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Endometriosis can occur after menopause

Endometriosis can occur after menopause

Despite being rare, endometriosis can appear or come back after menopause.

Doctors should be aware of this, particularly if there are complaints of pelvic pain or heavy bleeding, and they must not underestimate the risk of the disease progressing into cancer, an opinion piece written by several obstetrician-gynecologists says.

Researchers also call attention to a major therapeutic dilemma: Should a doctor prescribe hormonal replacement therapy (HRT) to a woman experiencing menopause symptoms, given that this may raise her risk of having endometriosis come back or degenerate into cancer?

The article, “Endometriosis and the menopause: why the question merits our full attention,” appeared in the journal Hormone Molecular Biology and Clinical Investigation.

Post-menopausal endometriosis is a rare condition but is a reality,” the authors stated.

As an estrogen-dependent disease, endometriosis primarily affects women of reproductive age, its activity lessening or even regressing at the onset of menopause.

However, there have been several reports of cases that demonstrate the disease may still develop at this time, in the absence of menstrual cycles and in a low-estrogen environment. During menopause, the ovaries’ activity drops drastically, including their capacity to secrete hormones.

The fact that endometriosis can appear in such conditions sheds doubt on Sampson’s theory of retrograde bleeding in explaining the disease origin, and implicates other mechanisms, researchers say.

Doubt persists, however, as to whether endometriosis persists into the post-menopausal period, whether it comes back from a pre-existing disease or if it can develop for the first time after menopause.

In any case, researchers propose several sources of estrogen in postmenopausal women that might serve as risk factors for endometriosis: conditions such as obesity, intake of plant-derived estrogens (phytoestrogens), the use of HRT or tamoxifen, and the production of estrogen by endometriosis lesions themselves.

Tamoxifen, a medication used for breast cancer, acts as an anti-estrogen in the mammary tissue, but as an estrogen-stimulating agent in cholesterol metabolism, bone density, and cell proliferation in the endometrium.

HRT, a common treatment used to relieve menopause symptoms, consists of taking hormone supplements, including estrogen, to restore some of the hormonal levels that decrease during menopause.

Other factors that may play a role include stress, genetic factors, hypothyroidism, or fatty acids (unsaturated omega 3).

Another factor to take into account is that HRT may increase the risk of endometriosis symptoms and disease recurrence after surgery to treat severe symptoms. If there are residues of endometriosis lesions before starting HRT, this risk may increase, particularly if the disease was more severe and surgery was incomplete.

Therefore, before prescribing HRT it is imperative “to weigh the risks and benefits,” researchers say.

The authors also call clinicians’ attention to not forgetting the risk of progression into cancer with or without HRT.

Endometriosis is a benign condition, but about 1% of cases are estimated to develop into cancer, most commonly in the ovary, but also in the bowel and even the lung.

Clinicians should be particularly attentive if a woman reports pelvic pain — dysmenorrhea, dyspareunia or chronic pelvic pain — and heavy bleeding. Diagnosis can be done through patient history, clinical examinations and using ultrasound and magnetic resonance imaging (MRI). However, laparoscopy (keyhole surgery) is the only way to fully confirm a diagnosis of cancer.

The first-line treatment for new-onset symptomatic post-menopausal endometriosis should be surgery because of diagnosis uncertainty and the risk of cancer. Medical therapy can be an alternative if pain comes back after surgery or if surgery is contraindicated, including aromatase inhibitors and levonorgestrel or gestodene, two hormonal contraceptives.

Source:https://www.degruyter.com/view/j/hmbci.ahead-of-print/hmbci-2018-0071/hmbci-2018-0071.xml

https://endometriosisnews.com/2019/04/02/doctors-must-be-aware-that-endometriosis-can-occur-after-the-menopause-article-says/

First endometriosis blood test detects up to 9 out of 10 cases

First endometriosis blood test detects up to 9 out of 10 cases

 Endometriosis is notoriously difficult to diagnose. A recent study showed that it usually takes 7-12 years from first experiencing symptoms to diagnosis.

A private company (MDNA Life Sciences) announced that it is to launch the world’s first blood test for endometriosis, able to detect the disease in up to 9 out of 10 cases. Results will be available in a matter of days after the test is carried out, enabling doctors to make earlier decisions on diagnosis and treatment.

Endometriosis, a debilitating condition affecting 1 in 10 women of reproductive age, causes years of pain and distress. A surgical procedure is required to definitively diagnose the condition, resulting in an average delay to diagnosis of 7.5 years.

Using its proprietary technology, MDNA has developed techniques to exploit the unique characteristics of mutations in mitochondrial DNA, which can act as biomarkers for the presence of a range of diseases.

After successfully identifying biomarkers for different types of cancer, researchers at MDNA’s Newcastle upon Tyne laboratory have now identified biomarkers associated with endometriosis. Results of a clinical study recently published in the peer-reviewed journal Biomarkers in Medicine, show that the newly identified biomarkers can accurately detect endometriosis in blood samples in up to 9 out of 10 cases, even in its early stages.

MDNA has now embarked on a programme to create a CE-marked test kit to enable clinical laboratories in the UK and worldwide to carry out the test on a commercial basis. The CE process will be completed in 9-10 months.

Dr Andrew Harbottle, MDNA Life Sciences’ Chief Science Officer explains: “Mutations in mitochondrial DNA act as ideal biomarkers, providing us with a unique and detailed diary of damage to the DNA and accurately detecting many difficult to diagnose diseases and conditions, such as endometriosis”.

MDNA’s Mitomi Technology platform identifies and optimises the best biomarkers to detect a specific disease. The company has already demonstrated the accuracy of its technology in a blood test for prostate cancer. As well as the new test for endometriosis, MDNA is planning to release tests for ovarian cancer and pancreatic cancer next year. Tests for lung, liver, and stomach cancers will follow in 2021 and more tests are in the pipeline.

Harry Smart, MDNA Life Sciences’ Chairman says “Our ground-breaking test for endometriosis will fundamentally change the way this debilitating disease is detected and diagnosed. We look forward to helping women get treatment sooner, reducing their pain and distress and providing cost savings to health services”.

My opinion

The development of a reliable non-invasive test for the diagnosis of endometriosis is highly desirable and necessary since it will spare many patients of unnecessary surgical interventions and it will facilitate and speed up the diagnosis and management of endometriosis. This will immensely improve the quality of life of millions of women worldwide.

Source:

https://mdnalifesciences.com/2019/04/worlds-first-blood-test-for-endometriosis-can-detect-up-to-9-out-of-10-cases/

Red grapes, blueberries, raspberries and peanuts benefit infertile women with endometriosis

Red grapes, blueberries, raspberries and peanuts benefit infertile women with endometriosis

Resveratrol, a natural substance present in many edible plants, is able to lower the levels of two enzymes, MMP-2 and MMP-9, which have been implicated in the development of endometriosis and associated infertility, an exploratory trial suggests.

The compound has anti-inflammatory properties that may have therapeutic effects for women with endometriosis, but more studies are needed to confirm this claim, the authors caution.

The study, “The modulating effects of Resveratrol on the expression of MMP-2 and MMP-9 in endometriosis women: a randomized exploratory trial,” was published in the journal Gynecological Endocrinology.

Endometriosis is an inflammatory disease marked by an overactivation of matrix metalloproteinases (MMPs), a group of enzymes that break down several proteins that make up the extracellular matrix, a network outside cells that provides support to cells and tissues.

MMPs play an important part in the organ’s development and tissue turnover but normally are not very active in adult tissues.

However, their activity can increase significantly in various disorders such as endometriosis, where they have been associated with the failure of embryo implantation after cycles of assisted reproduction technology (ART).

Two MMPs, MMP-2 and MMP-9, in particular, have been linked to this effect.

Resveratrol, a compound naturally occurring in plants such as red grapes, blueberries, raspberries, and peanuts, is able to inhibit MMP-2 and MMP-9 and has shown signs of preventing the formation of endometriotic lesions in some studies.

The compound is also sold as a supplement and used as a medicine for high cholesterol, cancer, heart disease, and many other conditions, although there is no solid evidence to support its use for these issues.

A team of researchers at the Tehran University of Medical Sciences in Iran have now investigated the effects of resveratrol on the levels of MMP-2 and MMP-9 in endometriosis patients.

They carried out an exploratory clinical trial, which included 34 patients who had endometriosis-associated infertility. They randomly divided 17 participants into a control group given a placebo and 17 into a treatment group given 400 mg of Resveratrol for 12 to 14 weeks.

Results showed that the levels of both MMP-2 and MMP-9 significantly dropped in the endometrium tissue as well as in the endometrium fluid and blood of women treated with resveratrol, compared with the control group.

The blood and endometrial fluid levels of both MMP-2 and MMP-9 were lower following the surgical removal of endometrial lesions.

We showed that Resveratrol can modify the inflammation process in the endometrium of women with endometriosis at least in the level of MMP-2 and -9 expressions,” the researchers wrote. “All participants in this study were infertile women with endometriosis stages III and IV, which may limit the generalization of the findings to all women with endometriosis.”

The therapeutic potency of Resveratrol in endometriosis needs more clinical studies,” they concluded.

Read more: https://www.ncbi.nlm.nih.gov/pubmed/30777471

Source: https://endometriosisnews.com/2019/03/12/resveratrol-helps-reduce-two-enzymes-endometriosis-trial/

Endometriosis diagnosis takes 7 to 12 years

Endometriosis diagnosis takes 7 to 12 years

Endometriosis may affect all aspects of a woman’s life, including sexual relations, social activities, emotional well-being and work productivity.

The disease is costly. Claims data show that average annual health care costs (medical and prescription) are more than three times higher for women with endometriosis compared to patients without endometriosis, even five years pre- and five years post-diagnosis. Τhe cost can increase in cases of greater severity of the disease, presence of pelvic pain and infertility.

However, endometriosis is still underfunded and under-researched, thus limiting scientific progress and the number of available diagnostic and treatment options, according to a new review study.

Aiming to address these concerns, the Society for Women’s Health Research (SWHR) brought together a group of researchers, clinicians, and patients as well as industry and government officials, who evaluated barriers affecting endometriosis diagnosis and treatment, reviewed current practice, and highlighted research priorities.

Multidisciplinary approaches addressing all patient needs and greater disease awareness are needed to improve care, diagnosis and development of treatments for people with endometriosis, showed the resutls of the research “Assessing Research Gaps and Unmet Needs in Endometriosis,” which was published in the American Journal of Obstetrics and Gynecology.

According to the expert group, the current lack of knowledge and awareness about the causes of endometriosis contributes to the significant delays (7 to 12 years) from first experiencing symptoms to diagnosis. These delays are even worse for women with pelvic pain and for younger women, and may cause physical and emotional damage, as well as increase costs associated with the disease.

Another contributing factor is that the current gold standard for diagnosis requires surgery (laparoscopy), warranting the development of accurate, noninvasive and less costly diagnostic tools, such as biomarkers. Also, current guidelines only recommend assessing endometrial lesions, despite reports of a questionable association between the number of lesions and disease severity, symptoms and impact on women’s quality of life.

Campaigns to educate patients, healthcare providers, and the public may also help achieve more timely and accurate diagnosis and treatment, the team noted.

Additional barriers are difficulties with insurance coverage, and the stigma around menstrual issues and society’s normalization of women’s pain, which may make patients reluctant to discuss symptoms or seek care.

“In addition, women who do bring up their symptoms may fall victim to the well-documented clinical gender bias that has resulted in some women’s pain being dismissed or inadequately treated,” Rebecca Nebel, PhD, the study’s senior author and director of scientific programs at SWHR, said.

Standardized screenings, such as those used in cases of potential violence against women, could be used as a model in endometriosis, the experts said.

Other barriers are related to healthcare providers, as women need to make an average of seven visits to their primary provider before being referred to specialists, and often are misdiagnosed.

As for current practice in treatment, most medical and surgical approaches — including hysterectomy and uterus removal — focus on managing pain and associated symptoms by suppressing or removing endometrial lesions, but may not be effective.

Physical therapy, acupuncture, and yoga are examples of non pharmacological strategies that may help ease pain. Mental health professionals may help treat depression and grieving associated with endometriosis, while also providing coping and relaxation strategies.

Available medical therapies may induce side effects such as bone loss, hot flashes, and weight gain. Also, many cannot be used when women are trying to get pregnant, often forcing them to decide on whether to minimize pain or time their attempts to conceive while off medication.

Overall, “future treatments and care should shift toward a patient-centric, multidisciplinary approach that focuses on the patient as a whole, rather than one symptom at a time,” the experts said.

Centers of expertise taking an interdisciplinary approach with experts in “laparoscopy, medical management, pain education, physical therapy, and psychological care” may help implement treatment strategies “that address all the needs of the patient, including quality-of-life issues,” the team stated.

Read more: https://www.ajog.org/article/S0002-9378(19)30385-0/pdf

https://www.ajog.org/article/S0002-9378(19)30385-0/fulltext

Source: https://endometriosisnews.com/2019/02/28/multidisciplinary-approach-awareness-will-most-benefit-endometriosis-patients-experts-say/

Contraceptive implants reduce endometriosis-associated pain

Contraceptive implants reduce endometriosis-associated pain

By I Soussis MD

 Contraceptive implants Implanon NXT and Mirena significantly curb pelvic pain and menstrual cramping in women with endometriosis, improving their health-related quality of life, researchers from Spain report.

The study, “Control of endometriosis-associated pain with etonogestrel-releasing contraceptive implant and 52-mg levonorgestrel-releasing intrauterine system: randomized clinical trial” was published in the journal Fertility and Sterility.

Pelvic pain and debilitating menstrual cramps (dysmenorrhea) are the most common symptoms of endometriosis. One of the main objectives of endometriosis treatment is pain control. Studies have shown that Mirena is effective in controlling endometriosis-associated pain. However, few studies have focused on etonogestrel implants and on comparing the efficacy of these hormonal treatments.

In this Phase 4 clinical trial, researchers compared the efficacy of two contraceptive implants (Implanon NXT and Mirena) in alleviating pelvic pain and menstrual cramps in women with endometriosis.

Implanon NXT is an etonogestrel-releasing contraceptive implant inserted under the skin in the upper arm. Mirena is a 52-mg levonorgestrel-releasing intrauterine device.

The study included 103 women experiencing endometriosis-associated chronic pelvic pain, menstrual cramps, or both for more than six months. The patients randomly received either Implanon NXT or Mirena. The initial follow-up period of the study was six months, with a checkup every month after implantation. The patients could keep the device after completion of the study.

The women were recruited from the Department of Obstetrics and Gynecology, University of Campinas Faculty of Medical Sciences, Campinas, Sao Paolo, Brazil. They were being treated for stage I–IV endometriosis or deep endometriosis.

There were 52 patients (mean age 33.4 years) who received Implanon NXT; 51 patients (mean age 34.7 years) received Mirena.

Researchers used the patient-reported visual analogue scale (VAS; 0-10) to determine the effect of these treatments on curbing noncyclic pelvic pain and menstrual cramps. The lower the VAS score, the lesser the pain. The mean score registered in the month before implant placement was considered the baseline.

Pelvic pain was significantly eased by both treatments, with no statistical difference between the two groups. The mean VAS score for pelvic pain in the Implanon NXT group decreased from 7.6 at baseline to 2 at the six-month evaluation. Similarly, among Minera users, the mean VAS score dropped from 7.4 at baseline to 1.9 during the study period.

Both treatments also markedly alleviated menstrual cramps, the team reported. A significant reduction in the VAS score for menstrual cramps between baseline and the six-month follow-up was observed in Implanon NXT users (7.5 to 2.2) as well as the Minera users (7.3 to 1.9).

The team used the Endometriosis Health Profile-30 (EHP-30 questionnaire) to assess the impact of the treatments on the patients’ health-related quality of life (HRQoL). The patients completed EHP-30 before the start of the study and at the six-month follow-up. A lower score corresponds to a better HRQoL.

The EHP-30 core segment assesses pain, control, and powerlessness, emotional well-being, social support, and self-image. It also has a modular section that covers questions about other areas of health and emotional status that patients may or may not experience. A significant reduction was reported by both groups in the scores for core and modular segments of the EHP-30, indicating a marked improvement in their HRQoL.

Menstrual bleeding pattern disturbances were reported in patients in both groups. In the Mirena group, participants reported infrequent bleeding (30%) and spotting (22.1%), at six months follow-up. In the Implanon NXT group, 28.8% reported a complete absence of bleeding (amenorrhea) and 24.4% infrequent bleeding at the six-month follow-up. However, none of the participants discontinued the study because of these disturbances.

Although further studies with a larger study population are required to assess the efficacy of these contraceptives, “both treatments are long-term feasible options for women with endometriosis-associated pelvic pain, with few side effects,” the study concluded.

 

 

Estrogen may play role in endometriosis associated pain

Estrogen may play role in endometriosis associated pain

By I.Soussis MD

Estrogen could be responsible for endometriosis-associated chronic pain by activating a type of immune cells called macrophages and nerve cells, which increases inflammation and sensitivity, according to a review study.

The article “Villainous role of estrogen in macrophage-nerve interaction in endometriosis” was published in Reproductive Biology and Endocrinology.

Endometriosis is a chronic inflammatory disease whose specific causes are unknown. Its origin has been attributed to a combination of several factors.

Estrogen secretion is essential for disease progression, and the levels of this hormone are abnormally high in patients with endometriosis.

Researchers have found that the immune system also plays a role in this disease, increasing inflammation at the sites of injury. Additionally, the number of macrophages (the immune cells that contribute most to inflammation in the endometrium) is higher in endometriosis. This increase is thought to influence development of the disease and the frequency of endometriosis-related pain.

The findings also include the nervous system, as an abnormal distribution of nerve cells is common in endometriosis lesions, leading to an increase in nervous terminals and pain.

The review proposes that these three factors might be related and that this relationship might be the cause of endometriosis-related pain.

Estrogen can influence the action of various types of cells, as long as they express estrogen receptors. The macrophages and nerve cells on the endometrium express high numbers of estrogen receptors, which makes them more susceptible to this hormone.

The interaction of estrogen with estrogen receptors in the macrophages leads to activation and inflammatory response.

Activated macrophages produce nerve growth factors, molecules that cause the nerve cells to grow and form ramifications. This causes an increase in nerve terminals in the endometrium.

The inflammatory response lowers the threshold of the nerve cells, making them more sensitive. This combination of more sensitive cells and more nerve terminals leads to chronic pain.

Additionally, estrogen causes nerve cells to secrete migration factors that attract the macrophage to the site of injury, creating a vicious circle in which more inflammation creates more pain and the reaction to pain attracts macrophages that increase inflammation.

The villainous communication between macrophages and nerve fibers has been demonstrated to be enhanced by the aberrant level of estrogen, providing a hypothesis in endometriosis-associated pain,” researchers wrote.

This suggests that “targeting estrogen levels [or] the receptors on macrophages and nerve fibers may be a potential approach to prevent the progression of endometriosis,” they added.

There are several substances that target hormone receptors and decrease hormonal level; such treatments might help prevent chronic pain in endometriosis patients.

A better understanding of estrogen in the interaction of nerves and macrophages inspires a novel insight of endometriosis-associated pain and provides a new strategy for diagnosis and a potentially valuable target for the treatment of endometriosis-associated pain,” researchers concluded.

Source/read more:

https://rbej.biomedcentral.com/articles/10.1186/s12958-018-0441-z

https://endometriosisnews.com/2019/01/22/estrogen-role-endometriosis-associated-pain-study/

Endometriosis may double the risk for ovarian cancer

Endometriosis may double the risk for ovarian cancer

By I. Soussis MD

Women with endometriosis are 1.9 times more likely to develop ovarian cancer, but are at no higher risk for endometrial and cervical cancers, a meta-analysis suggests.

The study, “Impact of endometriosis on risk of ovarian, endometrial and cervical cancers: a meta-analysis,” was published in the journal Archives of Gynecology and Obstetrics.

While endometriosis is considered a benign gynecologic disease, it displays features similar to those seen in malignant tumors, including:

  • the ability to invade other tissues

  • a high rate of new blood vessel formation

  • development of local and distant sites of lesions

These characteristics of endometriosis rendered its classification as behaving similar to tumor-like lesions by the World Health Organization, and growing evidence suggests that the condition may represent an initial stage of tumor progression.

While some studies have associated endometriosis with an increased risk for developing different gynecologic tumors, namely ovarian and endometrial cancers, the results are conflicting.

Therefore, a team of researchers in China performed a meta-analysis to investigate the link between endometriosis and the risk for three gynecological cancers: ovarian, endometrial, and cervical.

Out of 8538 studies retrieved from several databases, they analyzed 25 studies, which included 15 cohort and 10 case-control studies. These studies had been conducted in different countries, including Taiwan, the U.S., Australia, Sweden, Denmark, the Netherlands, Japan, Canada, and Spain, with one study involving joint participation of multiple countries.

The researchers evaluated the risk factor between endometriosis and ovarian cancer in 23 studies, between endometriosis and endometrial cancer in 9 studies, and between endometriosis and cervical cancer in 3 studies.

They found that endometriosis was associated with an increased risk (1.9 times) for developing ovarian cancer. In fact, the ovary is one of the major target organs for the malignant transformation of endometriosis. An integrated analysis of different studies revealed a great overlap between the genetic alterations of both endometriosis and ovarian cancer.

Of note, researchers found that endometriosis increased the risk for developing some subtypes of ovarian cancer: endometrioid and clear-cell type.

No clear evidence supports a link between endometriosis and the risk for endometrial cancer, and endometriosis was not associated with an increased risk for cervical cancer.

Despite the authors’ efforts in making a robust comparison of the different studies using rigorous selection criteria, they were limited to the number of available articles about each cancer type. There were more ovarian cancer studies available, which could have influenced the observations to some extent, the study noted.

There is insufficient evidence to support the theory of endometriotic lesions as a precancerous lesion,” the researchers wrote.

Their meta-analysis suggests that endometriosis is a potential risk factor for developing ovarian cancer, but additional studies are required to understand further if endometriotic lesions are precancerous.

If endometriosis is considered a precancerous lesion, the current treatment management needs to be modified,” the researchers concluded, noting that patients with endometriosis need to be closely observed and rechecked regularly to prevent malignant changes.

My opinion

The association between endometriosis and clear-cell cancer of the ovary and endometrioid ovarian cancer is well established. This meta-analysis confirms it and also clarifies that there is no increased risk between endometriosis and endometrial and cervical cancer.

Women with endometriosis should have life-long regular follow up by their doctors.

Source:

https://endometriosisnews.com/2019/01/24/endometriosis-may-increase-risk-ovarian-cancer-not-endometrial-cervical-cancers-study/

Read more:

https://link.springer.com/article/10.1007%2Fs00404-018-4968-1

Scientists identify the reason endometriosis causes infertility

Scientists identify the reason endometriosis causes infertility

By I Soussis MD

Deficiency of a protein in the womb has been identified as the reason why endometriosis causes infertility, according to a new study published in Science Translational Medicine.

American and South Korean researchers investigated the link between endometriosis and infertility. In endometriosis, womb-lining tissue grows outside of the uterus, often on the ovaries and fallopian tubes. This can lead to chronic pain and is associated with infertility, but the mechanism has been unclear.

Around ten percent of women have endometriosis and up to 50 percent of endometriosis patients have infertility”, said lead author Dr Jae-Wook.

The scientists compared endometrial tissue from 21 women with endometriosis and infertility with samples from healthy women.

They observed that levels of a protein called histone deacetylase 3 (HDAC3) in the lining of the uterus of women with endometriosis were lower compared to healthy women. Previously developed animal models of endometriosis in mice and baboons supported this finding.

The team then developed mice unable to produce HDAC3 in uterine cells, all of which were infertile. Dr Jeong and his colleagues were able to show that HDAC3 is necessary for embryo to implant in the womb. Follow-up experiments with human endometrial cells cultured in vitro showed that HDAC3 is a crucial part of the changes that occur in the uterus, in preparation for and during pregnancy.

This study could help endometriosis patients and their doctors select more effective treatments and enable a better understanding of female infertility.

My opinion

Finally, the enigma of endometriosis starts to unravel. This is a significant study that shows for the first time that the levels of HDAC3 are crucial for the development of fertile endometrium. This line of research may lead to new treatments for endometriosis caused infertility.

It may also help in cases of recurrent implantation failure in IVF patients without endometriosis.

Read more:

http://stm.sciencemag.org/content/11/474/eaaf7533

https://www.bionews.org.uk/page_140740

Image credit

https://www.theguardian.com/society/2019/jan/09/endometriosis-study-50-50-infertility-risk-women

 

Early life sexual and physical abuse dramatically increases risk of endometriosis

Early life sexual and physical abuse dramatically increases risk of endometriosis

By I.Soussis MD

A prospective cohort study found that women reporting severe and/or chronic abuse of multiple types during childhood and adolescence had a 79% higher risk of laparoscopically confirmed endometriosis.

Severe abuse was defined as being kicked, bitten, punched or physically attacked more than once, or choked or burned ever, whereas severe sexual abuse was considered forced sexual activity during both childhood and adolescence.

“We saw stronger associations among women whose endometriosis was most likely diagnosed as a result of pelvic pain symptoms,” said lead author Holly Harris, ScD, an assistant professor of epidemiology at the Fred Hutchinson Cancer Research Center in Seattle, Washington.

Previous studies led by members of Dr. Harris’ research team had shown a connection between early life abuse and both uterine fibroids and hypertension. “Given recent links found between endometriosis and hypertension, one of the next logical steps was to examine the association between abuse and risk of endometriosis,” Dr. Harris told Contemporary OB/GYN.

For the study, which appeared in the journal Human Reproduction, data were collected from 60,595 premenopausal women from 1989 to 2013 as part of the Nurses’ Health Survey II cohort.

Participants completed a questionnaire on exposure to violence.

A total of 3,394 cases of endometriosis were diagnosed during 24 years of follow-up.

Overall, 34% of study participants reported moderate or severe physical abuse during early life and 11% of study participants reported forced sex, while 14% of women diagnosed with endometriosis had severe sexual abuse history.

“It is extremely important for readers, clinicians and women with or those who care about women with endometriosis to understand that these results absolutely do not imply that all women who have endometriosis have been abused,” Dr. Harris said. “Abuse in early childhood and adolescence is common among both women with and without endometriosis.”

The associations between abuse and endometriosis were stronger in women presenting without infertility. This group was also more likely to report pelvic pain.

“Sadly, childhood abuse is real, is a major public health issue, and can have long-lasting impacts on health,” Dr. Harris said. “In addition, for women with pelvic pain with or without endometriosis, it is important that they know that these symptoms are not normal.”

When these women raise concerns about their pain with clinicians, they should not be dismissed, no matter their age or history, according to Dr. Harris. “There is a growing body of evidence that pain sensitization can result from a physiologic response to the stress and trauma of abuse,” she said. “This occurs not only among women with endometriosis but also among women with other pain conditions.”

 

Read more: https://academic.oup.com/humrep/article-abstract/33/9/1657/5055017?redirectedFrom=fulltext

 

Source: http://www.contemporaryobgyn.net/endometriosis/does-abuse-affect-risk-endometriosis?rememberme=1&elq_mid=4894&elq_cid=607376&GUID=69980457-AFA5-43B0-B217-28D67525EA6C

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