Bakgrund: Ungefär 200.000 kvinnor i Sverige har endometrios. Endometriumet växer utanför livmodern och utvecklandet av endometrios kan orsakas av retrograd menstruation i kombination med hormonella faktorer, ärftlighet och ett nedsatt lokalt immunförsvar. Vanliga symptom är hög smärta, minskad fertilitet och nedsatt livskvalité. Behandlingen syftar till att uppnå god funktionsnivå med hanterbara symptom. Fysioterapeutiska åtgärder har prioritet 2. Syfte: Att undersöka upplevelsen av fysioterapeutisk behandling vid endometrios ur patienters och fysioterapeuters perspektiv. Metod: Sex semistrukturerade intervjuer genomfördes, tre med endometriospatienter och tre med fysioterapeuter. Datan analyserades genom kvalitativ innehållsanalys. Resultat: Analysprocessen resulterade i fyra huvudkategorier: ”Anpassning utifrån den individuella patienten”, ”Syfte och effekt av behandling”, ”Känsloupplevelser och faktorer som bidrar till drivkraft och hopp” och ”Fysioterapeutens roll”. Den fysioterapeutiska behandlingen upplevdes sätta patientens behov i fokus genom individuell och anpassad behandling. Samstämmigt framkom att behandlingen upplevdes symptomlindra och frambringa skräckblandad förtjusning, men också hopp. Fysioterapeuten upplevdes ge trygghet och hjälp. Konklusion: Fysioterapi vid endometrios kan upplevas vara värdefull för att minska smärta och muskelanspänning samt för att hitta copingstrategier i vardagen. Fysioterapeuten upplevdes kunna få patienterna att känna sig hörda, sedda och hjälpta. / Background: In Sweden approximately 200.000 women have been diagnosed with endometriosis. Endometrial-like tissue is growing outside the uterus. The development of endometriosis could be multifactorial, caused by retrograde menstruation combined with hormonal factors, heredity and a weakened local immune system. Common symptoms are different variations of pain, infertility and decreased quality of life. The purpose of the treatment is to ensure a good level of functioning with manageable symptoms. Physical therapy is highly recommended when treating endometriosis. Purpose: To investigate the experiences of physical therapy treatment in endometriosis according to patients and physiotherapists. Method: Six semi-structured interviews were conducted, of which three were including patients with endometriosis and three were including physiotherapists. The data was analyzed through qualitative content analysis. Results: The analysis resulted in four main categories: “Adaptation based on the individual patient”, “Purpose and effect of the treatment”, “Emotional experiences and factors that contribute to power and hope” and “The role of the physiotherapist”. The physical therapy was perceived as focusing on the patient´s needs. It was unanimously agreed that the treatment reduced symptoms and could engender delight mingled with terror, but also hope. The physical therapy treatment was found to provide safety and assistance. Conclusion: Physical therapy in endometriosis can be experienced as valuable for reducing pain and muscle tension and for providing coping strategies in everyday life. The physiotherapist was found to be able to make the patients feel heard, seen and helped.

Background: Endometriosis is a hormonal reactive syndrome affecting women of reproductive age. The cause of endometriosis is unknown, but known symptoms include dysmenorrhea and infertility. Symptoms can amount to emotional and psychosociological disorders/issues such as depression and isolation which can result in limited ability to work and lead a normal daily life. Aim: To describe women with endometriosis experiences of reception from healthcare professionals. Method: Descriptive literature study. Main Result: The experience of normalization and distrust in symptoms as well as the lack of adequate information and support from healthcare professionals were reoccurring themes in the results of this study. Accounts from the included studies within this thesis portrayed women’s experiences of confusion, anxiety, anger, and frustration as a consequence of perceived unsatisfactory reception from healthcare professionals due to inadequate support and information. Women experienced difficulties in feeling understood and taken seriously by healthcare professionals. However, in cases where women in the aforementioned studies were met with understanding as well as pertinent information and support was appreciation expressed. Conclusion: The results presented in this study concluded that knowledge of endometriosis was perceived as partially inadequate. Regarding reception, it seems of importance that healthcare professionals portray qualities such as empathy and understanding as a reflection of women’s needs occasionally depicted in this study’s results. Studies reviewed in this paper, whose participants described their experiences of reception by healthcare professional in relation to endometriosis, exemplify the importance that healthcare professionals, in addition to the ability to provide good communication, also possess the ability to communicate empathy and understanding towards patients. / Bakgrund: Endometrios är en hormonreaktiv sjukdom som drabbar främst kvinnor i reproduktiv ålder. Dess orsak är okänd men effekter av sjukdomen kan innefatta fysiska symtom såsom dysmenorré, dyspareuni, menorragi och infertilitet. Detta kan ge upphov till emotionella och psykosociala besvär som depression och isolering vilket kan resultera i begränsad förmåga till sysselsättning. Syfte: Att beskriva kvinnor med endometrios erfarenheter och upplevelser av bemötande från vårdpersonal. Metod: Deskriptiv litteraturstudie. Huvudresultat: Genom analys av resultaten av de inkluderade studierna var upplevelser av normalisering, misstro, bristfällig information och stöd hos kvinnor i mötet med vårdpersonal återkommande teman. Kvinnor upplevde att det bristande bemötandet resulterade i känslor såsom förvirring, oro, ilska, och frustration. Kvinnor med endometrios upplevde svårigheter att känna sig förstådd och att symtomen skulle tas på allvar av vårdpersonalen. Hos de deltagande kvinnor som bemötts med förståelse, information, och stöd av vårdpersonal uttrycktes uppskattning för detta. Slutsats: Resultaten i föreliggande litteraturstudie tyder på att kunskapen om sjukdomen inom vården varit delvis upplevts som bristfällig. Gällande bemötande förfaller det utifrån föreliggande litteraturstudies resultat vara betydelsefullt att vårdgivare uppvisar den typ av förståelse och empati som kvinnorna i studien stundvis uttryckt behov av. Alla studier som granskats i detta litteraturstudie vars deltagare själva beskrivit sina erfarenheter av bemötande från vårdpersonal exemplifierar betydelsen av att vårdpersonalen, förutom att vara påläst även besitter förmågan av god kommunikation, empati och förståelse i mötet med patienter med endometrios.

Prior, E och Ratilainen-Malmgren, E. En litteraturstudie om kvinnors erfarenheterav smärta vid endometrios. Examensarbete i omvårdnad 15 högskolepoäng.Malmö universitet: Fakulteten för hälsa och samhälle, Institutionen förvårdvetenskap, 2019.Bakgrund: Endometrios är en gynekologisk sjukdom som drabbar 10 - 15 procentav kvinnorna i världen. Smärta är det mest framträdande symtomet som flerakvinnor tvingas leva med i flera år. Trots att sjukdomen drabbar flera kvinnorsaknas det kunskap om sjukdomen bland sjukvårdspersonal, vilket fördröjerdiagnostisering och behandling.Syfte: Syftet med studien var att belysa kvinnors erfarenheter av smärta videndometrios.Metod: Litteraturstudie baserad på tolv artiklar med kvalitativ ansats. Viastrukturerade databassökningar i PubMed och CINAHL identifierades artiklarsom ansågs vara relevanta i relation till studiens syfte.Resultat: Kvinnornas smärta påverkade alla aspekter av deras liv negativt.Smärtan kontrollerade kvinnornas liv och kroppar. Sjukvårdspersonalensbemötande hade inverkan på hur kvinnorna upplevde och hanterade sin smärta.Konklusion: Kvinnor med endometrios upplever en stor smärtproblematik vilketfår konsekvenser för kvinnornas yrkesliv, sociala relationer och ekonomi.Sjukvårdspersonal tenderar att förminska och normalisera kvinnors smärta vilketleder till att deras vårdbehov inte tillgodoses samt ett minskat förtroende försjukvårdspersonalen. Ökad insikt om smärtans komplexitet och lyhördhet förkvinnornas erfarenheter skapar förutsättningar för sjuksköterskan att bemötakvinnorna och ge god omvårdnad i ett professionellt vårdmöte.Nyckelord: Endometrios, erfarenheter, kvinnor, smärta. / Prior, E och Ratilainen-Malmgren, E. A literature review of women withendometriosis experience of pain. Degree project in nursing 15 Credits. MalmöUniversity: Faculty of Health and Society, Department of Care Science, 2019.Background: Endometriosis is a gynecological disease that affect 10-15 percent ofwomen worldwide. Pain is the most common symptom and many women had tolive with the pain for many years. Despite that the disease affect many women itexists a lack of knowledge amongst healthcare professionals which leads toprolonged diagnose and treatment.Aim: The aim of the study was to illustrate women with endometriosisexperiences of pain.Method: A literature review based on twelve studies with qualitative design.Through structured database searches in CINAHL and PubMed articles relevant tothe aim of the study were identified.Result: The pain affected all aspects of the women´s lives in a negative way. Thewomen felt that the pain controlled their bodies and lives. How the healthcareprofessionals talked and responded to the women had affect on their perception ofpain.Conclusion: Women with endometriosis experience a lot of pain which leads toconsequences in their work, their social relations and their economy.Healthcare professionals tend to minimize and normalize women´s pain whichleads to that their needs of care not are being met and that they lose theirconfidence in healthcare professionals. Gained insight about the complexity of thepain and more sensitivity about the women´s experiences would create a betterenvironment for the nurse to respond to the women and give them proper care in aprofessional care-meeting.Keywords: Endometriosis, experiences, pain, women.

Bakgrund: Endometrios är en kronisk, inflammatorisk och gynekologisk sjukdom däromkring var tionde kvinna i fertil ålder drabbas. Bristande kunskap inom hälso- ochsjukvården resulterar i fördröjd diagnos och behandling. Vanliga symtom videndometrios är smärta, fatigue och blödningar.Syfte: Syftet med studien var att belysa hur kvinnor med endometrios upplever attsjukdomen inverkar på deras vardagliga liv.Metod: En litteraturstudie med kvalitativ ansats. Genom databassökningar i CINAHLoch PubMed identifierades tolv kvalitativa, vetenskapliga artiklar somkvalitetsgranskades med mall för kvalitetsgranskning av studier med kvalitativforskningsmetodik - patientupplevelser utformad av Statens beredning för medicinskoch social utvärdering (SBU). Artiklarna analyserades med innehållsanalys.Resultat: Kvinnor med endometrios upplevde att sjukdomen inverkade negativt påderas vardagliga liv i många avseenden. Analysen resulterade i sex teman:funktionsförmåga; emotionellt mående; socialt liv; intima relationer; arbete, utbildningoch ekonomi; självbild och livsföring. Utöver dessa teman identifierades också tvåsubteman.Konklusion: Stöd, förståelse och bekräftelse av symtom är viktigt för kvinnornashantering av sjukdomen i det vardagliga livet. Okunskap och normalisering avmenstruationssmärtor i både samhället och inom hälso- och sjukvården gör att kvinnormed endometrios upplever ett utanförskap i samhället som kan leda till social isolering.Ökad kunskapsspridning om endometrios behövs inom både hälso- och sjukvården och isamhället för att kvinnorna ska kunna uppleva en bredare acceptans för sin sjukdom ochmötas av förståelse istället för misstro. Att synliggöra hur kvinnor med endometriosupplever att sjukdomen inverkar på deras vardagliga liv ger ökad förståelse för de härkvinnorna vilket är en förutsättning för att sjuksköterskan ska kunna ge personcentreradoch säker vård till den här patientgruppen. Sjuksköterskan kan bidra med information,samverkande åtgärder, stöd och bekräftande vilket kan minska lidande och risken försocial isolering.Nyckelord: Dagligt liv, endometrios, erfarenhet, inverkan, kvinnors hälsa, upplevelse,vardagligt liv. / Background: Endometriosis is a chronic, inflammatory and gynecological disease inwhich about one in ten women of childbearing age suffer. Lack of knowledge in healthcare results in delayed diagnosis and treatment. Common symptoms of endometriosisare pain, fatigue and bleeding.Aim: The aim of this study was to illustrate women’s experiences regarding the impactof endometriosis upon their everyday lives.Method: A literature study with a qualitative approach. Through database searches in CINAHL and PubMed, twelve qualitative, scientific articles were identified and quality-controlled with a template for quality review of studies with qualitative research methodology - patient experiences designed by the Swedish National Board for Medicaland Social Evaluation. The articles were analyzed with content analysis.Result: Women with endometriosis experienced negative impact of the disease:endometriosis affected several aspects of women's everyday lives and the analysisresulted in six themes: functional ability; emotional maturity; social life; intimaterelationships; work, education and economics; self-image and life-management. Twosubthemes were also identified.Conclusion: Support, understanding and confirmation of symptoms are important forwomen in order to cope with the disease in their everyday lives. However, women withendometriosis experience ignorance and normalization of menstrual pain in both societyand in healthcare which leads to alienation which can lead to social isolation. Increasedknowledge about endometriosis is needed in both healthcare and society in general, inorder for women to experience a broader acceptance of their illness and to be met byunderstanding rather than mistrust. Highlighting women’s experiences regarding theimpact of endometriosis upon their everyday lives leads to increased understandingwhich to the nurse is crucial information in order to guarantee a person-centered andsafe healthcare. The nurse can collaborate with other professions in healthcare andprovide information, support and confirmation to these women, which can reduce theirsuffering and risk of social isolation.Keywords: Daily life, endometriosis, everyday life, experience, impact, perception,women’s health.

Bakgrund: Endometrios är en sjukdom som drabbar 10% av alla kvinnor i världen. Endometrios har komplexa symtom och det finns fortfarande stora kunskapsluckor om sjukdomen. Syfte: Att beskriva kvinnors upplevelser av att ha sjukdomen endometrios. Metod: Studien genomfördes som en litteraturstudie med induktiv ansats, och 11 resultatartiklar inkluderades och bearbetades. Resultatartiklarna bearbetades genom att resultaten granskades, sammanställdes och kategorier skapades. Resultat: I resultatet framgick att kvinnor med endometrios upplevde många olika symtom som gav inverkan på flera aspekter av deras liv. Kvinnor upplevde att diagnosen försenades då de inte blev betrodda av hälso- och sjukvården eller av vänner och familj som kunde normalisera deras symtom. Resultatet delades in i fem huvudkategorier: Upplevelser av fysiska, psykiska och emotionella symtom, Upplevelser av mötet med hälso- och sjukvården, Upplevelser av behandlingsformer, Upplevelser av intima relationer och sexualitet och Upplevelser av att inte bli tagen på allvar. Konklusion: Endometrios kan påverka flera dimensioner av kvinnans hälsa och liv. Det är av vikt att sjukvården tillgodoser kvinnans fysiska och psykiska välbefinnande. En ökad medvetenhet om hur sjukdomen påverkar kvinnan och hennes livssituation är väsentligt i ett omvårdnadsperspektiv. / Background: Endometriosis is a disease that affects 10% of all women in the world. Endometriosis generates complex symptoms and there are still substantial knowledge gaps about this disease. Objective: To describe women’s experiences of having the disease endometriosis. Method: The study was conducted as a literature study with an inductive approach, where 11 result articles were used and processed. The articles were processed by reviewing and compiling the results and thereafter categories were created. Results: In the result it appeared that women with endometriosis experienced multiple different symptoms that had impact on numerous aspects of their life. Women experienced a delay in diagnosis due to not being believed by healthcare professionals and family and friends who could normalize their symptoms. The analysis resulted in five main categories: Experiences of physical, psychological and emotional symptoms, Experiences of encounters with healthcare, Experiences of treatment, Experiences of intimate relationships and sexuality and Experiences of not being taken seriously. Conclusion: Endometriosis can impact multiple different aspects of women’s lives. It is of importance that healthcare meets the needs of the women’s psychological and physical well-being. An increased awareness of how the disease affects the woman and her life situation is essential from a nursing perspective.

Endometriosis is a common chronic disease that effects approximately 10–15% of the women in today’s society. However, there is a lack of research that examines if endometriosis produces pathological changes in the skeleton. This thesis addresses the association between the osteological discipline and endometriosis.The primary purpose of this thesis is to test a hypothesis which was created during a previous paper. In order to test the hypothesis, it’s fundamental to analyze female pelvises and to see if endometriosis is detectable in the skeleton and leaves pathological changes in the shape of discoloration. The source material includes 39 female pelvic bones that are available at the medical history museum in Uppsala, Sweden. The collection includes 22 pelvic bones from individuals of Swedish descent and 17 pelvic bones from individuals of diverse foreign descent. This thesis also focuses on mental illness in association with endometriosis among historical women.                                                                                      The analysis of pelvic bones showed that 8 of them had pathological changes in the shape of discoloration. The analysis also demonstrated how women, in today’s- and historical society, was affected mentally and socially. The discussion includes how the skeleton is affected by endometriosis and how osteologist can trace the disease if it isn’t visible in the skeleton. The discussion also includes how historical women was mentally affected by the disease and if we can reach the mental illness through modern women. The study also demonstrates how women was affected economically.Currently, there is not enough research in order to prove the hypothesis about pathological changes in the shape of discoloration. We need more research to further investigate the hypothesis. To continue further investigation of the hypothesis, we need to examine modern patients diagnosed with endometriosis.

No description available.

Grado de magíster en ciencias biológicas, mención inmunología / La endometriosis es una enfermedad inflamatoria benigna que se caracteriza por la presencia y crecimiento de tejido endometrial fuera de la cavidad uterina (ectópico), cuya etiología y fisiopatología permanece aún sin aclarar. Se ha demostrado que el endometrio eutópico de mujeres con endometriosis exhibe alteraciones moleculares, indicando que el defecto primario se encontraría en este tejido. Por otro lado, la desregulación del sistema inmune permite que las células endometriales que han llegado a la cavidad pélvica escapen de la vigilancia inmune, se implanten y proliferen, lo que favorece la formación de las lesiones ectópicas endometriales. Las células Natural Killer (NK) son linfocitos que participan en la inmunovigilancia y poseen un receptor de activación denominado NKG2D, el cual interactúa con diferentes ligandos (NKG2DL) expresados por células bajo estrés celular. Las interleuquinas (IL)-10 e IL-12 juegan un rol importante en la función inmunoreguladora, la cual involucra a macrófagos, linfocitos T y NK. Los niveles de NKG2DL, IL-10 e IL-12 en células endometriales del endometrio eutópico de mujeres con endometriosis no han sido estudiados hasta la fecha. Por lo tanto, en este trabajo, propusimos la siguiente hipótesis: “Durante el ciclo menstrual, en el endometrio eutópico de mujeres con endometriosis, los niveles de los ligandos del receptor NKG2D, activadores de las células Natural Killer (NK), se encuentran disminuidos, así como las citoquinas IL-10 e IL-12, lo que contribuye a la alterada respuesta inmunológica descrita en esta patología”. Para ello, se caracterizaron los niveles transcripcionales y la presencia de los ligandos MICA, MICB, ULBP-1, ULBP-2 y ULBP-3 y de IL-10 e IL-12 en el endometrio eutópico de mujeres con y sin endometriosis durante el V ciclo menstrual, así como se evaluó el efecto del estradiol y prostaglandina E2 en células endometriales aisladas de pacientes y controles, simulando el microambiente estrogénico e inflamatorio descrito en el endometrio de las pacientes con endometriosis. Se evaluaron los niveles de mRNA por RT-PCR y los niveles proteicos por inmunohistoquímica (IHQ) y citometría de flujo. Se detectó la expresión de todos los NKG2DL estudiados, tanto al nivel de mRNA como proteico, en ambos grupos de endometrios durante el ciclo menstrual, encontrándose que los niveles de MICA aumentaron en la fase secretora media y tardía en el grupo control, pero su expresión no presentó diferencia significativa durante el ciclo menstrual de las pacientes. En contraste, la expresión de MICB aumentó en la fase secretora inicial, disminuyendo fuertemente al final del ciclo en las mujeres con endometriosis. Los niveles de mRNA de ULBP-3 fueron significativamente mayores en el endometrio eutópico de las pacientes comparado al grupo control durante la fase secretora media, mientras que los niveles de ULBP-2 aumentaron gradualmente hacia las etapas finales del ciclo menstrual en ambos grupos, y los niveles de ULBP-1 no se modificaron durante el ciclo menstrual. Muy bajos niveles de mRNA de IL-12p40 fueron detectados en el endometrio control durante el ciclo menstrual, a diferencia del endometrio de fase secretora media de endometriosis, cuyos niveles fueron significativamente mayores que el grupo control. Por el contrario, la proteína IL-12 fue localizada en forma focal, aumentando su presencia solamente en el endometrio control secretor tardío. En forma similar, los niveles de la proteína IL-10 aumentaron significativamente en el compartimiento estromal control de la fase secretora tardía, y disminuyó en endometriosis en comparación al grupo control. En células VI epiteliales aisladas de ambos grupos, se detectaron, al nivel proteico y transcripcional, los NKG2DL estudiados, encontrándose disminuidos en endometriosis comparados al grupo control. La presencia de estradiol y/o prostaglandina no modificó el nivel de mRNA de ningún ligando estudiado. En síntesis, hemos caracterizado, por primera vez, la expresión de los NKG2DL MICA, MICB, ULBP-1, ULBP-2 y ULBP-3 en el endometrio normal y patológico durante el ciclo menstrual. El aumento sostenido de los niveles de MICA y ULBP-2 hacia la fase secretora tardía sugiere una mayor activación de células NK en el tejido pre-menstrual normal que coincide con una reducida expresión de MICB en endometriosis. Por otro lado, la expresión diferencial de ULBP-3 e IL-12 en los endometrios secretores de endometriosis, además de la fuerte disminución en la expresión de IL-10 en la fase secretora tardía, podrían estar favoreciendo la implantación ectópica de los debris endometriales que arriban a la cavidad pélvica. Estos resultados sugieren que los ligandos del receptor NKG2D, principalmente MICA y ULBP-2, como también IL-10 e IL-12, jugarían un papel importante en las etapas finales del ciclo menstrual, período en que el endometrio experimenta una exhaustiva remodelación, preparándose para la acogida embrionaria o, en su defecto, para su eliminación a través de la menstruación. Las diferencias observadas en el endometrio de mujeres con endometriosis podrían explicar, al menos en parte, la infertilidad, como también la capacidad del tejido menstrual de escapar a la inmunovigilancia, como ha sido descrito en estas pacientes. / Endometriosis is a benign inflammatory disease characterized by the presence and growth of endometrial tissue outside the uterus (ectopic), whose etiology and pathophysiology still remains unclear. It has been shown that the eutopic endometrium of women with endometriosis exhibits molecular alterations, indicating that the primary defect would be present in this tissue. On the other hand, deregulation of the immune system allows the endometrial cells that have reached the pelvic cavity to escape immune surveillance, which favors their implantation and proliferation, resulting in ectopic endometrial lesions. Natural Killer (NK) cells are innate lymphocytes that participate in immune surveillance. They express the activating receptor NKG2D, which interacts with different ligands (NKG2DL) on nucleated cells under cell stress. Interleukin (IL)-10 and IL-12 play a role in the immune regulatory function involving macrophages, T lymphocytes and NK cells. To date, the levels of NKG2DL, IL-10 and IL-12 on endometrial cells of the eutopic endometrium of women with endometriosis have not been described. Therefore, here we proposed the following hypothesis: "During the menstrual cycle, in the eutopic endometrium of women with endometriosis, the ligands of the NKG2D receptor, which activate natural killer (NK) cells, are decreased, as well as the cytokines IL-12 and IL-10, which contribute to the altered immune response described in this pathology". For this purpose, the transcriptional levels and the presence of MICA, MICB, ULBP-1, ULBP-2 and ULBP-3 ligands and IL-10 and IL-12 were characterized in the eutopic endometrium of women with and without endometriosis during the menstrual cycle. We also evaluated the effect of estradiol and prostaglandin E2 in isolated endometrial cells from patients and controls, simulating the estrogenic and inflammatory microenvironment described in the endometrium of patients with endometriosis. The mRNA levels were evaluated by RT-PCR and the presence of proteins was assessed by immunohistochemistry (IHC) and flow cytometry. Both, mRNA and protein of all NKG2DL studied were detected in both groups of endometria during the menstrual cycle. MICA levels increased in the mid and the late secretory phases only in the endometrium of control individuals, although its expression did not show significant difference during all phases of the menstrual cycle in patients with endometriosis. In contrast, MICB expression increased in the early secretory phase and fell sharply in the late secretory phase only in the endometrium of women with endometriosis. The mRNA levels of ULBP-3 were significantly higher in the eutopic endometrium from patients compared to controls during the mid-secretory phase. In addition the mRNA levels of ULBP-2 gradually increased towards the end of the menstrual cycle, while ULBP-1 did not change during the menstrual cycle in both groups of individuals. Very low levels of IL-12p40 mRNA were detected in the control endometrium during the menstrual cycle, which differed from the mid secretory phase in the endometrium of women with endometriosis, which presented significantly higher IL-12p40 messenger levels than the control group. In contrast, IL-12 protein levels were focally localized in the endometrial tissue, and its expression increased significantly only in the late secretory control endometrium. Similarly, the IL-10 protein increased significantly in the late secretory phase in the control stromal and epithelial compartments, whereas its levels reduced significantly in endometriosis compared to the control group in the same menstrual cycle phase and tissue compartments. IL-10 mRNA levels were not detected in any endometrium. We detected the expression of all NKG2DL studied both, at the mRNA and protein levels, in epithelial cells isolated from the endometrium of both groups However, the transcripts and protein levels of these ligands were decreased in endometriosis compared to the control group. The presence of estradiol and/or prostaglandin did not affect the level of mRNA of any ligand studied. In summary, we have characterized, for the first time, the expression of the NKG2DL MICA, MICB, ULBP-1, ULBP-2 and ULBP-3 in normal and pathological endometrium during the menstrual cycle. The sustained increase in MICA and ULBP-2 expression towards the late secretory phase suggests a greater activation of NK cells in the healthy premenstrual tissue, which coincides with a reduced expression of MICB in endometriosis. On the other hand, the differential expression of ULBP-3 and IL-12 observed in the secretory endometrium of women with endometriosis, in addition to the sharp decline in IL-10 expression observed in the late secretory phase in these patients, may favor the ectopic implantation of endometrial debris that reach the pelvic cavity. These results suggest that NKG2D receptor ligands, mainly MICA and ULBP-2, as well as IL-10 and IL-12 play an important role in the final stages of the menstrual cycle, during which the endometrium undergoes extensive remodeling preparing for embryo implantation or otherwise for disposal through menstruation. The results obtained herein in relation to the endometrium of women with endometriosis may partially explain infertility, as well as the ability of the menstrual tissue to escape immune surveillance, as described in these patients.

Introduction: The main goal of our work was to compare the diagnostic accuracy of ultrasound examination and magnetic resonance imaging (MRI) in the assessment of deep endometriosis in the pelvis. Our second aim was to establish a learning curve of a sonographer and a radiologists (non-experts). As an introduction to the subject we have published 3 reviews on the diagnosis and one narrative review on the classification systems in the evaluation of endometriosis has been submitted for publication. Methodology: Reviews were written as narrative reviews based on PubMed search and scientific societies recommendations. We have offered participation to all patients in the endometriosis centre with high suspicion of deep endometriosis, who then underwent examination by ultrasound and MRI by expert and non-expert before their surgical treatment, all findings described according to the consensus IDEA (international Deep Endometriosis Analysis group, 2016). Surgical and histological findings were used as a reference standard. Learning curve was defined as an improvement in accuracy in three blocks, into which the patients were assigned in the chronological order. Results of the scientific studies: From 07/2016 to 02/2018 the participation was offered to 111 patients, 51 underwent both imaging examinations...

Bakgrund: Endometrios är en kronisk, inflammatorisk sjukdom som drabbar var tionde kvinna i fertil ålder, världen över. Patogenesen är inte helt klarlagd. Sjukdomens symtom, däribland dysmenorré, dyspareuni och nedsatt fertilitet kan påverka kvinnan livet ut.  Syfte: Att beskriva kvinnors erfarenheter av att leva med endometrios.  Metod: Examensarbetet är en sammanställning av åtta empiriska, kvalitativa artiklar. Artiklarna hittades i tre databaser, Cinahl, PubMed och Scopus. Analysen utfördes enligt Fribergs femstegsmodell. Resultat: Litteraturöversiktens resultat presenteras i tre teman, ‘Lära sig leva med smärta’, ‘Hantera att ensam måste vara stark’ och ‘Acceptera att framtiden är oviss’. Under dessa återfanns sex subteman.  Konklusion: Endometrios har en stor inverkan på livet varför ytterligare forskning för att öka kunskapen om sjukdomen är av stor vikt. Sjuksköterskans kan med sin omvårdnadskompetens spela en central roll i vården för denna patientgrupp genom att vara uppmärksam på symtomen och ha insikt om hur sjukdomen påverkar den som drabbas. / Background: Endometriosis is a chronic, inflammatory disease that affects 10% of all fertile women worldwide. The pathogenesis is not fully understood. The symptoms of the disease, including dysmenorrhea, dyspareunia and reduced fertility, can affect women for life. Aim: The aim of this study was to describe women’s experience of living with endometriosis.  Methods: This study was based on eight empirical, qualitative articles. The articles were found in three databases, Cinahl, PubMed and Scopus. The analysis was conducted by the five step model of Friberg.  Results: The result of the study is presented in three themes and six subthemes. The themes are: ‘Learn to live with pain’, ‘Learning that being alone, one has to be strong’ and ‘Accepting the uncertainty of the future’.  Conclusion: Endometriosis has a major impact on life, which is why further research to increase knowledge about the disease is very important. With their nursing competence, the nurse can play a central role in the care of this patient group, by being aware of the symptoms and having insight into how the disease affects them.