Pelvic pain in endometriosis: is success of therapy gone in cigarette smoke?


The objective of the study was to assess potential individual factors influencing the efficacy of combined surgical and medical therapy in en-dometriosis patients with pelvic pain. For this purpose we performed a prospective study using a specifically designed questionnaire among patients suffering from persistent pelvic pain and undergoing laparoscopy and further GnRH analogue therapy in a university-based gyne-cologic department. Eighty-one women of re-productive age with histologically confirmed endometriosis were enrolled. A questionnaire gathered information from women on the fol-lowing groups of variables: age, marital status, education, reproductive and medical history including previous pregnancies and parity, knowledge of accompaniing pelvic disorders, concurrent cigarette smoking, as well as general quality of life estimates including self-image. Pelvic pain was scored using a visual analogue scale. Patients filled out the questionnaires before surgery and upon completing medical therapy. Data were statistically evaluated. After cessation of therapy, 53% of patients reported absence of pain. Only 12% of pain-free patients were smokers. This corresponded to slightly more than one third (35%) of all smokers in the study. However, 56% of non-smoker participants reported a positive outcome that proved to be significantly larger than the ratio of pain-free smoker participants (p = 0.02). Improvement in quality of life was reported by 74% of all patients, and only 9% of them were smokers. However, 47% were smokers among patients reporting no change or worsening in quality of life (p < 0.01). Based on our results, we can conclude, that regular smoking might have a disadvantageous impact on the success rate of combined surgical and medical therapy for endometriosis related pelvic pain.

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Koppan, A. , Hamori, J. , Vranics, I. , Garai, J. , Kriszbacher, I. , Bodis, J. , Oehmke, F. , Tinneberg, H. and Koppan, M. (2011) Pelvic pain in endometriosis: is success of therapy gone in cigarette smoke?. Health, 3, 571-576. doi: 10.4236/health.2011.39098.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Birnbaum, L.S. and Cummings, A.M. (2002) Dioxins and endometriosis: A plausible hypothesis. Environmental Health Perspectives, 110, 15-21. doi:10.1289/ehp.0211015
[2] Garai, J., Molnar, V., Varga, T., Koppan, M., Torok, A. and Bodis, J. (2006) Endometriosis: Harmful survival of an ectopic tissue. Frontiers in Bioscience, 11, 595-619. doi:10.2741/1821
[3] Balasch, J., Creus, M., Fabregues, F., et al. (1996) Visible and non-visible endometriosis at laparoscopy in fertile and infertile women and in patients with chronic pelvic pain: A prospective study. Human Reproduction, 11, 387-391.
[4] Tinelli, A., Martignago, R., Vergara, D., Leo, G., Malvasi, A. and Tinelli, R. (2008) Endometriosis management: Workflow on genomics and proteomics and future biomolecular pharmacotherapy. Current Medicinal Chemistry, 15: 2099-2107. doi:10.2174/092986708785747571
[5] Prentice, A. (2001) Regular review: Endometriosis. British Medical Journal, 323, 93-95. doi:10.1136/bmj.323.7304.93
[6] McCann, S.E., Freudenheim, J.L., Darrow, S.L., Batt, R.E. and Zielezny, M.A. (1993) Endometriosis and body fat distribution. Obstetrics & Gynecology, 82, 545-549. doi:10.1097/00006250-199310000-00014
[7] Batt, R.E., Buck, G.M. and Smith, R.A. (1997) Health and fertility outcomes among women surgically treated for endometriosis. The Journal of the American Association of Gynecologic Laparoscopists, 4, 435-442. doi:10.1016/S1074-3804(05)80035-0
[8] Sutton, C.J., Ewen, S.P., Whitelaw, N. and Haines, P. (1994) Prospective, randomized, double-blind, controlled trial of laser laparoscopy in the treatment of pelvic pain associated with minimal, mild, and moderate endometriosis. Fertility and Sterility, 62, 696-700.
[9] Birnbaum, L.S. (1994) Evidence for the role of the Ah receptor in response to dioxin. In: Spitzer, H.L., Slaga, T.J., Greenlee, W.F. and McClain, M., Ed., Receptor-Mediated Biological Processes: Implications for Evaluating Carcinogenesis, Progress in Clinical and Biological Research, 387, Wiley-Liss, New York, 139-54.
[10] Kitamura, M. and Kasai, A. (2007) Cigarette smoke as a trigger for the dioxin receptor-mediated signaling pathway. Cancer Letters, 252, 184-194. doi:10.1016/j.canlet.2006.11.015
[11] Gerhard, I. and Runnebaum, B. (1992) The limits of hormone substitution in pollutant exposure and fertility disorders. Zentralblatt für Gyn?kologie, 114, 593-602.
[12] Koninckx, P.R., Braet, P., Kennedy, S.H. and Barlow, D.H. (1994) Dioxin pollution and endometriosis in Belgium. Human Reproduction, 9, 1001-1002.
[13] Eskenazi, B., Mocarelli, P., Warner, M., et al. (2002) Serum dioxin concentrations and endometriosis: A cohort study in Seveso, Italy. Environmental Health Perspectives, 110, 629-634. doi:10.1289/ehp.02110629
[14] Bruner, K.L., Matrisian, L.M., Rodgers, W.H., Gorstein, F. and Osteen, K.G. (1997) Suppression of matrix metalloproteinases inhibits establishment of ectopic lesions by human endometrium in nude mice. The Journal of Clinical Investigation, 99, 2851-2857. doi:10.1172/JCI119478
[15] Cummings, A.M. and Metcalf, J.L. (1995) Effects of estrogen, progesterone, and methoxychlor on surgically induced endometriosis in rats. Fundamental and Applied Toxicology, 27, 287-290. doi:10.1006/faat.1995.1135
[16] Wilson, C.L., Bodnar, J.A., Brown, B.G., Morgan, W.T., Potts, R.J. and Borgerding, M.F. (2008) Assessment of dioxin and dioxin-like compounds in mainstream smoke from selected US cigarette brands and reference cigarettes. Food and Chemical Toxicology, 46, 1721-1733. doi:10.1016/j.fct.2008.01.009
[17] IARC Working Group (1997) The evaluation of carcinogenic risks to humans: Polychlorinated dibenzo-para- dioxins and polychlorinated dibenzofurans. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, 69, 1-631.
[18] Birnbaum, L.S. and Tuomisto, J. (2000) Non-carcinogenic effects of TCDD in animals. Food Additives & Contaminants, 17, 275-288. doi:10.1080/026520300283351
[19] Yonemoto, J. (2000) The effects of dioxin on reproduction and development. Industrial Health, 38, 259-268. doi:10.2486/indhealth.38.259
[20] Lai, Z.W., Pineau, T. and Esser, C. (1996) Identification of dioxin-responsive elements (DREs) in the 5’ regions of putative dioxin-inducible genes. Chemico-Biological Interactions, 100, 97-112. doi:10.1016/0009-2797(96)03691-5
[21] Lai, Z.W., Hundeiker, C., Gleichmann, E. and Esser, C. (1997) Cytokine gene expression during ontogeny in murine thymus on activation of the aryl hydrocarbon receptor by 2,3,7,8-tetrachlorodibenzo-p-dioxin. Molecular Pharmacology, 52, 30-37.
[22] Holladay, S.D. (1999) Prenatal immunotoxicant exposure and postnatal autoimmune disease. Environmental Health Perspectives, 107, 687-691.
[23] Baron, J.A. (1996) Beneficial effects of nicotine and cigarette smoking: The real, the possible and the spurious. British Medical Bulletin, 52, 58-73.
[24] Cramer, D.W., Wilson, E., Stillman, R.J., et al. (1986) The relation of endometriosis to menstrual characteristics, smoking, and exercise. Journal of the American Medical Association, 255, 1904-1908. doi:10.1001/jama.255.14.1904
[25] Darrow, S.L., Vena, J.E., Batt, R.E., Zielezny, M.A., Michalek, A.M. and Selman, S. (1993) Menstrual cycle characteristics and the risk of endometriosis. Epidemiology, 4, 135-142. doi:10.1097/00001648-199303000-00009
[26] Matorras, R., Rodiquez, F., Pijoan, J.I., Ramon, O., De Gutierrez, T.G., Rodriguez-Escudero, F. (1995) Epidemiology of endometriosis in infertile women. Fertility and Sterility, 63, 4-8.
[27] Missmer, S.A., Hankinson, S.E., Spiegelman, D., Barbieri, R.L., Marshall, L.M. and Hunter, D.J. (2004) Incidence of laparoscopically confirmed endometriosis by demographic, anthropometric, and lifestyle factors. American Journal of Epidemiology, 160, 784-796. doi:10.1093/aje/kwh275

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