ENDOMETRIOSIS LESIONS

Stinging nettle reduces size of lesions in rat model of endometriosis

Stinging nettle reduces size of lesions in rat model of endometriosis

Treatment with the aerial parts of the stinging nettle (Urtica dioica L.), a plant used in traditional medicine, reduced the size of endometrial lesions in a rat model of endometriosis,according to the results of a new study.

The study, “Bioactivity-guided isolation of flavonoids from Urtica dioica L. and their effect on endometriosis rat model,” were published in the Journal of Ethnopharmacology.

U. dioica L., commonly known as the stinging nettle, is a medicinal herb that has been used traditionally for centuries. U. dioica leaves and roots are used as a blood purifier, an emmenagogue (herbs that stimulate blood flow in the pelvic area and uterus), and a diuretic as well as to treat menstrual hemorrhage, rheumatism, and eczema.

Many studies have assessed the biological activity of U. dioica, reporting antioxidant, antidiabetic, antiviral, [liver protective], antimicrobial, diuretic, anti-inflammatory, anti-hyperlipidemic (lowers the levels of fatty molecules), [antiparasitic], analgesic, anti-arthritic, anti-cancer, hypotensive (lowers blood pressure), and immunomodulatory activities,” they added.

In this study, a team of investigators from the Gazi University in Turkey evaluated the effects of U. dioica in the treatment of endometriosis, using a rat model of disease.

They started by inducing endometriosis in the animals by injecting womb cells from female rat donors into the abdominal walls of other female rats. Then they collected plant extracts containing chemical compounds found on the aerial parts of U. dioica, using three different reagents: methanol, ethyl acetate, and n-hexane.

In addition, in an attempt to isolate the specific compounds that might have relevant clinical activity, they used a technique called chromatography to obtain four different fractions (A, B, C, and D), each containing chemical compounds of different “weights,” found on plant extracts that had been obtained using methanol.

To assess the activity and effects of the different types of extracts and fractions, they then treated animals who had developed endometriosis with the different compounds, all administered orally, once a day, for four weeks, at a dose of 100 mg/kg.

In addition, some animals were treated with buserelin acetate (sold under the brand name Suprefact by Sanofi) — a medication to treat endometriosis — to be used as reference controls.

Results showed that animals treated with methanol plant extracts and those treated with buserelin acetate had a significant reduction in the size of endometrial lesions, compared to rats that had been treated with carboxymethyl cellulose (CMC; controls).

In addition, treatment with methanol plant extracts and with buserelin acetate significantly reduced the levels of two inflammatory markers — tumor necrosis factor alpha (TNF-α) and interleukin-6 (IL-6) — and those of a molecule that controls blood vessel growth, called vascular endothelial growth factor (VEGF), found on the fluid surrounding the lesions.

Analysis of the different fractions that had been obtained from methanol plant extracts revealed fraction C was the most active, having practically the same effects as the original extract at reducing the size of endometrial lesions and the levels of disease activity markers.

A subsequent analysis showed that fraction C contained six different compounds, all belonging to a class of chemicals known as flavonoids: rutin, isoquercetin, kaempferol-3-O-rutinoside, isorhamnetin-3-O-rutinoside, kaempferol-3-O-glucoside and isorhamnetin-3-O-glucoside. Flavonoids are natural substances found in plants and are known for their anti-oxidative, anti-inflammatory and anti-cancer properties.

Flavonoids act as antioxidants, arrest the cell cycle and some of them have been shown to decrease cytokine expression and secretion release,” the researchers said. Cytokines are molecules that mediate and regulate immune and inflammatory responses.

Therefore, flavonoids as cytokine modulators can be effective in the regression of endometriosis,” they concluded.

Read more: https://www.sciencedirect.com/science/article/pii/S0378874118326138?via%3Dihub

Endometriosis can also affect adolescents

Endometriosis can also affect adolescents

By I.Soussis MD

Although endometriosis is commonly characterized as a disease affecting adult women of reproductive age, a review article compiled by an international panel of experts and published in Best Practice & Research Clinical Obstetrics and Gynaecology highlighted that it can also affect adolescents and younger women.

In addition, the authors reported that many women may experience their first symptoms in their teen years, but that they may not be recognized as indicative of endometriosis until later in their lives.

Risk factors for endometriosis in adolescents and young women include:

  • congenital abnormalities of the Müllerian duct  (due to increased incidents of retrograde menstruation),
  • first-degree relative with endometriosis, which accounts for approximately 50% of the risk for developing the disease,
  • early onset of menses,
  • prolonged menstruation (> 5 days),
  • short menstrual cycle interval (< 28 days), and
  • early-onset dysmenorrhea.

Studies have also reported associations between endometriosis and exposure to passive smoke during childhood and elevated levels of 2,4-dihydroxybenzophenone (found in sunscreens).

Other risk factors include premature birth, low body mass index, high caffeine or alcohol intake, and acne.

Consumption of soy formula as an infant has been observed to double the risk of endometriosis compared to that in women who were not exposed to dietary soy isoflavones as infants, reported the authors.

Potential protective factors identified:

  • use of oral contraceptives (OCs)
  • regular exercise
  • onset of menses after age 14
  • increased intake of omega-3 fatty acids

Black and Hispanic race compared to white or Asian race may also offer some degree of protection.

Symptoms and signs in adolescents:

Endometriosis lesions often have a different appearance in adolescents than in adults when visualized on laparoscopy: ovarian endometriomas and deep endometrial lesions are more the norm compared to powder-burn lesions seen in adult women.

Ovarian endometriomas are typically filled with “syrup-like chocolate material” and are surrounded by duplicated ovarian parenchyma. They have fibrotic walls and adhesions on the surface, according to the authors and are lined by endometrial epithelium, stroma, and glands. They are typically visualized in the rectovaginal septum, rectum, rectosigmoid colon, bladder, ureter, uterine ligaments, and vagina.

As in adults, the lesions should be staged from minimal disease (Stage 1) to severe disease (Stage 4), based on their size, location, and the types seen, and the extent of adhesions.

Distinguishing primary dysmenorrhea from endometriosis:

Many teens present with dysmenorrhea, which in light of the new information about the development of endometriosis in adolescents and young women should be evaluated to rule out endometriosis.

In adolescents with endometriosis, dysmenorrhea tends to be the first symptom of the disease and increases in severity over time. The pain is both cyclic and acyclic and interferes with school attendance, social activities, and exercise. Teens who are sexually active often report dyspareunia and gastrointestinal distress.

The clinical diagnosis can be verified with pelvic ultrasound and magnetic resonance imaging (MRI), but laparoscopy is the only way to obtain a definitive diagnosis.

The disease is unlikely to resolve spontaneously and is typically treated with nonsteroidal anti-inflammatory drugs, oral contraceptives, and progestin-only contraceptives. Laparoscopy and surgery may be an option for adolescents who fail to respond to medical therapy.

Source/image credit:

http://www.contemporaryobgyn.net/endometriosis/endometriosis-can-affect-adolescents-well-adult-women

 

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