells express IL-25, which could favor the development of allergies by perpetuating a hypersensitivity reaction. Further, IL-25 may also hold a role as a diagnostic tool.

Endometriosis and type 1 allergies/immediate type hypersensitivity: a systematic review.

Endometriosis is a chronic and debilitating disorder affecting up to 5-10% of women in reproductive age. Investigators have described deficiency in cellular immunity in women suffering from endometriosis, and in the recent years endometriosis has been linked to other diseases, allergic disease being one of them. The objective of this paper is to systematically review the existing literature on the possible association between endometriosis and allergic disease. This review is based on the recommendations by the preferred reporting of systematic reviews and meta-analysis (PRISMA) statement. PubMed and Embase were searched for studies on women diagnosed with endometriosis and with manifestations of allergic disease who were compared to a reference group. Out of 316 articles screened, 6 were reviewed and 5 ultimately met the inclusion criteria. Four out of the five studies reported a positive correlation between endometriosis and allergic manifestations, including hay fever, sinus allergic rhinitis, and food intolerance/sensitivities (food allergy). Investigators reported an odds ratio (OR) as high as 4.28 (95% CI: 2.93-6.27) for a positive history of allergy among women suffering from endometriosis. Equivocal results were found on asthma prevalence in women with endometriosis. Due to the heterogeneity of the included studies, no meta-analyses could be performed. The available literature clearly indicates that women with endometriosis are at an increased risk of allergic disorders compared to controls, but due to the lack of a concise definition of allergic disease and therefore diagnostic criteria, further studies are needed in order to draw firm conclusions on the association between endometriosis and allergic disease.