Wednesday, 15 December 2010

In the news this week

You may have seen, in one of the many news outlets that have reported it this week, that there has been a major story in endometriosis. This is the story concerning the finding of a new genetic locus associated with endometriosis (if you’ve not read it yet, there’s a good report here).

But what does it all actually mean? Well let’s start at the beginning. Several groups of researchers from the US, UK and Australia have been looking at why some women get endometriosis and other don’t. As endometriosis runs in some families the best place to look is at your DNA. Your DNA is like the set of instructions that makes you, and even though you share around 99.99% of your DNA with any other person on this planet each person’s DNA is individual in some way. If you imagine your DNA as a book, it is divided into 23 ‘chapters’ we call chromosomes. In each chromosome we have hundreds, sometimes thousands, sets of instructions for making proteins, each instruction we call a gene. However, the instructions sometimes get corrupted which is what is known as mutation. A mutation in a gene (or set of genes) can cause it to stop working properly which can be bad news for your body as it can lead to cells going haywire and causing disease.

This is what we think happens in endometriosis, mutations occur that make certain cells behave in an unusual manner leading to disease presentation. The only trouble is finding the mutation/s responsible is a daunting task, a task that was taken on by the collaborative research team mentioned above. What they did was to look at the DNA of women with and without endometriosis and look for any errors common only to the women with endo.

What they found was a particular genetic variation on chromosome 7 that was associated with an increased risk of developing endometriosis. The trouble is the variation they found was not in a gene. If we go back to our analogy of DNA being like a book with instructions in, most of the ‘text’ in our DNA book is actually just rubbish that doesn’t contain any useful instructions (what is known as an ‘intronic region’), this is where the researchers found their variation, in a region dubbed, rather unpoetically, rs12700667. However, sometimes variations in these ‘rubbish’ regions can give us clues as to where to look for genes that are involved in endometriosis. For example, the authors of the paper identified two genes of interest, named NFE2L3 and HOXA10, in the abstract. HOXA10 is particularly important in this case as it is a major controller for the development of the uterus.

So what does this mean for endo patients? Well unfortunately it’s unlikely to will lead to any new cures or diagnostic methods anytime in the near future. What it will do though is help us better understand who is at risk from the disease and why is it passed along some family lines.

The original research was published in Nature Genetics, you can buy the full text article or view the abstract free here.

Wednesday, 17 November 2010

On the Origin

Gradually there are more and more people becoming interested in endometriosis these days, which may be largely due to the internet allowing sufferers, researchers and clinicians to communicate effectively and efficiently (the fact that I would’ve been able to write this blog 20 years ago goes some way to prove this point), but endometriosis is not a modern disease, it is a condition that has been around for a very long time. If we take it to its logical conclusion, endometriosis is probably older than humanity itself. The fact that some species of primate, with which we share a common ancestor, can develop endometriosis in captivity suggests the disease is millions of years old (around 25 million years as an approximation).

Earliest accounts of endometriosis date back to Europe about 300 years ago, where it was described as ‘cysts’ in the pelvic cavity then later described in detail by a physician named Von Rokitansky in 1860. And yet throughout the long, sad natural history of endometriosis, it has only been during the last 100 years or so that we have actually gained any practical insight into the disease. Trying to find the origin of endometriosis in 20th century literature is especially difficult as the disease has not always been known as endometriosis.

A recent publication has found that a Canadian gynaecologist named Thomas Cullen was the first to identify the disease under the name ‘adenomyoma’ around 1908. However, it was not until Dr John Sampson started formulating his theories on the pathology of the disease (in particular retrograde menstruation) that it came to be known as ‘endometriosis’ which roughly translates as ‘disease inside the uterus’.

Thus it went from there; the number of papers published on endometriosis research has exploded over the years:
From 69 publications in 1960
To 125 in 1970
To 196 in 1980
To 430 in 1990
To 453 in 2000
To 901 in 2010
In total there are over 17,000 articles with endometriosis as a keyword published to date, a 13 fold increase over 50 years. So the scientific community have sat up, taken notice and are trying to come up with solutions that will hopefully be improving lives in the not too distant future.

Tuesday, 9 November 2010

A little bit more good news

Some of you may have read that endometriosis is associated with an increase in risk of certain cancers, in particular ovarian cancer. Whilst this is true, it was found that the risk only significantly applies to those with long standing endometriosis (i.e. between 10-15 years) and actual increase in risk is very small (only about 2-5%) after all, we can take some solace knowing that endometriosis is very common but ovarian cancer is not.

But while it may be saddening to hear you have an increased risk of certain cancers (even if the risk is small) perhaps the most important factor is the survive rate. The study I’ve referenced above found that women who have endometriosis and ovarian cancer tended to have their cancer diagnosed at a younger age, which may be beneficial as a good prognostic factor for cancer is early diagnosis.

The issue of survival of cancer in endometriosis patients is the focus of a recent study from Sweden. This study took 4,278 women with endometriosis and some form of malignancy and 41,831 women with malignancy but without endometriosis. The findings were quite encouraging as they found women with endometriosis had a better rate of survival for malignancies in general, but specifically better for breast and ovarian cancer. There was however, a poorer rate of survival for malignant melanoma (but remember, melanoma has excellent survival rates).

So although women with endometriosis have a slightly higher risk of developing ovarian cancer, it would seem women with endometriosis also have a better survival rate, funny how the universe balances out sometimes. Why might this be the case? I’m not completely sure, it may be that women with a chronic health condition like endometriosis are more aware of their health in general and may be more adept at detecting deviations from the norm that signal cancer, thus seeing their doctor sooner and getting treatment sooner. Of course women with endometriosis also see doctors more often, so the likelihood of incidentally discovering cancer earlier is also increased.

Monday, 25 October 2010

Endometriosis and Parkinson’s disease

There’s not usually much good news when it comes to endometriosis, so I know what some of you may be thinking “Oh no, he’s going to tell us we’re more likely to get Parkinson’s if we have endometriosis” well, you shall be pleasantly surprised to hear that, in fact, I’m going to report the opposite. Well, ok it’s not quite the opposite, but a current study has found that women with endometriosis are no more likely to develop Parkinson’s than those without endo.

The study was carried out by the Boston University School of Medicine and took 12,093 Parkinson’s patients from the Danish National Registry of Patients. The authors then looked at what other estrogen related diseases these women had been diagnosed with before Parkinson’s. It may be news to some of you, it certainly was to me, that estrogen exposure has been associated with Parkinson’s. However, whereas an increase in estrogen exposure is suspected as a causative factor for endometriosis; endogenous (that is, the body’s own) estrogen is thought to be protective against Parkinson’s, this may be the reason that men are more at risk of developing Parkinson’s than women.

Parkinson’s disease is a progressive neurodegenerative disease. That is to say it is a disease that causes loss of brain cells leading to problems with movement, which gradually gets worse over time. It is a disease that usually affects older people (61 is the average age of onset in the U.S). Like endometriosis there is no single cause for Parkinson’s, which currently cannot be cured, but can be treated. Some of the early signs of Parkinson’s are:
- Difficulty/slowness/stiffness of movement
- Dementia
- Speech changes
- Difficulty chewing/eating
- Changes in mood or sleeping patterns
If you’d like some more information on Parkinson’s follow the link below for some good information

Monday, 11 October 2010

Runaround (again)

Firstly I’d just like to apologise for not posting for while, I’ve been busy sorting out my master’s thesis which, thankfully, is all done now so I can get back on with this! So to start here’s an interesting article enquiring as to whether exercise or painkillers are better to alleviate the pelvic pain symptoms associated with endometriosis. Initially it seems like a question common sense could answer, but in fact the study was comparing the effectiveness of painkillers in women who have regular exercise and those who don’t. Their conclusion was that women who exercise regularly find painkillers less effective than those who do not exercise regularly.

Unfortunately I can’t get access to the full article which is tricky as I can’t find out which painkillers each group was taking. After all, if the group who did not exercise were talking stronger painkillers then this might skew the results. Another problem with this study is the sample size. For the analysis of the effectiveness of painkillers the authors only used 14 women who exercised and 33 who didn’t. Although a statistical difference was found between the two groups, we have to think with such small numbers of women, was it really a fair comparison?

It is also important to consider that women with endometriosis who exercise regularly may be able to do so because they experience less severe symptoms than those who may be unable to exercise regularly. There are also socio-economic factors to consider, for example women who are being supported by their partners would have more time to exercise compared to those who have to work full time.

Without having all the details to hand it is hard to judge however, is it right for the authors to conclude “....that taking painkillers might be less effective among endometriosis patients performing regular daily sport activities” with such a small study? What if women with endometriosis who exercise regularly decide not to take painkillers on the basis of this finding when they could have helped? As a scientist you have to be very careful what you say and how you say it, especially if what you say can be fed through, what I like to call, the ‘Out of Context Generator’. This is a machine owned by all media outlets, especially newspapers. Basically, facts are fed into this machine and then sensationalist headlines are spat out that help increase revenue for said media outlet. If we were to feed the above article into this machine we would get a headline something like “Exercise found to be better than Drugs for Painful Womb Condition” (because journalists so love to refer to endometriosis as such).

Unscrupulous pedlars of alternative medicines could use this as ‘proof’ that natural regimes are preferential to drugs forced upon us by evil, faceless pharmaceutical companies. Do you see how a relatively innocuous statement can get out of hand? What can we do to avoid such attempts to confuse us? As Socrates once said “The greatest danger to both the individual and society is the suspension of critical thought ”. Basically don’t be afraid to question whatever you read, wherever you read it, but of course I would be a hypocrite if I didn’t say, don’t take my word for it.

Wednesday, 18 August 2010

Depression Survey Results

At the beginning of the year I started a small study, the main reason for this was that I found myself frustrated at the lack of information about the effects of depression on women with endometriosis. So I came up with this study and have not long finished writing up the report. There are some interesting findings in there which I hope my readers will also find informative. Anyway it’s all explained in the report which you can download (in the form of a PDF) from the link at the end of this post.

Monday, 12 July 2010

Endo, endo everywhere

Endometriosis is a condition that you usually associate with the pelvic organs (the uterus, ovaries, fallopian tubes etc); however it is not exclusive to these areas. Endometriosis can be found pretty much anywhere around the body, though cases of extra pelvic endo are rare. Below is a list of sites in which endo has been found, although I’ve tried to make the list as complete as possible I admit I may have missed some items (feel free to add any in the comment box below!). I’ve put the medical names of each site in brackets in case anyone would like to further research these areas.

The Brain (cerebral)
The Heart (myocardial)
The Lungs (pulmonary or catamenial pneumothorax/hemothorax/hemoptysis)
The Diaphragm
The Liver (hepatic)
The Stomach (gastric)
The Kidney (renal)
The Pancreas (pancreatic)
The Intestines (ileum or colon)
The Appendix (appendiceal)
The Navel/Bellybutton (umbilicus)
Tear Ducts (nasolacrimal)
The Nose (nasal)
The Skin (cutaneous)
The Buttocks (gluteal)
The Leg Muscle (soleus and gastrocnemius)

Now if you read any of the above links a frequent comment you will probably notice relates to the rarity of endometriosis outside the pelvis. While it is true extra pelvic endometriosis is rare, it can be quite serious. Extra pelvic endometriosis can become malignant, although again this is quite rare. The case of endo of the heart reported above proved to be fatal. If you read the case of gluteal endo reported above it turned out the woman was left permanently disabled. Generally the way to recognise extra pelvic endo is if you find there is any unusual pain or bleeding that occurs in regular cycles, so it pays to be wary, but not paranoid!

Friday, 9 July 2010

First Worldwide Study Finds that Women’s Productivity at Work is Significantly Impacted by Endometriosis

Some time ago the Global Study of Women’s Health (GSWH) was started by the World Endometriosis Research Foundation (WERF). This study recruited 1418 women aged between 18-45 from 16 different countries around the world. The study used questionnaires to assess the impact endometriosis on their lives. During the 26th meeting of the European Society of Human Reproduction and Embryology some of the preliminary results of this study were announced. The main press release for these results can be found by following this link. However, I’ll summarise a few of them now.

Average time between onset of symptoms and diagnosis was found to be 7 years. This is a saddening but fairly typical result.

65% of the women with endometriosis presented with pain. The press release doesn’t go into detail as to what type of pain was most prevalent, but I can take an educated guess at dysmenorrhoea (heavy, painful periods) and dyspareunia (painful intercourse) being at the top of the list.

The stage of endometriosis was not related to the amount of pain the woman suffered. This echoes the findings of previous studies; in fact some studies have suggested minimal endometriosis can be more painful than severe forms of the disease.

The pain decreased productivity at work by 38%, this loss of productivity was actually due more to problems at work rather than time off for illness. That 38% equated to around 11 hours per woman week lost to endometriosis. Now let’s do some quick calculations. There are an estimated 2 million endo sufferers in the UK, each losing 11 hours per week, that’s 22,000,000 woman hours of work lost each week or just over 1 BILLION woman hours lost every. Single. Year. For the USA that number goes up to approximately 30 BILLION woman hours per annum. These are the sort of statistics politicians are really interested in, so if you bump into your MP or Senator or Mayor and you really want to get their attention, shove some of those statistics in their face.

The study also found that non-job related activities such as exercise, housework, childcare, shopping, studying etc were also severely affected by the pain caused by endo, but you probably already knew that.

On a different but quite similar note there have been a series of talks on endometriosis from the Endometriosis Foundation of America which make for very interesting watching (I would advise watching the videos instead of reading the transcripts as some of them have been improperly transcribed). Here is the link to the video gallery.

Friday, 2 July 2010

Getting under your skin

Endometriosis can be found pretty much anywhere in the body (I’m going to do a separate post on that at some point, but I digress) for this post though I’ll be focussing on endometriosis of the skin, or cutaneous endometriosis as it is known. There have been several reports of endometriosis found on the skin, although the phenomenon is still considered rare, reports of this subtype of endometriosis go back to the 50’s. Most commonly cutaneous endometriosis is found on surgical scars and around the umbilicus (belly button/navel). Symptoms typically include cyclic pain emanating from a mass near/on a scar or the umbilicus and can be misdiagnosed as suture granuloma, lipoma, abscess, cyst, hernia or skin cancer.

Let’s take a look at reports of some typical examples; three years after having a caesarean section a 37 year old woman found a nodule under her scar that became painful during menses. The nodule was removed surgically and after examination it was found to be cutaneous endometriosis. Another report found a woman with dark brown mass on the umbilicus associated with cyclic pain. Although the woman was found not to have pelvic endometriosis the mass on her umbilicus was found to be endometriosis.

The reason for me discussing cutaneous endometriosis is that a paper has recently been published in Brazil that suggests caesarean section greatly increases the risk of endometriosis developing on the scar. The study looked at 72 patients diagnosed with scar endometriosis between 1978 and 2003. It was found that the risk of scar endometriosis developing was far higher after caesarean section, where the risk was 0.2%, than other procedures e.g. episiotomy, where the risk was 0.06%. There are several parallels that can be drawn between cutaneous endometriosis and pelvic endometriosis. Both conditions are often misdiagnosed, both present with cyclic pain and we still don’t really understand how the disease gets to where it is. As cutaneous endometriosis appears around scars it could be hypothesised that somehow fragments of endometrium find their way into the open wound during surgery where they later form endometriotic implants.

The good news though is cutaneous endometriosis can be easily removed with surgery and once it is gone it usually doesn’t come back.

Friday, 25 June 2010

A Seminal Paper

There are many external factors that we suspect may play a role in the growth and development of endometriotic lesions. The main contenders being environmental toxicants such as dioxin or bisphenols which are thought to disrupt the body’s normal hormonal balance. Other factors that have been suggested include metals like lead and cadmium, eating red meat or trans fats and alcohol consumption. However, a recent study has identified another potential candidate, semen.

Yes that’s right, a study from Japan has found that seminal fluid increases the growth of endometriotic cells in culture. The logic behind the original thinking is that seminal fluid contains a lot of macromolecules, a rather nonspecific term that in this context refers to factors which may lead to the growth of endometrial tissue. This study found that when seminal fluid plasma was added to endometrial cells from women with and without endometriosis it stimulated growth of these cells. What is interesting is the finding that normal endometrium from women with endometriosis displayed increased growth over normal endometrium from women without endometriosis. This suggests that even the normal endometrium from women with endometriosis is somehow more sensitive to growth signals. This lends some support to the retrograde menstruation theory. If endometrial cells are somehow ‘primed’ for increased growth capacity in some women, then when these cells are refluxed they will be more likely to implant, proliferate and eventually form endometriotic lesions.

The growth signals in question that are found in seminal fluid are hepatocyte growth factor (HGF), estrogen and prostaglandin E2 (PGE2). PGE2 in particular has been touted as a major factor regulating a number of processes essential for developing and sustaining endometriosis.

Now you may very well ask, as I did “how does seminal fluid come into contact with endometriotic lesions?” After all endometriotic lesions are found on the outside of the pelvic organs. Apparently seminal fluid can come into contact with endometriotic lesions via “hematogenous dissemination or direct tissue perfusion through the anterior or posterior vaginal formix after sexual intercourse” which basically means it can diffuse through the rear wall of the vagina much like water diffusing through a sponge. I need to point out though that this does not suggest endometriosis can be caused by unprotected sex, but it may irritate the existing endometriosis.

However, on the other side the macromolecules found in seminal fluid promotes the development and implantation of the embryo, which is good if you are trying to conceive. Of course, as with any new findings there is more work to be done before we draw any definitive conclusions, further studies may prove or dispose what has been found.

Monday, 14 June 2010

Fat of the land

Talk of endometriosis and the role of diet is bound to crop up sooner or later. Some women have found that changes to their diet can help reduce the symptoms of endometriosis, some women find that certain foods make their symptoms worse, particularly if they have bowel symptoms.

Some studies have found that women who consume higher levels of fish oil experience less pain symptoms, although it could be that higher fish consumption is merely an indicator of a healthier lifestyle overall. Other studies agree that a diet high in green vegetables and fruit is associated with a decreased risk of endometriosis, whereas a diet high in red meat was found to increase the risk of developing endometriosis. Again though, these dietary factors are probably related to overall lifestyle health.

Recently a study from the Harvard Medical School found that consumption of certain types of fats was associated with an increased risk in endometriosis. This study used data from the Nurses’ Health Study II cohort, a very large repository of information on 116,607 registered female nurses in the US. Information has been collected from 1989 to 2001 and includes data on illness, environmental and lifestyle factors, so it’s a great source of information about the relationship between risk factors and illness. The aforementioned study looked at data on the 1199 cases of laparoscopically confirmed endometriosis and compared it with data from a food frequency questionnaire. This is what they found.

Total fat intake was not associated with any significant increased risk for developing endometriosis

There was a suggestion that animal fat intake may lead to an increased risk of developing endometriosis, which agrees with the studies mentioned previously that suggested increased consumption of red meat increases the risk of developing endometriosis. Although, intakes of the main components of animal fats i.e. saturated fat and monounsaturated fat were not associated with an increased risk of endometriosis.

Intake of trans-unsaturated fats was associated with a higher risk of endometriosis, with the risk becoming higher if protein intake was also increased.

Intake of long chain omega-3 fatty acids was associated with a decreased risk of endometriosis.

In this prospective study of US nurses the main sources of the seemingly protective long chain omega-3 fatty acids were salad dressing, tuna and dark fish. The major sources of trans-unsaturated fats were fried foods, margarine and crackers.
These results appear to show that a diet high in trans-fats increases the risk of developing endometriosis. However, it may be (and I’m probably sounding like a stuck record now) that a person who has a diet high in trans-fats, does not have a healthy lifestyle compared to someone who eats a lot of omega-3 containing foods. Therefore, the people who eat a lot of omega-3 are not necessarily at a decreased risk of endometriosis because they eat omega-3, but because their lifestyle is healthier overall. You may very well ask “if endometriosis is a disease you are born with, does diet really make that much difference?” Well it could be that having a consistently healthy lifestyle from an early age somehow suppresses the disease much in the same way as a healthy lifestyle can stave off cancer in those with a family history of the disease.

And, if nothing else, it’s another good reason to get trans-fats out of your diet, because although they taste delicious, they’ll make you fat and prone to heart attacks.

Wednesday, 19 May 2010

She’s definitely born with it

Way back when I first started this blog in April 2009 you may remember I reported on the finding that endometriosis had been discovered in unborn foetuses. This evidence pretty much provides conclusive proof that endometriosis is a disease you are born with. Well a very recent study from the same research group in Italy has confirmed their previous findings. After performing autopsies on 13 human foetuses, deceased from placental pathology or miscarriage, they found one 25 week old foetus showed clear evidence of endometriosis. It is now becoming clear that endometriosis is a disease you are born with, the only trouble is we still don’t know why.

Tuesday, 11 May 2010

A Pain in the.....Shoulder?

During my routine searching through the recent literature on endometriosis I happened upon an article that got my attention. If you follow the link you’ll see there isn’t much there, merely a report of right shoulder pain which was later found to be due to endometriosis. That’s unusual in itself but I realised that’s not the first time I’ve heard a report like this. Doing some further searching I found papers referring to endometriosis of the diaphragm. Endometriosis of the diaphragm can lead to a condition known as catamenial hemothorax, where blood accumulates in the pleural cavity (the part in your chest where your lungs are).

Although cases of diaphragmatic endometriosis are rare, I found about eight papers describing the phenomenon, most of which described cyclic right shoulder pain as an indicator of endometriosis of the diaphragm. Why pain in the right shoulder should be an indicator of endometriosis in a completely different part of the body I’m not sure. How endometriosis comes to be on the diaphragm as well is somewhat of a mystery. There are theories which suggest endometriosis can travel or ‘metastasise’ around the body. Others think that patches of endometriosis are formed around the body whilst you are in utero (i.e. still in the womb) and lay dormant until something triggers them to develop into endometriotic implants. Unfortunately there is no certain conclusion yet, but as soon as there is I’ll let you know, whatch this space.

Sunday, 9 May 2010

A Weighty Issue

Despite the fact every conceivable media outlet for the last fifty years has been forcing the notion down our collective throats that being thin is the most important thing in the universe, when it comes to endometriosis being thin is apparently not the preferred body model of choice. There have been several studies that suggest women with a lower BMI are more at risk of developing endometriosis than those with a higher BMI.

BMI, I should clarify, stands for Body Mass Index, essentially a ratio of weight to height that is often (mistakenly) used as a measure of overall health, but more on that later. Having a BMI of:
Less than 18 means you are underweight
Between 18 and 25 means you are of normal size
Between 25 and 30 means you are overweight
Over 30 means you are obese
Over 40 means you are morbidly obese
Anything over 50 and you will probably receive a personal visit from Richard Simmons.

Firstly, a Korean study, published only a year ago, looked at women with minimal and mild endometriosis and women with advanced endometriosis. It turned out that women with advanced endometriosis had a significantly lower BMI than those with minimal/mild disease. You may think then that being thin is bad, but looking at the details, that is not necessarily the case. The average BMI for women in this study with minimal disease was 23.0, the average BMI for women with severe disease was 21.4. Both of these groups of women fell well within the ‘normal’ BMI bracket meaning that neither group could be considered under or over weight. Also this particular study did not include a control group (i.e. a group of disease free women) to compare with women with endometriosis, which widens the margin for error.

Another study, this time from Italy in 2005, looked at the differences in BMI between women with and without surgically confirmed endometriosis. This study concluded, much like the Korean study, that women with endometriosis were significantly taller and weighed less than controls. So does this mean that women with endometriosis are spindly giants, wandering the countryside like elfin goddesses? Well not quite, sorry. The average height for women in the control group was 162.4cm (about 5 foot 4), the average height for the women with endometriosis was 164.5cm (about 5 foot 5). The average weight of the control group was 58.8Kg (129.4 pounds), the average weight of women with endo was 57.2Kg (125.8 pounds). Not that much different I think you’ll agree. But I did say the results were significantly different. The trouble is I meant mathematically significant, which is simply the product of several very long statistical calculations that may not appear significant in general terms. Confusing? Yes, but also necessary.

The next two studies both come from the USA, albeit one from May 2010 and one from Nov 2005. These two studies again both concluded that women with endometriosis tended to be slimmer and taller than controls (although not by much in real terms). However, these studies concluded that having a leaner body shape during adolescence and young adulthood increased the likelihood of developing endometriosis regardless of adult body habitus and menstrual characteristics. So does that mean we should all force feed pies to our children? Well, no because as one author points out “That women diagnosed with endometriosis may have a consistently lean physique during adolescence and young adulthood lends support to the suggestion of there being an in utero or early childhood origin for endometriosis”. Meaning that being thin during early life and having endometriosis go hand in hand. Essentially being thin doesn’t cause endometriosis, endometriosis causes you to be thin (when you’re young anyway). Why might this be the case? Perhaps the genetic or causes for endometriosis, whatever they may be, bring along other changes such as changes to metabolism which may lead to leaner body shape during childhood.

You’ll notice that most of these studies use BMI as a measure for weight. Therefore, you may think having a high BMI means you're fat. However that is simply not the case (up to a point). A body builder, for example, may have the same BMI as an obese person, because BMI is not an accurate measure of body fat, it is only a ratio of height to weight. So it should be worth noting next time you read a story connecting endometriosis to body weight whether they use BMI or body fat as a variable, it could make all the difference.

Although it would appear changing your diet cannot stop you from developing endometriosis, some changes may result in symptomatic relief. For more information on diet and endometriosis I recommend you check out Dian Mills’ book ‘A Key to Healing through Nutrition’.

Monday, 29 March 2010

An Inflammatory Subject

Endometriosis has a lot of what is termed co-morbid conditions. That is, conditions you are more likely to have if you have endometriosis. A shortlist of such conditions, in no particular order, is given below.

Upper respiratory tract infections
Vaginal infections
Urinary infections
Irritable Bowel Syndrome
Chronic Fatigue

That’s a short list by the way, endometriosis likes company apparently. Anyway there’s another co-morbid condition to add to the pantheon of existing ones you’ll be overjoyed to hear. A recent study found that pelvic inflammatory disease (PID) is more common in women with endometriosis. PID is a general term used when it is found that any of the pelvic organs (uterus, ovaries, fallopian tubes etc) are inflamed. Untreated PID can lead to the formation of adhesions between nearby organs which cause pain. PID is a very generic term as well because it doesn’t really tell us why the pelvic organ is inflamed, although it is usually due to an infection of some kind.

Irritatingly, despite the fact that endometriosis and PID are two very different conditions, endometriosis can often be misdiagnosed as PID and diagnosing each condition individually would be very difficult if a woman has both endo and PID.

The study in question looked at all the women who underwent surgery for ovarian endometriosis between 2000 and 2007, (a total of 720) between two hospitals in Greece. PID was identified in 2.9% of cases, which is a small number but still higher than the general population. So, why are women with endo more likely to have PID? Like most of the questions associated with endometriosis, we don’t really know, and that’s very annoying. Judging by the above list of co-morbid conditions it would appear women with endo are more susceptible to infections, possibly due to deficiencies in the immune system. Anyway, enough of my mental flailing, if you want to know more about PID there is a fact sheet here.

Wednesday, 17 February 2010

Full of Hot Air

As you probably all know endometriosis has a list of symptoms as long as my arm (and I have long arms), which is one of the major barriers to speedy diagnosis. Some of the symptoms are more common (or more well recognised) than others. For example, painful, heavy periods and pain during intercourse are two of the most widely reported. In my experience some of the least well recognised symptoms of endometriosis are painful bowel movements (often dismissed as Irritable Bowel Syndrome) and chronic fatigue (often just dismissed).

However, a recent study has highlighted one of the least well recognised symptoms, abdominal bloating. Chances are, if you have endometriosis or not, you have experienced abdominal bloating but might have thought it was just caused by something you ate. This study took 26 women with endometriosis and 25 women without and got them to fill out questionnaires as well as measuring the girth of their abdomen throughout the menstrual cycle. According to this study having endometriosis meant that you were much more likely to experience abdominal bloating, 96% of women with endo reported abdominal bloating compared to 64% of controls, and your abdominal bloating was likely to be much more severe and can be accompanied by hand swelling and cycles of diarrhoea and constipation.

That study came just a few months after one I wrote about in September, which also concluded that bloating was the most common gastrointestinal symptom of endometriosis. However, it transpired that gastrointestinal symptoms were not related to involvement of endometriosis with the bowel which raises more questions than it answers. How can it be that women with endometriosis present with so many gastrointestinal symptoms, but endometriosis isn’t necessarily present on the bowel? One answer I can think of is that the female reproductive organs and the bowel exist in very close proximity to one another. Inflammatory factors produced by diseased tissue on the ovaries or uterus could therefore come into contact with the bowel causing inflammation of the bowel, resulting in the multitude of unpleasant symptoms many women associate with endometriosis. That’s my guess anyway, if you happen to know for sure, don’t keep it to yourself!

Friday, 29 January 2010

Now ruining your enjoyment of a sunny day

If, like me, you live in England then over exposure to sunlight is not high on your list of worries, however I imagine that for some people the sun can be a bit of a worry. Well according to a growing body of research, women with endometriosis are joining the ranks of those who shouldn’t venture into the sun very often. The most recent article on this subject found that women with endo are more sensitive to the sun than women who don’t have endo. This may tie in with other findings which suggest women with endometriosis have more moles and freckles than controls. This further makes sense of other research that found that women with endo are more at risk of developing skin cancer.

So in order to break it down further:
1) If you have endometriosis you are more likely to have fair skin and more moles and freckles
2) Thus you are more sensitive to the sun’s radiation and more likely to burn quicker and more easily when exposed to the sun
3) Thus you are at a higher risk of skin cancer

I’m not sure why this appears to be the case, maybe there are genetic traits that come with fair skin and freckles that make a woman more susceptible to developing endometriosis. I should probably point out as well that the current research does not suggest sun exposure causes endo. I firmly believe endometriosis is something you are born with and therefore, unlike melanoma, no amount of sunscreen can avoid.