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.
Tuesday, 9 November 2010
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
http://parkinsoninfo.org/more_info.asp
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
http://parkinsoninfo.org/more_info.asp
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.
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.
http://www.mediafire.com/?nzwy1jljicj1mxm
http://www.mediafire.com/?nzwy1jljicj1mxm
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!
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.
http://www.endofound.org/video/event/medical-conference-2010/83
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.
http://www.endofound.org/video/event/medical-conference-2010/83
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.
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.
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