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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/

Is there a link between caffeine and endometriosis?

Is there a link between caffeine and endometriosis?

By I.Soussis MD

 

Research on the link between caffeine and endometriosis does not give a definite answer.

A 1993 study released by the Harvard School of Public Health found that women who drank two or more cups of caffeinated coffee per day, or four cans of soda, were twice as likely to develop endometriosis.

A meta-analysis of eight studies (including a total of 1,407 women with endometriosis) conducted in order to establish whether caffeine influences the risk of endometriosis, provided no evidence of an association between coffee/caffeine consumption and the risk of endometriosis.

Many believe that caffeine intake increases estrogen levels, which may increase the chance of developing endometriosis or worsening the symptoms of the condition.

Caffeine inhibits the liver’s ability to reduce our estrogen levels. Εstrogen levels, which are increased by the caffeine intake cannot be reduced by the body’s natural functions.

Studies have shown that women who drink one cup of coffee per day have higher estrogen levels than women who drink none and that women who drink 4-5 cups of coffee per day have 70% higher estrogen levels than other women. Coffee consumption and total caffeine use may increase the levels of oestradiol in the first part of the cycle, independently of related habits of alcohol or tobacco use.

My opinion

High intake of caffeine (from various sources) may be linked to the development of endometriosis. Coffee/caffeine consumption, as currently used in diet, does not carry a health risk. Women need to establish whether their own consumption of caffeine is related to the severity of the symptoms of endometriosis.

References:

https://www.ncbi.nlm.nih.gov/pubmed/24481690

https://www.fertstert.org/article/S0015-0282(01)02005-2/pdf

https://www.ncbi.nlm.nih.gov/pubmed/8333416

Depression in women with endometriosis linked to chronic pain

Depression in women with endometriosis linked to chronic pain

By I.Soussis MD
The complex relationship between endometriosis and depression in women is largely determined by chronic pelvic pain, a systematic review has found.

According to the researchers, raising awareness among physicians on the nature of this relationship, which “is arguably more complex than a direct cause-effect relationship,” is essential to finding the best course of treatment and improving the quality of life of women with endometriosis.

The review study, “Depressive symptoms among women with endometriosis: a systematic review and meta-analysis,” was published in the American Journal of Obstetrics & Gynecology.

Endometriosis, a chronic disease caused by the abnormal growth of endometrium outside the uterus, is estimated to affect approximately 10 percent of women of reproductive age.

The disorder is mainly associated with infertility and chronic pelvic pain, but patients may also experience painful sexual intercourse (dyspareunia), painful or irregular menstrual cycles (dysmenorrhea), painful bowel movements (dyschezia), psychological issues, and overall low quality of life.

Symptoms of depression are significantly more common among individuals with chronic pain. Therefore, “an association between endometriosis and depression may be reasonably expected,” the researchers say. However, so far, no study explored this potential relationship thoroughly.

In this review study, the authors established two goals: first, to determine if there is a link between endometriosis and depression; and second, to assess whether depression is more common in women with chronic pelvic pain associated with endometriosis than in women with endometriosis but without pelvic pain and women with pelvic pain but without endometriosis.

The review included studies published over the past 30 years focused on comparing the clinical outcomes of women with and without endometriosis, or, among those with endometriosis, women with and without chronic pelvic pain.

A meta-analysis from 24 studies involving a total of 99,614 women revealed that those with endometriosis had significantly higher levels of depression than those not affected by the disease. This effect was even stronger when the researchers performed the same type of analysis on 11 studies (1,070 women) comparing between healthy women and those with endometriosis.

Further analysis showed that women with endometriosis who also experienced chronic pelvic pain had higher levels of depression than those who did not report pain.

However, no significant differences were found between women with endometriosis and chronic pain and those with chronic pain not affected by the disease.

“The findings of our multiple meta-analyses provide converging evidence that chronic pain, rather than endometriosis itself, is the main determinant of depressive symptoms,” the researchers wrote. “Screening for psychiatric symptoms among women with endometriosis has therefore been advocated, and our findings would suggest to particularly direct it to those with chronic pain.”

“Future studies into possible modulators of the association will hopefully provide further insights about how to improve the quality of life of women with endometriosis and/or pelvic pain,” they concluded.

 

My opinion

In our effort to provide personalized care in patients with endometriosis, the impact of chronic pelvic pain on the quality of life should be taken into consideration. Such patients might benefit from psychological assessment and possibly treatment for depression.

Read more:

https://www.ncbi.nlm.nih.gov/m/pubmed/30419199/

image credit https://www.medicalnewstoday.com/articles/301822.php

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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