ENDOMETRIOSIS TREATMENT

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

 

Is medical cannabis effective as a treatment for endometriosis?

Is medical cannabis effective as a treatment for endometriosis?

By. I.Soussis MD

Studies show that medical cannabis has a positive effect on symptoms of endometriosis and may even stop its proliferation, according to Moshe Hod, a Tel Aviv University medical school professor of obstetrics and gynecology and president of the European Association of Perinatal Medicine. Moshe Hod is also head of Gynica, an Israeli startup specializing in cannabis-based solutions in the field of women’s health.

According to Gynica, the female reproductive system contains the most endocannabinoid receptors in the human body, after the brain.

Gynica is the first company that will carry out research and development at the newly licensed Lumir Lab.

Israel is extending its reputation as a world leader in medical cannabis research with the establishment of Lumir Lab (a cannabinoid research lab) at the campus of the Hebrew University of Jerusalem. Cannabinoids is one of the active ingredients unique to the cannabis plant.

The lab is headed by Czech analytic chemist Lumír Ondřej Hanuš, one of the world’s leading cannabinoids researchers.

Gynica and the Lumir Lab will collaborate on a treatment for endometriosis, a disease common in women that is defined by abnormal extrauteral growths of uterine endometrial tissue and associated with severe pain. Partly because how the abnormal growths become associated with pain is poorly understood, the pain is difficult to alleviate without resorting to hormones or surgery.

Recent studies showed that sensory and sympathetic nerve fibers sprout branches to innervate the abnormal growths. This situation, together with the knowledge that the endocannabinoid system is involved in uterine function and dysfunction and that exogenous cannabinoids were once used to alleviate endometriosis-associated pain, suggests that the endocannabinoid system is involved in both endometriosis and its associated pain.

Approximately 180 million women suffer from endometriosis worldwide.

“More research is needed in order to understand the mechanisms of action and identify which active cannabinoids most effectively eliminate endometriotic lesions, prevent recurrence and reduce pain with no negative impact on the ovulation cycle” professor Moshe Hod said.

“Currently, the vast majority of the cannabis products available in various markets have no scientific basis, which prevents the medical community from supporting the legitimacy of treatments based on cannabis,” said Hod. “We aim to provide tools and solutions that are not currently available.”

Israel has one of the world’s most progressive regulatory frameworks for medical cannabis.

Sources:

https://www.israel21c.org/endometriosis-latest-target-for-medical-cannabis-research/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2972363/

Image credit: https://www.health.harvard.edu/diseases-and-conditions/endometriosis2

 

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