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Article ; Online: Early Fetal Growth Restriction with or Without Hypertensive Disorders: a Clinical Overview.

Mecacci, Federico / Romani, Eleonora / Clemenza, Sara / Zullino, Sara / Avagliano, Laura / Petraglia, Felice

Reproductive sciences (Thousand Oaks, Calif.)

2023 Volume 31, Issue 3, Page(s) 591–602

Abstract: Early onset fetal growth restriction (FGR) is one of the main adverse pregnancy conditions, often associated with poor neonatal outcomes. Frequently, early onset FGR is associated with early onset hypertensive disorders of pregnancy (HDP), and in ... ...

Abstract	Early onset fetal growth restriction (FGR) is one of the main adverse pregnancy conditions, often associated with poor neonatal outcomes. Frequently, early onset FGR is associated with early onset hypertensive disorders of pregnancy (HDP), and in particular preeclampsia (PE). However, to date, it is still an open question whether pregnancies complicated by early FGR plus HDP (FGR-HDP) and those complicated by early onset FGR without HDP (normotensive-FGR (n-FGR)) show different prenatal and postnatal outcomes and, consequently, should benefit from different management and long-term follow-up. Recent data support the hypothesis that the presence of PE may have an additional impact on maternal hemodynamic impairment and placental lesions, increasing the risk of poor neonatal outcomes in pregnancy affected by early onset FGR-HDP compared to pregnancy affected by early onset n-FGR. This review aims to elucidate this poor studied topic, comparing the clinical characteristics, perinatal outcomes, and potential long-term sequelae of early onset FGR-HDP and early onset n-FGR.
MeSH term(s)	Infant, Newborn ; Pregnancy ; Female ; Humans ; Fetal Growth Retardation/etiology ; Placenta/pathology ; Hypertension, Pregnancy-Induced/diagnosis ; Hypertension, Pregnancy-Induced/pathology ; Pre-Eclampsia/pathology ; Pregnancy Complications/pathology
Language	English
Publishing date	2023-09-08
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2276411-2
ISSN	1933-7205 ; 1933-7191
ISSN (online)	1933-7205
ISSN	1933-7191
DOI	10.1007/s43032-023-01330-9
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Article ; Online: Hormonal treatments for endometriosis: The endocrine background.

Vannuccini, Silvia / Clemenza, Sara / Rossi, Margherita / Petraglia, Felice

Reviews in endocrine & metabolic disorders

2021 Volume 23, Issue 3, Page(s) 333–355

Abstract: Endometriosis is a benign uterine disorder characterized by menstrual pain and infertility, deeply affecting women's health. It is a chronic disease and requires a long term management. Hormonal drugs are currently the most used for the medical treatment ...

Abstract	Endometriosis is a benign uterine disorder characterized by menstrual pain and infertility, deeply affecting women's health. It is a chronic disease and requires a long term management. Hormonal drugs are currently the most used for the medical treatment and are based on the endocrine pathogenetic aspects. Estrogen-dependency and progesterone-resistance are the key events which cause the ectopic implantation of endometrial cells, decreasing apoptosis and increasing oxidative stress, inflammation and neuroangiogenesis. Endometriotic cells express AMH, TGF-related growth factors (inhibin, activin, follistatin) CRH and stress related peptides. Endocrine and inflammatory changes explain pain and infertility, and the systemic comorbidities described in these patients, such as autoimmune (thyroiditis, arthritis, allergies), inflammatory (gastrointestinal/urinary diseases) and mental health disorders.The hormonal treatment of endometriosis aims to block of menstruation through an inhibition of hypothalamus-pituitary-ovary axis or by causing a pseudodecidualization with consequent amenorrhea, impairing the progression of endometriotic implants. GnRH agonists and antagonists are effective on endometriosis by acting on pituitary-ovarian function. Progestins are mostly used for long term treatments (dienogest, NETA, MPA) and act on multiple sites of action. Combined oral contraceptives are also used for reducing endometriosis symptoms by inhibiting ovarian function. Clinical trials are currently going on selective progesterone receptor modulators, selective estrogen receptor modulators and aromatase inhibitors. Nowadays, all these hormonal drugs are considered the first-line treatment for women with endometriosis to improve their symptoms, to postpone surgery or to prevent post-surgical disease recurrence. This review aims to provide a comprehensive state-of-the-art on the current and future hormonal treatments for endometriosis, exploring the endocrine background of the disease.
MeSH term(s)	Aromatase Inhibitors/therapeutic use ; Endometriosis/drug therapy ; Endometrium ; Female ; Humans ; Infertility/drug therapy ; Uterine Diseases/drug therapy
Chemical Substances	Aromatase Inhibitors
Language	English
Publishing date	2021-08-17
Publishing country	Germany
Document type	Journal Article ; Review ; Research Support, Non-U.S. Gov't
ZDB-ID	2185718-0
ISSN	1573-2606 ; 1389-9155
ISSN (online)	1573-2606
ISSN	1389-9155
DOI	10.1007/s11154-021-09666-w
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Article ; Online: Low Molecular Weight Heparins (LMWH) and Implications along Pregnancy: a Focus on the Placenta.

Zullino, Sara / Clemenza, Sara / Mecacci, Federico / Petraglia, Felice

Reproductive sciences (Thousand Oaks, Calif.)

2021 Volume 29, Issue 5, Page(s) 1414–1423

Abstract: Low molecular weight heparins (LMWH) have been largely studied for their use during pregnancy. The biology and the pharmacology of these molecules are well known and may be summarized in three main mechanisms of action: anti-coagulant, anti-inflammatory, ...

Abstract	Low molecular weight heparins (LMWH) have been largely studied for their use during pregnancy. The biology and the pharmacology of these molecules are well known and may be summarized in three main mechanisms of action: anti-coagulant, anti-inflammatory, and immunomodulant. The clinical implications of these drugs during pregnancy are mainly related to their action on the placenta, because of the presence of specific molecular and cellular targets, particularly at the trophoblast-endometrial interface. As well as for the prevention and treatment of thromboembolism, LMWH have been largely investigated for the improvement of embryo implantation and for the prevention of placenta-related complications such as preeclampsia, fetal growth restriction, and intrauterine fetal death. However, data on this topic are still unclear. The present review discusses the biological features, the mechanisms of action, and the possible contribution of LMWH to the success of placentation along pregnancy, pointing out the need for future basic science and clinical researches in this important field with the final aim to improve clinical practice in high-risk pregnancies.
MeSH term(s)	Female ; Heparin, Low-Molecular-Weight/therapeutic use ; Humans ; Placenta ; Placentation ; Pre-Eclampsia/drug therapy ; Pregnancy ; Trophoblasts
Chemical Substances	Heparin, Low-Molecular-Weight
Language	English
Publishing date	2021-07-06
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2276411-2
ISSN	1933-7205 ; 1933-7191
ISSN (online)	1933-7205
ISSN	1933-7191
DOI	10.1007/s43032-021-00678-0
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Article ; Online: Progesterone receptor ligands for the treatment of endometriosis.

Clemenza, Sara / Capezzuoli, Tommaso / Eren, Ecem / Garcia Garcia, Jose M / Vannuccini, Silvia / Petraglia, Felice

Minerva obstetrics and gynecology

2022 Volume 75, Issue 3, Page(s) 288–297

Abstract: Estrogen dependence and progesterone resistance play a crucial role in the origin and development of endometriosis. Therefore, hormonal therapies are currently the most effective treatment. Progestins are considered the first-line approach, especially ... ...

Abstract	Estrogen dependence and progesterone resistance play a crucial role in the origin and development of endometriosis. Therefore, hormonal therapies are currently the most effective treatment. Progestins are considered the first-line approach, especially for a long-term management. Progestins are synthetic compounds that mimic the effects of progesterone by binding progesterone receptors. Continuous use of progestins leads to the suppression of ovarian steroidogenesis with anovulation and low serum levels of ovarian steroids, causing endometrial pseudodecidualization. Moreover, they act by interfering on several endometriosis pathogenetic pathways, decreasing inflammation, provoking apoptosis in endometriotic cells, stimulating atrophy or regression of endometrial lesions, inhibiting angiogenesis, and decreasing expression of metalloproteinases, thus diminishing the invasiveness of endometriotic implants. Progestins are effective for pain relief and improvement of the quality of life (QoL). The side effects are limited, and the compounds are available in different formulations and routes of administration and represent, in most cases, an inexpensive treatment option. Dienogest, Medroxyprogesterone acetate and Norethisterone acetate are the labeled progestins for endometriosis, but other progestins, such as Dyhidrogesterone, Levonorgestrel and Desogestrel, have been shown to be effective in the treatment of endometriosis-associated pain. The present review aims to describe the available and emerging evidences on progestins used for the treatment of endometriosis.
MeSH term(s)	Female ; Humans ; Progestins/therapeutic use ; Progestins/pharmacology ; Endometriosis/drug therapy ; Endometriosis/pathology ; Receptors, Progesterone/metabolism ; Quality of Life ; Ligands ; Pain/chemically induced ; Pain/drug therapy
Chemical Substances	Progestins ; Receptors, Progesterone ; Ligands
Language	English
Publishing date	2022-10-18
Publishing country	Italy
Document type	Review ; Journal Article
ZDB-ID	3062815-5
ISSN	2724-6450
ISSN (online)	2724-6450
DOI	10.23736/S2724-606X.22.05157-0
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Article ; Online: Does chronic low molecular weight heparins use during pregnancy increase the risk of postpartum hemorrhage?

Huri, Mor / Zullino, Sara / Marinelli, Laura / Clemenza, Sara / Petraglia, Felice / Mecacci, Federico

Thrombosis research

2022 Volume 222, Page(s) 12–15

MeSH term(s)	Pregnancy ; Female ; Humans ; Postpartum Hemorrhage ; Heparin, Low-Molecular-Weight/adverse effects ; Risk Factors
Chemical Substances	Heparin, Low-Molecular-Weight
Language	English
Publishing date	2022-12-18
Publishing country	United States
Document type	Letter
ZDB-ID	121852-9
ISSN	1879-2472 ; 0049-3848
ISSN (online)	1879-2472
ISSN	0049-3848
DOI	10.1016/j.thromres.2022.12.009
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Article ; Online: Uterine Fibroids, Perceived Stress, and Menstrual Distress: a Key Role of Heavy Menstrual Bleeding.

Vannuccini, Silvia / Clemenza, Sara / Cassioli, Emanuele / Rossi, Eleonora / Castellini, Giovanni / Ricca, Valdo / Petraglia, Felice

Reproductive sciences (Thousand Oaks, Calif.)

2022 Volume 30, Issue 5, Page(s) 1608–1615

Abstract: Uterine fibroids (UFs) are the most common benign tumors in women of reproductive age, frequently associated with pain symptoms and heavy menstrual bleeding (HMB), leading to impaired quality of life. Thus, the aim of the study was to evaluate the global ...

Abstract	Uterine fibroids (UFs) are the most common benign tumors in women of reproductive age, frequently associated with pain symptoms and heavy menstrual bleeding (HMB), leading to impaired quality of life. Thus, the aim of the study was to evaluate the global perception of stress and the menstrual distress in patients with UFs. A cross-sectional observational study was conducted on a group (n = 69) of fertile age women with UFs compared to age-matched controls, by administering two questionnaires: the perceived stress scale (PSS) and the Menstrual Distress Questionnaire (MEDI-Q). The PSS, MEDI-Q Total Score and 3 subscales-menstrual symptoms (MS), menstrual symptoms distress (MSD), and menstrual specificity index (MESI)-were evaluated. Patients with UFs showed higher PSS than controls (18.5 ± 5.0 vs. 13.8 ± 5.0, p < 0.001) and PSS values were very high in those with HMB, severe dysmenorrhea, and impaired social and working life. Patients with UFs also showed significantly higher score for MEDI-Q Total Score (16.51 ± 12.99 vs. 10.86 ± 12.36) (p < 0.01) as well as for the subscales MSD (2.54 ± 1.07 vs. 1.57 ± 0.98) (p < 0.001) and MESI (0.76 ± 0.30 vs 0.60 ± 0.39) (p < 0.05). The menstrual distress was associated to being uncomfortable about uterine bleeding; in fact, MEDI-Q Total Score was significantly higher in women with HMB compared to those with moderate/normal bleeding. UF characteristics (number, type, and size) did not correlate with perceived stress or menstrual distress. In conclusion, women with UFs have significantly higher levels of perceived stress and menstrual distress than controls and HMB plays a major role in determining such conditions.
MeSH term(s)	Female ; Humans ; Menorrhagia/complications ; Quality of Life ; Cross-Sectional Studies ; Leiomyoma/complications ; Leiomyoma/diagnosis ; Stress, Psychological/complications
Language	English
Publishing date	2022-12-05
Publishing country	United States
Document type	Observational Study ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2276411-2
ISSN	1933-7205 ; 1933-7191
ISSN (online)	1933-7205
ISSN	1933-7191
DOI	10.1007/s43032-022-01126-3
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Article ; Online: Dysmenorrhea and Heavy Menstrual Bleeding in Elite Female Athletes: Quality of Life and Perceived Stress.

Vannuccini, Silvia / Fondelli, Flavia / Clemenza, Sara / Galanti, Giorgio / Petraglia, Felice

Reproductive sciences (Thousand Oaks, Calif.)

2020 Volume 27, Issue 3, Page(s) 888–894

Abstract: In female athletes, the incidence of menstrual disorders is variable, and their impact on perceived stress and quality of life (QoL) is poorly known.The aim of the present study was to investigate the menstrual cycle characteristics and disorders in ... ...

Abstract	In female athletes, the incidence of menstrual disorders is variable, and their impact on perceived stress and quality of life (QoL) is poorly known.The aim of the present study was to investigate the menstrual cycle characteristics and disorders in athletes performing different sports, also evaluating perceived stress and QoL according to their menstrual cycle features. A cross-sectional survey was conducted in nulliparous elite athletes of reproductive age, and the study population included 112 cases. Three questionnaires were administered on (1) gynecological health, (2) perceived stress scale (PSS), and (3) short form QoL (SF-12). A group of women not practising regular sport activities (n = 103) was used as control. Data obtained in elite athletes were also analyzed according to the static and dynamic component percentage of practised sports in 3 sub-groups. Athletes had a significantly higher incidence of irregular periods and heavy menstrual bleeding (HMB) (p < 0.01) and a lower incidence of dysmenorrhea (p < 0.01) than controls. Furthermore, athletes had a better physical QoL (53.9 ± 5.9 vs 51.2 ± 6.0) (p < 0.05) but higher PPS level (17.3 ± 4.8 vs 13.8 ± 4.8) and a worse mental QoL (44.9 ± 9.9 vs 47.6 ± 9.0) (p < 0.05) than controls. HMB was associated with lower mental scores (39.7 ± .8.9 vs 45.6 ± 9.9) and higher PSS scores (19.8 ± .3.2 vs 17.0 ± .4.9) than those observed in athletes with normal bleeding. No difference was found in different sports regarding gynecological health, PSS level, and QoL. An increased incidence of HMB should be considered in elite athletes with increased PSS and impaired QoL.
MeSH term(s)	Adolescent ; Athletes/psychology ; Cross-Sectional Studies ; Dysmenorrhea/complications ; Dysmenorrhea/epidemiology ; Dysmenorrhea/psychology ; Female ; Humans ; Menorrhagia/complications ; Menorrhagia/epidemiology ; Menorrhagia/psychology ; Menstrual Cycle ; Quality of Life ; Stress, Psychological/complications ; Stress, Psychological/psychology ; Surveys and Questionnaires ; Women's Health ; Young Adult
Language	English
Publishing date	2020-01-06
Publishing country	United States
Document type	Journal Article
ZDB-ID	2276411-2
ISSN	1933-7205 ; 1933-7191
ISSN (online)	1933-7205
ISSN	1933-7191
DOI	10.1007/s43032-019-00092-7
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Article ; Online: Is primary dysmenorrhea a precursor of future endometriosis development?

Clemenza, Sara / Vannuccini, Silvia / Capezzuoli, Tommaso / Meleca, Chiara Immacolata / Pampaloni, Francesca / Petraglia, Felice

Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology

2021 Volume 37, Issue 4, Page(s) 287–293

Abstract: Primary dysmenorrhea (PD) is the most common gynecologic disorder during adolescence and it is characterized by crampy lower abdominal pain that occurs during menstruation. Secondary dysmenorrhea, in contrast, has the same clinical features but occurs in ...

Abstract	Primary dysmenorrhea (PD) is the most common gynecologic disorder during adolescence and it is characterized by crampy lower abdominal pain that occurs during menstruation. Secondary dysmenorrhea, in contrast, has the same clinical features but occurs in women with a disease that could account for their symptoms (endometriosis, adenomyosis, uterine fibroids, pelvic inflammatory disease). Endometriosis is the most common cause of secondary dysmenorrhea and it should be considered in patients with persistent and clinically significant dysmenorrhea despite treatment. It is often diagnosed after a long delay, increasing the likelihood of pain chronicity and fertility problems at a later age. Women who suffer from dysmenorrhea in adolescence have higher risk of endometriosis in future. The open question is if endometriosis was already present at the onset of dysmenorrhea but undiagnosed or if PD favors subsequent development of endometriosis-associated pain. Since PD is associated with higher risk for developing chronic pain state and shares some of the same pain pathways of endometriosis (prostaglandins overproduction, inflammation, peripheral sensitization, central sensitization and abnormal stress responses), a correlation between PD and endometriosis is suggested. To know whether it is a risk factor for the development of endometriosis-associated pain may provide an opportunity for early intervention and prevention. The present review aims to investigate the clinical and pathogenetic features of PD and endometriosis in order to identify a possible association between the two conditions.
MeSH term(s)	Contraceptives, Oral, Combined/therapeutic use ; Dysmenorrhea/immunology ; Dysmenorrhea/physiopathology ; Endometriosis/immunology ; Endometriosis/physiopathology ; Female ; Humans ; Inflammation/immunology ; Inflammation/physiopathology ; Pelvic Pain/immunology ; Pelvic Pain/physiopathology ; Risk Factors
Chemical Substances	Contraceptives, Oral, Combined
Language	English
Publishing date	2021-02-11
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	639237-4
ISSN	1473-0766 ; 0951-3590
ISSN (online)	1473-0766
ISSN	0951-3590
DOI	10.1080/09513590.2021.1878134
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Zs.A 2284: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MO 608: Show issues

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Article ; Online: Long-term treatment of endometriosis-related pain among women seeking hormonal contraception.

Vannuccini, Silvia / Biagiotti, Chiara / Esposto, Maria Celeste / La Torre, Francesco / Clemenza, Sara / Orlandi, Gretha / Capezzuoli, Tommaso / Petraglia, Felice

Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology

2022 Volume 38, Issue 5, Page(s) 398–402

Abstract: Objective: To evaluate the different effects of a progestin-only contraceptive with desogestrel (DSG) vs combined oral contraceptives (COCs) for a first line long-term treatment of endometriosis-related pain among patients seeking hormonal contraception. ...

Abstract	Objective: To evaluate the different effects of a progestin-only contraceptive with desogestrel (DSG) vs combined oral contraceptives (COCs) for a first line long-term treatment of endometriosis-related pain among patients seeking hormonal contraception. Methods: An observational retrospective cohort study was conducted in collaboration with a local outpatient clinic for endometriosis among a group of nulliparous young women ( Results: No significant difference was found between the two groups in terms of clinical characteristics and pain scores before treatment. After 6 months both treatments were effective in reducing endometriosis-related pain, and those treated with DSG showed lower levels of dysmenorrhea, dyspareunia and nonmenstrual pelvic pain than COCs group ( Conclusions: A progestin-only contraceptive with DSG is a valid option for long term management of endometriosis-related pain in patients seeking hormonal contraception.
MeSH term(s)	Contraception ; Contraceptives, Oral, Combined/adverse effects ; Desogestrel/adverse effects ; Endometriosis/complications ; Endometriosis/drug therapy ; Ethinyl Estradiol/therapeutic use ; Female ; Hormonal Contraception ; Humans ; Male ; Pelvic Pain/drug therapy ; Pelvic Pain/etiology ; Progesterone Congeners ; Progestins/therapeutic use ; Retrospective Studies
Chemical Substances	Contraceptives, Oral, Combined ; Progesterone Congeners ; Progestins ; Ethinyl Estradiol (423D2T571U) ; Desogestrel (81K9V7M3A3)
Language	English
Publishing date	2022-03-03
Publishing country	England
Document type	Journal Article ; Observational Study
ZDB-ID	639237-4
ISSN	1473-0766 ; 0951-3590
ISSN (online)	1473-0766
ISSN	0951-3590
DOI	10.1080/09513590.2022.2047172
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Article: Undifferentiated Connective Tissue Disease in Pregnancy: A Topic Yet to be Explored.

Serena, Caterina / Clemenza, Sara / Simeone, Serena / Zullino, Sara / Ottanelli, Serena / Rambaldi, Marianna Pina / Vannuccini, Silvia / Petraglia, Felice / Mecacci, Federico

Frontiers in pharmacology

2022 Volume 13, Page(s) 820760

Abstract: Undifferentiated connective tissue disease (UCTD) is characterized by signs and symptoms suggestive of a connective tissue disease (CTD), but not fulfilling criteria for a specific CTD. Although UCTD is probably the most common rheumatic disease ... ...

Abstract	Undifferentiated connective tissue disease (UCTD) is characterized by signs and symptoms suggestive of a connective tissue disease (CTD), but not fulfilling criteria for a specific CTD. Although UCTD is probably the most common rheumatic disease diagnosed in pregnant women, data about disease course during pregnancy and perinatal outcomes are very limited. Compared to other CTDs, UCTD seems to have milder clinical manifestations in pregnancy. Its natural history is related to disease activity at conception. In fact, if the disease is in a state of remission or minimal activity at conception, pregnancy outcomes are generally good. On the contrary, patients who become pregnant in a moment of high disease activity and/or who have multiple antibodies positivity show an increased risk of disease flares, evolution to a definite CTD and obstetric complications, such as fetal growth restriction, preeclampsia and preterm birth. Therefore, a preconception assessment is essential in women with UCTD to evaluate maternal and fetal risks, to initiate interventions to optimize disease activity, and to adjust medications to those that are least harmful to the fetus. The aim of the present study was to review the available literature about pregnancy course, maternal and fetal outcomes and therapeutic approaches of pregnant women with UCTD.
Language	English
Publishing date	2022-01-20
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2587355-6
ISSN	1663-9812
ISSN	1663-9812
DOI	10.3389/fphar.2022.820760
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