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.
Friday, 25 June 2010
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.
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.
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’.
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
Migraine
Depression
Irritable Bowel Syndrome
Allergies
Chronic Fatigue
Infertility
Anxiety
Fibromyalgia
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.
Upper respiratory tract infections
Vaginal infections
Urinary infections
Migraine
Depression
Irritable Bowel Syndrome
Allergies
Chronic Fatigue
Infertility
Anxiety
Fibromyalgia
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!
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!
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