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Endometriosis

Hugging a Pillow

The healthyher.life team supports a holistic approach to managing women’s hormonal healthcare. Our goal is to help our members be well-informed about their hormonal health, by providing them with evidence-based integrated health information that includes the current standard of medical care advised by qualified physicians, clinical insights from licensed allied health professionals (naturopathic doctors, nurse-practitioners, nutritionists, psychotherapists) and new health innovations that will be soon coming to market. Always consult with your doctor regarding your medical condition, diagnosis, treatment, or to seek personalized medical advice. 

Introduction of Endometriosis 
 

Reviewed by Rina Carlini, PhD and Joanne Tejeda, PhD
 

Endometriosis affects about 1 in 10 women and individuals with female reproductive anatomy. Endometriosis is a complex and chronic inflammatory condition where tissues that resemble the inner lining of the the uterus, the endometrium, grow in areas outside the uterus. Abnormal endometrial tissue growths are referred to as lesions. Endometriosis is categorized according to the size of lesions, location, and disease severity into 4 stages from least to most severe as Stage I, Stage II, Stage III, and Stage IV.  

Examples of endometriosis according to the location of lesions in the body include: 

  • superficial peritoneal endometriosis (lesions on the pelvic cavity)

  • ovarian endometriomas (lesions inside or on the ovary)

  • deep infiltrating endometriosis (lesions on the bladder, rectovaginal septum, and sigmoid colon; this type is the most severe form)

 

Unfortunately, endometriosis is multi-factorial disease and manifests very differently from one person to the other, making its diagnosis incredibly challenging. 

Endometriosis also has a negative impact on all aspects of quality of life - from personal and work relationships to mental health. 

Symptoms

The most reported symptom is chronic pelvic pain (CPP) that worsens during the menstrual cycle. As the disease progresses, pain can evolve to include non-menstrual pelvic pain, including pain during intercourse. 

Other symptoms include

  • Infertility,

  • Heavy menstrual bleeding

  • Irregular bleeding (spotting in between the menstrual cycle)

  • Irregular menstrual cycle

  • Chronic inflammation

  • Migraines

  • Depression

  • Painful bladder syndrome

  • Irritable bowel syndrome (IBS)

  • Uterine fibroids and ovarian cysts

 

Diagnosis and Treatment

As of today, the only way to truly confirm the presence of endometriosis is through laparoscopic surgery.  Laparoscopy uses a device called a laparoscope; a thin tubular device that is equipped with a camera that is inserted into the abdomen to help guide the surgeon. During the surgery, if endometriosis is found, it is removed from the area to help relieve pelvic pain. The surgery can also temporarily aid with infertility. Despite being the current standard for diagnosis, laparoscopic procedures may not be available or recommended for some individuals as it is very invasive.

 

As such, alternative diagnostic methods are being explored and include: 

 

  • Pelvic exam

  • Transvaginal and transabdominal ultrasounds

  • Magnetic Resonance Imaging (MRI)

  • Blood biomarkers (undergoing research)

 

Treatment for endometriosis often involves surgery to remove lesions, or other non-surgical treatment options for the management symptoms. Examples include: 

Hormone Therapies:

  • Estrogen-progestin hormonal contraceptives (birth control pills)

  • Progestins (synthetic hormone drug)

  • Gonadotrophin-releasing hormone (GnRH) agonists

  • Danazol (androgenic steroid)

 

Pain Management Medication:

  • Non-steroidal anti-inflammatory drugs (NSAIDs) for pain management

 

Drug-free Pain Management Treatments: 

  • Pelvic floor therapy

  • Acupuncture

  • Cognitive therapies

  • Digital therapies

  • Heating pads and warm baths

 

Due to the complicated nature of endometriosis and the overlap of symptoms with other gynecological issues such as pelvic pain, there is often a delay in diagnosis of 7-10 years, which means that many individuals continue to suffer without answers.

Tags

Endometriosis, laparoscopy, surgical treatment, chronic inflammation, lesions, pelvic pain, drug, drug-free, therapy, chronic pelvic pain, hormonal health disorders, women’s health.

References

[1] Symons LK, Miller JE, Kay VR, et al. The Immunopathophysiology of Endometriosis. Trends Mol Med. 2018;24(9):748-762. doi:10.1016/j.molmed.2018.07.004

[2] As-Sanie S, Black R, Giudice LC, et al. Assessing research gaps and unmet needs in endometriosis. Am J Obstet Gynecol. 2019;221(2):86-94. doi:10.1016/j.ajog.2019.02.033

[3] Agarwal SK, Chapron C, Giudice LC, et al. Clinical diagnosis of endometriosis: a call to action. Am J Obstet Gynecol. 2019;220(4):354.e1-354.e12. doi:10.1016/j.ajog.2018.12.039

[4] Chapron C, Marcellin L, Borghese B, Santulli P. Rethinking mechanisms, diagnosis and management of endometriosis. Nat Rev Endocrinol. 2019;15(11):666-682. doi:10.1038/s41574-019-0245-z

[5] Moradi Y, Shams-Beyranvand M, Khateri S, et al. A systematic review on the prevalence of endometriosis in women. Indian Journal of Medical Research. 2021;154(3):446-454. doi:10.4103/ijmr.IJMR_817_18

[6] Missmer SA, Tu FF, Agarwal SK, et al. Impact of endometriosis on life-course potential: A narrative review. Int J Gen Med. 2021;14:9-25. doi:10.2147/IJGM.S261139

[7] Hirata T, Koga K, Osuga Y. Extra-pelvic endometriosis: A review. Reprod Med Biol. 2020;19(4):323-333. doi:10.1002/rmb2.12340

[8] Parasar P, Ozcan P, Terry KL. Endometriosis: Epidemiology, Diagnosis and Clinical Management. Curr Obstet Gynecol Rep. 2017;6(1):34-41. doi:10.1007/s13669-017-0187-1

[9] Watras AJ, Kim JJ, Ke J, et al. Large-field-of-view visualization with small blind spots utilizing tilted micro-camera array for laparoscopic surgery. Micromachines (Basel). 2020;11(5). doi:10.3390/mi11050488

[10] Mounsey AL, Wilgus A, Slawson DC. Diagnosis and management of endometriosis. Am Fam Physician. 2006;74(4). https://www.aafp.org/pubs/afp/issues/2006/0815/p594.html   

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Switching to the Mediterranean Diet can be effective at reducing chronic endometriosis-related pelvic pain 

Reviewed by Rina Carlini, PhD
November 17, 2023

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A study of 35 women with endometriosis found a positive correlation between switching to a Mediterranean diet for at least 6 months and significantly reduced non-menstrual pelvic pain, especially during intercourse (dyspareunia), urination (dysuria), and defecation (dyschezia). After only three months on the Mediterranean diet, pain experienced during intercourse (dyspareunia) and defecation had lessened, and after six months, pain from urination was significantly reduced. 

 

The researchers also found both positive and negative correlations between lipid metabolism (from unsaturated plant oils) and non-menstrual pelvic pain. The research study had a few notable limitations, including a small population size of only 35 women, all of whom were Causasian, and the study was conducted during a short 6 month period of time. However researchers concluded with relative confidence that switching to a Mediterranean diet holds promise as an effective strategy for managing chronic endometriosis-related pain over the long term. 

 

Reference 

​[1] M. Cirillo et al.; “Mediterranean Diet and Oxidative Stress: A Relationship with Pain Perception in Endometriosis.” Int J Mol Sci, 2023, 24(19):14601;  DOI: 10.3390/ijms241914601 

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A Starch-Based Barrier Reduces Pain and Improves Fertility After Endometriosis Surgery

Source: Endo News
August 22, 2023

A randomized controlled trial study conducted on women with endometriosis underwent surgery for deep infiltrating endometriosis found that using the “4DryField® PH” starch-based gel barrier during the operation had reduced pain development and improved fertility outcomes. The gel, which forms a barrier between surgical sites, showed an 85% reduction in adhesions during follow-up surgeries, and both pelvic pain and dysmenorrhea had decreased for the women. The use of the gel also led to a higher rate of pregnancies for the women in the study

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A new potential non-invasive biomarker for endometriosis

Source: Journal of International Medical Research
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A study published in the Journal of International Medical Research found that leukorrhea-exosomes – small vesicles that store biological information derived from vaginal discharge – have shown promising potential as non-invasive biomarkers for diagnosing endometriosis. The research article sheds light on the importance of developing valuable non-invasive diagnostic tools as an alternative to invasive laparoscopic surgery for improved early detection of endometriosis. 

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Endometriosis and cardiovascular disease: a population-based cohort study

Source: Canadian Medical Association Journal 
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A Canadian population study published in the Canadian Medical Association Journal (CMAJ) revealed that individuals with endometriosis may be at an increased risk of cardiovascular disease (CVD) due to chronic inflammation or early menopause. The study analyzed administrative health data from Ontario residents from 1993 to 2015 to identify risk factors of CVD in young individuals with endometriosis.

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Pain reduction with an immersive digital therapeutic in women living with endometriosis-related pelvic pain: at home self-administered randomized controlled trial

Source: Journal of International Medical Research
June 28, 2023

Management of chronic pelvic pain for individuals with endometriosis is complex and often requires the long-term use of prescription drugs (e.g., opioids), making drug-free alternatives for pain management highly sought after. A clinical trial conducted by the Franco European Multidisciplinary Endometriosis Institute (France) evaluated the efficacy and safety of an immersive digital therapeutic (DTx) treatment based on virtual reality (VR) for women with endometriosis suffering from moderate-to-severe pelvic pain. The study confirmed a reduction in pain medication intake for patients where self-repeated 20-minute sessions with the VR software were administered.This new solution provides a promising drug-free approach to managing chronic pelvic pain at home and reducing the reliance on traditional prescription drugs for pain relief for endometriosis patients, while also marking a groundbreaking use of VR software as a DTx  treatment for overall management of chronic pain.

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Researchers found that the Fusobacterium species of bacteria facilitates the development of endometriosis lesions 

Source: Science Translational Medicine
June 14, 2023

In a new study published in Science Translational Medicine, Fusobacterium was found in the endometrium and endometrial lesions of more than half of endometriosis patients. When studied in a mouse model, the presence of Fusobacterium bacteria increased the number of endometrial lesions. Treatment with antibiotics specific for gram-negative bacteria was found to decrease the size of lesions. This study paves the way to explore antibiotics for Fusobacterium infection as a new therapeutic option for endometriosis patients. 

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