endometriosis

Therapeutic potential of ginseng component for endometriosis

Therapeutic potential of ginseng component for endometriosis

An active ingredient of the ginseng medicinal plant may suppress endometriosis by regulating cell death and blood vessel formation processes in the endometrium or lining of the uterus, a study in cells from patients suggests.

Endometriosis has long been considered a disease of uncontrolled and aberrant growth of endometrium tissue outside of the uterus, but the exact molecular mechanisms disrupted in this disorder remain unknown.

Research indicates that there is not just one single molecular culprit, but several signaling pathways that contribute to the disease mechanism of endometriosis, including ones involved in cell proliferation, cell adhesion and programmed death (apoptosis), blood vessel formation (angiogenesis), and immune function.

The protein complex NF-kappaB (NF-kB) is involved in such processes, and has been shown to favor the development and maintenance of endometriosis by preventing cell death and stimulating proliferation of various cell types, like endometrial and endometriosis-related cells, as well as inflammation.

Ginsenoside Rg3 is a main effective component extracted from ginseng, which is a Chinese medical herb,” the scientists wrote.

In rats, the compound was seen to inhibit the development of new endometriosis lesions, reduce the volume of existing lesions, and halt the formation of new blood vessels. Nonetheless, the effects of Rg3 on endometriosis-related cells from people is still poorly understood.

Investigators at the Women Health Center of Shanxi and Children’s Hospital of Shanxi, in China, evaluated this compound on human endometrial cells in a lab dish.

Endometrial tissue samples were obtained from six women (ages 28-40 years) with ovarian endometriosis and regular menstrual cycles. Using tissue from their endometrial lesions, scientists grew endometrial stromal cells, or connective tissue cells found in the endometrium, in the lab.

Cells were then treated with five distinct doses of Rg3 (0, 25, 50, 100, and 150 mg/mL) and the compound’s effects were evaluated at 24, 48 and 72 hours post-treatment.

Ginsenoside Rg3 was found to stop the cells from spreading in a time- and dose-dependent manner, with higher doses being associated with lesser cell proliferation.

Scientists reported that after “48, 72h, 100 mg/mL and 150 mg/mL of concentration of Rg3 inhibited the viability of human ectopic endometrial cells,” which was found to be statistically significant in comparison to untreated cells.

Rg3 also significantly lowered levels of the NF-κB p65 subunit and the protein TNF-α in diseased cells, suggesting the NF-κB pathway plays a role in the mechanism of endometriosis. Of note, women with endometriosis are known to have very active NF-κB and high serum levels TNF-α, a potent NF-κB inducer.

A significant decrease in the concentration of vascular endothelial growth factor (VEGF), which stimulates new blood vessel formation, and a significant increase in the levels of caspase 3, a protein that regulates the apoptosis process, were also seen after Rg3 was used.

When TNF-α was administered together with Rg3, the latter was able to neutralize TNF-α-induced changes, including cell death and blood vessel formation.

Our results indicate that Ginsenoside Rg3 suppresses endometriosis by reducing the viability of human ectopic [outside of the normal location] endometrial stromal cells involving the nuclear factor-kappaB signaling pathway,” the researchers concluded.

NF-κB signaling pathway may be a potential target in the process of the Rg3 treatment for endometriosis,” they added.

The study, “Ginsenoside Rg3 attenuates endometriosis by inhibiting the viability of human ectopic endometrial stromal cells through the nuclear factor-kappaB signaling pathway” was published in the Journal of Gynecology Obstetrics and Human Reproduction.

Source: https://bit.ly/2qqvB4H

Can endometriosis cause leg pain?

Can endometriosis cause leg pain?

By I.Soussis MD

Experts have only recently begun to recognize how widespread leg pain may be in women with endometriosis. Usually endometriosis patients experience extremely painful, heavy periods, pain after or during sexual activity (called dyspareunia) and pelvic pain. When endometriosis growths though impact the nerves surrounding the pelvis, they can cause pain in the legs, hips and buttocks.

As many as 50 percent of women with endometriosis may experience some form of leg pain, according to a 2016 study. 

Diagnosing endometriosis-related leg pain can be tricky because of a wide range of other medical conditions that are better understood and easier to diagnose can also cause leg pain.

During regular menstruation, the uterus lining sheds and leaves the body through the vagina. This happens in response to changing hormone levels. When endometrial tissue grows outside the uterus, the cells still shed, but they cannot leave the body, causing painful symptoms.

In some cases, endometrial tissues grow in and around the many nerves that travel through the pelvis and hip. Abnormal growths can put pressure on the pelvic nerves. This may cause pain and numbness in the hips, buttock, and legs. 

Nearly all of the documented cases of leg pain associated with endometriosis involve abnormal growths on the sciatic nerve or one of its branches.The sciatic nerve is considered the largest and longest nerve in the human body. It begins in the lower back, runs through the pelvis, and down the leg into the foot, branching into several smaller nerves along the way. Pressure on this nerve can cause pain in the lower body.

The sciatic nerve provides sensation to most of the lower portion of the body. Pressure on the sciatic nerve can, therefore, cause a lot of different symptoms, most commonly pain, numbness, and tingling that radiates into the following areas: 

  • outside of the leg
  • back of the thighs and calf
  • knee
  • sole, heel, and top of the foot 
  • hips 
  • buttock

Everyday tips for finding relief include:

  • gentle stretching focusing on the buttocks, thighs, calf, and feet muscles
  • gentle exercise, such as yoga, swimming, or walking can often help ease inflammation. 
  • counter pain medications and pain-relieving topical treatments on painful areas can ease inflammation and pain. 

Patients have seen good results when they eat:

  • fruits and vegetables rich in fiber and antioxidants (such as leafy green vegetables, berries, and citrus fruits).
  • lean meats and nuts that contain anti-inflammatory compounds, such as omega-3 (such as fish, walnuts, almonds, sesame seeds)

Also, when they avoid:

  • foods linked with inflammation (such as red meat, alcohol, heavily refined or preserved foods)

Drinking a lot of water also helps. Dehydration can intensify inflammation and pain throughout the whole body. Alternative therapies, such as acupuncture and massage therapy have proven to be effective for some endometriosis patients who experience leg pain.

Source: https://www.medicalnewstoday.com/articles/321457.php 

 

Individualised approach to ‘fertile windows’ could help couples understand when pregnancy is likely to occur

Individualised approach to ‘fertile windows’ could help couples understand when pregnancy is likely to occur

Only 13% of women having menstrual cycles that last 28 days, according to a new study led by UCL and Natural Cycles, a contraceptive app.

The study, published in Nature Digital Medicine is one of the biggest overviews of menstrual cycles to date and analysed data over 600,000 menstrual cycles and 124,648 women from Sweden, USA and the UK. It could help couples better understand when pregnancy is likely and unlikely to occur.

Researchers set out to investigate menstrual cycle characteristics and associations with age, BMI and body temperatures. The findings show an average cycle length is 29.3 days and only around 13% of cycles are 28 days in length. Across the study, 65% of women had cycles that lasted between 25 and 30 days.

The menstrual cycle begins and ends with menstrual bleeding and is divided by ovulation into two phases: the follicular and luteal phases. Researchers found the average follicular phase length was 16.9 days and the average luteal phase length was 12.4 days. The average cycle length decreased by 0.18 days and average follicular phase length decreased by 0.19 days per year of age from 25 to 45 years. The average variation of cycle length for obese women was 0.4 days or 14% higher. Cycle length variability was observed to a lesser extent in non-obese and underweight women.

Co-author, Professor Joyce Harper (UCL Institute for Women’s Health), said: “Our study is unique in analysing over half a million cycles and re-writing our understanding of the key stages. Traditionally studies have concentrated on women who have approximately 28 day cycles and these studies have formed our understanding of the menstrual cycle.

“For the first time our study shows that few women have the text book 28 day cycle, with some experiencing very short or very long cycles. We studied all women who used the app.

“We also demonstrate that ovulation does not occur consistently on day 14 and therefore it is important that women who wish to plan a pregnancy are having intercourse on their fertile days. In order to identify the fertile period, it is important to track other measures such as basal body temperature as cycle dates alone are not informative.”

Co-author, Dr Simon Rowland, Head of Medical Affairs at Natural Cycles, said: “Given the variations in cycle length and follicular phase length that we have described, especially for cycles outside the average range (25-30 days), an individualised approach to identify the fertile window should be adopted.

“Apps giving predictions of fertile days based solely on cycle dates could completely miss the fertile window and it is therefore unsurprising that several studies have shown that calendar apps are not accurate in identifying the fertile window.

“Besides the potential benefits to the individual, fertility awareness apps and the associated databases of fertility data provide a unique opportunity to examine a large number of menstrual cycles in order to improve understanding.”

Data was collected from women using the app between September 2016 and February 2019 aged 18 to 45 and had a BMI between 15 and 50 and had not been using hormonal contraception within the 12 months prior to registration. Users who stated at registration that they had a pre-existing medical condition (polycystic ovarian syndrome, hypothyroidism or endometriosis) or who had menopausal symptoms were excluded.

The authors note the main limitation of this study is that the study population is derived solely from users of the app who may not be representative of the wider population. In particular, only 8% of women in our study were obese compared to 15% of women in the general population.

Professor Harper added, “The widespread use of mobile phone apps for personal health monitoring is generating large amounts of data on the menstrual cycle. Provided that the real-world data can be validated against traditional clinical studies done in controlled settings, there is enormous potential to uncover new scientific discoveries.

“This is one of the largest ever analyses of menstrual cycle characteristics. These initial results only scratch the surface of what can be achieved. We hope to stimulate greater interest in this field of research for the benefit of public health.”

Read more: https://www.nature.com/articles/s41746-019-0152-7

Source: https://www.ucl.ac.uk/news/2019/aug/individualised-approach-fertile-windows-could-benefit-many-women

What is endo belly and why does it occur?

What is endo belly and why does it occur?

Severe bloating in women with endometriosis, also known as “endo belly” is often painful and uncomfortable and takes a toll on self-image.

Endo belly is a complex situation as endometriosis is a complex disease. Even a CT scan, cannot reveal the cause why it is happening. 

There are a few theories: 

  • Endometriosis causes adhesions that can reduce the mobility of the bowel. 
  • Endometriosis lesions can flare at different parts of the menstrual cycle, which can cause an immune response, which includes swelling.
  • The ectopic endometrial tissue growing on other organs, at the time of  menstruation is also bleeding internally, and the body gets inflamed. 
  • Endometriosis patients can be more sensitive in regards to how their intestines and gut process food. Endo belly could be a side effect of the intestines working overtime.

There is no proven explanation on what causes bloating with endometriosis, so there is no official cure for endo belly.

1. Make sure it is only endo belly

Several diseases and conditions are marked by severe swelling. Women with endo are more prone to Small Intestinal Bacterial Overgrowth (SIBO), which is often characterized by painful bloating, constipation, and painful bowel movements. Fibroids or cysts may also lead to bloating as well as Irritable Bowel Syndrom. 

2. Track food and water 

Log food and water intake. It helps you to identify patterns. Get advice from a dietitian/nutritionist about food that your body reacts to.

Nutritionists and wellness advocates recommend mindful eating, which includes sitting upright at the table for meals and undistracted consumption with thorough chewing. All of this helps support digestion and reduce bloating risk.

3. Check your gut 

Try an anti-inflammatory diet. The best way to find your version of this diet is to start with an elimination diet, slowly add things back in, and note when endo belly occurs. Eliminate those foods. Your dietitian can help you through this process.

The following are regularly recommended to endo patients: generally eliminate alcohol, gluten, dairy, eggs, soy, red meat, preservatives, artificial sugars, and caffeine. 

Women report positive experiences with the keto diet and low-carb diets, but also with natural remedies like drinking fresh celery juice first thing in the morning.  

There’s no one diet for endometriosis. You have to see what’s best for you and what you react to.

4. Check your hormones

Endometriosis comes with hormonal imbalance. Keeping blood sugar balanced will help support proper hormone balance. Make an appointment with an endocrinologist. Acupuncture may help balance hormones, it has been found to release norepinephrine and put us in a state of rest and digest, which is when our body can begin healing itself.

5. Workout 

Many women are afraid to workout when they are in pain, but exercising will actually decrease the pain over time, because it helps with the circulation of the blood, reduce stress, and maintain nutrient and oxygen flow to the whole body. Gentle twisting motions will aid in circulation and movement through the abdominal region and help with pain as well as bloating.

6. Get enough sleep

The body repairs itself during deep sleep. Sleep deprivation can cause hormonal and metabolic changes and increase pain and stress responses (and thus bloating), and women with endo often struggle with insomnia. Popular sleep inducing recommendations include lavender scents, blue light phone filters in the evenings, eliminating electronics after a certain time, and chamomile teas. 

7. Limit the stress

Stress fuels endometriosis and its symptoms, and endometriosis creates physical and mental stress, so the cycle needs to be slowed as much as possible. Breathing exercises, physical and emotional therapy, and exercise have been essential for many endo women.

Sources: https://www.endofound.org/endo-belly 

https://www.health.com/menstruation/endo-belly 

 

Image: https://www.instagram.com/p/Bfbd_88gkng/ 

 

Levels of thyroid hormones affect chronic pain and severity of endometriosis

Levels of thyroid hormones affect chronic pain and severity of endometriosis

Endometriosis patients with thyroid dysfunction may have increased risk of more intense chronic pain and increased disease severity, a study suggests.

The underlying disease mechanism of endometriosis is still unclear.

Autoimmune thyroid disorders are associated with endometriosis, but the mechanism by which the two diseases are linked is unknown.

Each cell in the body carries protein markers called antigens that allow a cell to be identified as “self” or “non-self” by the immune system. In autoimmune thyroid disorders, the body’s own immune system attacks and damages the thyroid gland. These diseases are characterized by the production of autoantibodies against thyroid-specific antigens, including the thyroid itself and the thyroid-stimulating hormone receptor.

Now, researchers at the Université Paris Descartes looked at the relationship between endometriosis and autoimmune thyroid disorders, specifically at how thyroid disorders affect the progression of endometriosis.

They first found that both the levels of RNA and proteins involved in thyroid metabolism were altered in the biopsied endometrium of patients with endometriosis compared to healthy people. RNA molecules act as templates to make proteins, which perform key functions in the cell.

Moreover, in endometriotic cells, the amount of thyroid hormones was altered compared to that of control cells. The thyroid hormone T4 (thyroxine) is converted into T3 (triiodothyronine), which is much more active than T4. In the endometriotic cells, T4 production was increased while that of T3 was reduced.

The thyroid-stimulating hormone regulates the production of T3 and T4. In vitro (lab) studies using cells from the endometrium of endometriotic patients and healthy controls showed that thyroid-stimulating hormone increased cells’ proliferation. But the researchers saw no differences in the increase of proliferation rate between endometriotic cells and control cells.

Mouse studies confirmed the data gained in vitro since endometriotic implants were found to be bigger when thyroid hormones increased. A retrospective analysis of endometriosis patients with or without a thyroid disorder revealed an increased chronic pelvic pain and disease score in endometriotic patients with a thyroid disorder.

The study, “Role of thyroid dysimmunity and thyroid hormones in endometriosis” was published in the journal PNAS

Read more: https://www.pnas.org/content/116/24/11894

Laparoscopic surgery especially benefits endometriosis patients with pelvic pain

Laparoscopic surgery especially benefits endometriosis patients with pelvic pain

Patients with severe endometriosis and pelvic pain show the most pronounced improvements in quality of life within one year after undergoing laparoscopic surgery, a new study reports.

Laparoscopic surgery is the current gold standard to treat endometriosis. A small incision is made to allow a tool called a laparoscope, coupled with a small camera, to go inside the abdomen to guide the removal of endometriosis lesions.

Although surgery has the potential to reduce pain and improve patients’ quality of life, it is crucial to evaluate how surgery is affecting physical and mental health as well as patients’ social well-being.

Endometriosis often causes chronic pelvic pain, severe pain during menstruation (dysmenorrhea), and pain during sex (dyspareunia). Other non-gynecologic symptoms include constipation, diarrhea, and rectal bleeding. Together, these symptoms have a significant impact on patients’ quality of life.

In order to investigate which factors led to changes in patients’ quality of life, a team of researchers analyzed 981 patients from five districts in the Auvergne region of France who underwent laparoscopic treatment between 2004 and 2012.

Enrolled participants, ages 15-50, had received laparoscopic surgery or been newly diagnosed with a histological confirmation of endometriosis.

The team compared quality of life prior to surgery and one year after surgery using the 36-Item Short Form (SF-36) questionnaire, data on presence or absence of specific symptoms, and intensity of pain. Improvement in quality of life was measured using effect size method (ES), in which a value of 0.8 or higher corresponds to a significant improvement.

The SF-36 consists of eight sections covering physical functioning, energy/fatigue, bodily pain, role limitations due to physical health, general health perception, social functioning, role limitations due to emotional problems, and emotional well-being. The lower the score in the questionnaire, the greater the disability.

In total, 44% of patients with endometriosis and chronic pelvic pain had an improvement in quality of life equal to or above 0.8 ES compared to 23% of patients without pain who had similar ES scores.

Moreover, 47% of patients with stage 4 endometriosis had an ES score above 0.8, whereas only 26%, 31%, and 27.5% of patients in stage I, II, and III respectively had a similar improvement in quality of life.

Researchers observed that patients with chronic pelvic pain were more likely to improve their quality of life after surgery compared to those without it. Fertile patients also were more likely to improve quality of life compared to infertile patients.

Mental health of patients with chronic pelvic pain was also improved after surgery compared to patients without pain.

Similarly, patients with anxiety also showed better mental score compared to non-anxious patients.

Overall, researchers found that chronic pelvic pain was the most significant factor in predicting patients’ improvement in quality of life after surgery.

Patients presenting with severe endometriosis and who experience higher levels of pain are more likely to show improvement in [quality of life] after surgery,” researchers said.

[Chronic pelvic pain] is the most significant independent predictive factor for changes in QoL scores,” the study concluded.

The study, “Identification of predictive factors in endometriosis for improvement in patient quality of life,” was published in the Journal of Minimally Invasive Gynecology.

Read more: https://www.sciencedirect.com/science/article/pii/S1553465019302274?via%3Dihub

 

Medical cannabis treatment for endometriosis in clinical trial

Medical cannabis treatment for endometriosis in clinical trial

Israeli researchers have already started pre-clinical studies to examine the impact of medical cannabis in the treatment of endometriosis, which affects one in 10 women of childbearing age.

The research is led by Gynica, a company licensed by the Israeli Health Ministry to develop cannabis-based products for women, in cooperation with Lumir Lab, a cannabis research facility in the Biotechnology Park, Hadassah Ein Karem Jerusalem.

Endometriosis affects some 176 million women worldwide. In women with endometriosis, the uterine lining grows outside the uterus, in the fallopian tubes, ovaries and other areas of the abdominal cavity and in the pelvis. These women suffer from severe pain before and during menstruation, bleeding and pain during and after intercourse, dyspepsia and frequent or painful urination.

Anecdotal evidence has shown that women who smoke cannabis find relief from their pain, said Dr. Sari Sagiv, VP of research and development at Gynica. The researchers set out to find out what compounds or combination of compounds of cannabis can potentially address the problem.

Endometriosis is a complicated disease,” she said, as it has a number of factors working together that need to be addressed.

I believe cannabis has enough compounds that can affect a number of factors” of the disease, she said, including reducing pain, inflammation and the risk of recurrence.

The researchers have already tested a variety of cannabis compounds of endometriosis cells in vitro to see how they react to the compounds.

We are trying single or a combination of compounds on these cells” to find out if there is an impact and what it is, she explained. “We have already seen that there are different parts of the compounds that have a lot of impact.”

The researchers are now whittling the compounds down to a “lead candidate,” with which they will start clinical trials.

We already have an indication of what can be a lead candidate to deal with a number of factors that can cure endometriosis, not just address the pain. But she declined to reveal additional details until a patent has been filed. We want to start clinical trials in the third quarter of the year,” Sagiv said.

In parallel with the research process being conducted at Lumir Lab, Gynica is collaborating with Canadian company Strainprint, a firm that specializes in data collection and analysis of the effects of cannabis on various diseases. The companies are working on setting up the world’s largest data collection platform to analyze the effects of cannabis on women.

Lumir Lab is run by Prof. Lumir Hanush, a leading cannabis researcher, who is responsible for some of the most important discoveries made in the field of cannabis active substances. Gynica is led by Prof. Moshe Hod, a gynecologist and president of the European Association of Obstetricians. The firm does R&D specializing in cannabinoids based in the field of gynecology.

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

Source: https://www.timesofisrael.com/israeli-researchers-probe-how-cannabis-can-treat-endometriosis/

Endometriosis patients have imbalance in vaginal and cervical microbiota

Endometriosis patients have imbalance in vaginal and cervical microbiota

The population of microorganisms that reside in the vagina and cervix of patients with stage 3/4 endometriosis differs from that of healthy controls, suggesting a potential role of microorganism imbalance in this condition, according to a study.

The study, titled “The Endobiota Study: Comparison of Vaginal, Cervical and Gut Microbiota Between Women with Stage 3/4 Endometriosis and Healthy Controls,” was published in the journal Scientific Reports.

Endometriosis is a chronic condition where uterine cells are found outside of the uterus, most commonly in the pelvis. These cells can also spread to other parts such as the intestine.

Researchers believe that endometriosis likely occurs through retrograde menstruation, which causes endometrial cells to leave the uterus and implant in the pelvis. However, all women at some point experience retrograde menstruation, so researchers are looking for other possible causes of endometriosis, which affects about 10% of women of reproductive age.

Microorganisms, such as bacteria, fungi, and viruses, live and play important roles in the body. Together, they form the human microbiota.

Evidence indicates that imbalance in the human microbiota (known as dysbiosis) is associated with disease. For example, disruption of gut microbiota can lead to the development of inflammatory bowel disease as microorganisms help regulate the immune system. This phenomenon has also been associated with other conditions, such as “neuropsychiatric diseases, psoriasis, arthritis, and some cancers, especially colon cancer,” the researchers wrote.

Since inflammation and activation of immune cells have been linked to endometriosis, the researchers hypothesized that dysbiosis might also play a role in the development of the condition, and conducted a study to compare the microbiota between women with and without endometriosis.

The researchers sampled the vaginal, cervical, and gut microbiota from 14 women with stage 3/4 endometriosis and from 14 healthy controls, and they looked for the presence of different microorganisms by sequencing their genomes.

Results indicated that there was an overall similarity between the microbiota composition between the stage 3/4 endometriosis group and controls.

However, there was a difference between the two groups at the genus level, which ranks above species and below family in the hierarchy of biological classification.

There was a total lack of the genus Atopobium in the vaginal and cervical microbiota of the endometriosis group, but the researchers found an increase in the species Gardnerella, Streptococcus, Escherichia, Shigella, and Ureoplasma — all potentially pathogenic (able to cause disease) — in the cervical microbiota of stage 3/4 endometriosis patients.

More women in the disease group were also found to have a stool microbiome dominated by Shigella/Escherichia.

If confirmed in other studies, the complete absence of Atopobium in the vagina and cervix, together with the increased presence of Gardnerella, Escherichia/Shigella and Ureoplasma in cervical microbiome of patients with endometriosis could be a relevant finding of this study,” the authors wrote.

While overall microbiome composition in the cervix, vagina and gut seems similar between women with stage 3–4 endometriosis and healthy controls, there seems to be some differences at the genus level,” they said.

Further studies are needed to clarify whether the association between dysbiosis and endometriosis is causal, and whether dysbiosis leads to endometriosis or vice versa, the researchers said.

Read more:https://www.researchgate.net/publication/331170382_The_Endobiota_Study_Comparison_of_Vaginal_Cervical_and_Gut_Microbiota_Between_Women_with_Stage_34_Endometriosis_and_Healthy_Controls

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

Acupuncture found to be effective adjunctive treatment for endometriosis-related pain

Acupuncture found to be effective adjunctive treatment for endometriosis-related pain

By I.Soussis MD, Fertility Specialist

Endometriosis, Pain Management Meta-analysis of 3 studies of acupuncture for relief of endometriosis-related pain found positive results for reduction in pain intensity, according to research published in the Journal of Pain Research. This alternative and complementary therapy has been proven to be safe, with a low side-effect profile.

Swedish researchers performed a literature search for clinical trials, case reports, and observational studies with abstracts written in English using the keywords “acupuncture and endometriosis.” 

They retrieved 3 articles involving a total of 99 women with diagnosed endometriosis (stages I-IV) aged 13 to 40. All of the studies entailed acupuncture sessions during which 7 to 12 needles were inserted per subject and left in for 15 to 25 minutes. 

The needles were placed in the lower back,/pelvic area, lower abdominal area, feet, and/or hands. Depth of stimulation with the needles ranged from intracutaneous to subcutaneous to intramuscular, and the stimulation was primarily manual in nature. 

The number of treatments varied from 9 to 16 and occurred once or twice a week, and treatments were given in a hospital, acupuncturist’s office, or patient’s home. All of the studies reported a decrease in rated pain intensity, but differed in terms of research design, needle stimulation techniques, and the instruments used to evaluate the outcomes.

Two of the studies were prospective, randomized, single-blind, placebo/sham trials and the other was a retrospective observational case series study (n=2). The Visual Analog Scale, Numeric Rating Scale, and Verbal Rating Scale were used to measure patient-rated pain intensity. Subjects were permitted to continue using their standard analgesic in 2 studies.

The results indicated that no matter the specific technique used, acupuncture effectively and safely reduced pain intensity compared to baseline. One study found that acupuncture also reduced pain-related disability, and 2 studies found reduced analgesic intake and perceived stress. Likewise, 2 studies found that the therapy improved health-related quality of life, and social activity and attendance in school were increased after acupuncture treatment in the observational study.

 

Although acupuncture has been used for many years to relieve pain and has been noted to have few serious side effects, its use remains controversial due to a lack of understanding of its mechanism of action. 

The authors reported that “the pain-alleviating effects induced by acupuncture have been attributed to different physiological and psychological processes such as activation of endogenous descending pain inhibitory systems, deactivation of brain areas transmitting sensations of pain-related unpleasantness, interaction between nocioceptive impulses and somato-visceral reflexes, and as a method that induces the expectation of symptom relief.” 

They noted that currently available therapies for pain management in endometriosis patients are often ineffective or accompanied by adverse effects, and there is need for nonpharmacological interventions such as acupuncture. 

Source: http://www.contemporaryobgyn.net/endometriosis/acupuncture-found-be-effective-adjunctive-treatment-endometriosis-related-pain?rememberme=1&elq_mid=2570&elq_cid=607376

 

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