{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T16:59:40Z","timestamp":1776099580087,"version":"3.50.1"},"reference-count":18,"publisher":"S. Karger AG","license":[{"start":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T00:00:00Z","timestamp":1773187200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/karger.com\/pages\/terms-and-conditions"},{"start":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T00:00:00Z","timestamp":1773187200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/karger.com\/pages\/terms-and-conditions"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Gynecol Obstet Invest"],"abstract":"<jats:p>Objectives: The objective of this study was to evaluate whether ultrasound-based #Enzian classification predicts pain profiles and response to hormonal therapy in patients with endometriosis. Endometriosis is a chronic inflammatory disease affecting 10% of reproductive-age women, often causing debilitating pelvic pain. Although #Enzian is validated for surgical planning, its predictive role in medical therapy remains unexplored. Design: A retrospective cohort study, including 89 premenopausal patients referred between 2018 and 2023, was conducted. Hormonal therapies included progestin-only pills (dienogest \u2013 POP-D or other progestins \u2013 POP-O), combined estrogen-progestin pills (dienogest \u2013 EP-D or other EP-O), or norethisterone acetate. Pain was assessed via a 0\u201310 VAS at baseline, \u22653 months, and \u22656 months. Participants\/Materials, Setting, Methods: Patients had ultrasound-confirmed endometriosis and were hormone therapy-na\u00efve for \u22656 months. Baseline evaluation included demographic data, reproductive history, prior surgeries, and six pain domains. #Enzian classification mapped lesion location and size (A: rectovaginal\/vagina; B: uterosacral\/parametria; C: rectum; FA: adenomyosis; FB: bladder; FU: ureter; FI: intestine above rectum; FO: extra pelvic; O: ovary; P: peritoneum; T: fallopian tubes\/adhesions). Linear regression and linear mixed-effects models assessed associations between #Enzian compartments and pain trajectories. Results: Dysmenorrhea occurred in 86.5%, and dyspareunia occurred in 56.2%. Ovarian endometriomas (O) were present in 76.4%, deep infiltrating endometriosis (A, B, C) in 51.7%, and adenomyosis (FA) in 66.3%. POP-D was most effective in reducing ovulatory pain in ovarian (O), uterosacral\/parametria (B), rectal (C), and tubal\/adhesion (T) involvement, while EP-D was superior for dyspareunia in T. Chronic pelvic pain (CPP) remained refractory. Higher total #Enzian scores correlated with reduced therapy efficacy. Limitations: Retrospective design, single-center, small sample, use of aggregated pain scores, and incomplete follow-up may limit generalizability. Conclusion: Ultrasound-based #Enzian classification correlates with lesion distribution and predicts hormonal therapy efficacy. POP-D therapy is superior at lower #Enzian scores; CPP remains challenging. Findings support individualized medical management and warrant prospective validation including multidimensional pain and quality-of-life assessments.<\/jats:p>","DOI":"10.1159\/000550102","type":"journal-article","created":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T17:00:47Z","timestamp":1773248447000},"page":"1-7","source":"Crossref","is-referenced-by-count":0,"title":["The #Enzian Classification as a Predictor of Hormonal Therapy Response in Endometriosis-Associated Pain: A Retrospective Cohort Study in a Referral Center"],"prefix":"10.1159","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-0755-2416","authenticated-orcid":false,"given":"Sofia","family":"Gambigliani Zoccoli","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonio","family":"La Marca","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martina","family":"Di Gianvito","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Riccardo","family":"Cuoghi Costantini","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matilde","family":"Morini","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emma","family":"Bertucci","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlo","family":"Alboni","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"127","published-online":{"date-parts":[[2026,3,11]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpobgyn.2018.06.001"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph17134683"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1002\/uog.15955"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1016\/j.jmig.2020.02.014"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.3390\/jcm11226727"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1007\/s00404-022-06766-z"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1002\/uog.24833"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.52054\/FVVO.16.1.008"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2022.07.011"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2016.07.497"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2009.05.007"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.1016\/s0015-0282(97)81391-x"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1016\/j.jmig.2025.01.017"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.1055\/a-1713-3573"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2011.12.019"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.1111\/ajo.12358"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.23736\/S2724-606X.23.05351-4"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.1080\/0092623X.2019.1676852"}],"container-title":["Gynecologic and Obstetric Investigation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/karger.com\/article-pdf\/doi\/10.1159\/000550102","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T16:01:00Z","timestamp":1776096060000},"score":1,"resource":{"primary":{"URL":"https:\/\/karger.com\/article\/doi\/10.1159\/000550102"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,11]]},"references-count":18,"URL":"https:\/\/doi.org\/10.1159\/000550102","archive":["Portico"],"relation":{"is-supplemented-by":[{"id-type":"doi","id":"10.6084\/m9.figshare.31643251","asserted-by":"subject"}]},"ISSN":["0378-7346","1423-002X"],"issn-type":[{"value":"0378-7346","type":"print"},{"value":"1423-002X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,11]]}}}