Endometriosis is well known, especially by the sufferer, to cause a myriad of symptoms. Apart from the obvious pelvic pain, gastrointestinal symptoms appear to be the next most common. This can often lead a patient with endometriosis to think that maybe the disease is present on the bowel.
A new study has been published recently that may allay some of those fears though. A paper published in the Australian & New Zealand Journal of Obstetrics and Gynaecology. This study found 290 women with endometriosis of which 90% had gastrointestinal symptoms. The most common symptom was bloating. Of the 290 women, only 7.6% actually endometriosis on the bowel which is a surprisingly small number. Of course this raises the problem of why, if there is no endometriosis on the bowel, do patients experience bowel problems? I don’t have the answer myself and I can only theorise upon what it might be. It could be that adhesions, a separate entity to endometriosis, are present on the bowel which may cause problems. It could be that problems with the immune system that are often present in women with endometriosis, play a role in altering the function of the bowel. It still remains a bit of a mystery.
Oh and it will probably come as no surprise to any of you that 76 of the aforementioned women were originally misdiagnosed with irritable bowel syndrome.
Tuesday, 8 September 2009
Tuesday, 25 August 2009
Having the Nerve
I think anyone that has been for a laparoscopy to diagnose endometriosis has at some point wondered “isn’t there an easier way?” Unfortunately the answer is ‘no’, which comes as somewhat of a surprise and disappointment even to me. There’s been a great increase in endometriosis research over the last few years (believe it or not) and yet not much has come from it. There are a few new treatment options (which have mostly been retro-designed from cancer therapies) and slightly improved use of imaging techniques such as Ultrasound and MRI, but that’s about it. The average time for diagnosing endometriosis is still somewhere between 8 and 9 years which is wholly unacceptable. It seems that although we have a better understanding of the disease, that knowledge isn’t being put to practical use.
However, there have been some promising new developments that have come to light recently, in particular, there’s been some news about a new diagnostic method for endometriosis. Although I am naturally begrudged to provide a link to a media interpretation of scientific information, a good report on the subject can be found here on the BBC website. The BBC report on one article published in Human Reproduction, but there are actually two, which you can see here and here. Both articles report on the same subject and draw very similar conclusions.
It is all about a new ‘semi-invasive’ diagnostic test for endometriosis that would take a similar form to that of a smear test (albeit a bit more invasive), but it’s called an endometrial biopsy, follow this link for more info on that. What will then happen is that someone will look at the biopsy and count the number of small nerve fibres. The basic finding from the aforementioned studies was that upon analysing these endometrial biopsies, women with endometriosis had significantly more nerve fibres in their endometrium, up to 14 times higher, than women without endo. The good thing about this is that it is a pretty simple test to do and results shouldn’t take long to get. Also the preliminary findings indicate that this test is quite accurate. One report stated 97.5% accuracy and the other stated 91% accuracy, but they did use different methods.
Although these are encouraging results they were only small studies, much more investigation in larger groups of women is needed before this test can be widely adopted. The other problem is that this new test cannot replace a laparoscopy. This test will only be able to tell you if you have endometriosis, a laparoscopy would still have to be performed to tell what the stage the endometriosis is at, where the endometriosis is, and if there are any adhesions or other complications. Nevertheless I can see a promising future for this new test as a screening method. It could be used in women who have only just started presenting with symptoms, or for young women with a family history of endometriosis, allowing for earlier medical intervention, hopefully drastically reducing the delay in diagnosis.
However, there have been some promising new developments that have come to light recently, in particular, there’s been some news about a new diagnostic method for endometriosis. Although I am naturally begrudged to provide a link to a media interpretation of scientific information, a good report on the subject can be found here on the BBC website. The BBC report on one article published in Human Reproduction, but there are actually two, which you can see here and here. Both articles report on the same subject and draw very similar conclusions.
It is all about a new ‘semi-invasive’ diagnostic test for endometriosis that would take a similar form to that of a smear test (albeit a bit more invasive), but it’s called an endometrial biopsy, follow this link for more info on that. What will then happen is that someone will look at the biopsy and count the number of small nerve fibres. The basic finding from the aforementioned studies was that upon analysing these endometrial biopsies, women with endometriosis had significantly more nerve fibres in their endometrium, up to 14 times higher, than women without endo. The good thing about this is that it is a pretty simple test to do and results shouldn’t take long to get. Also the preliminary findings indicate that this test is quite accurate. One report stated 97.5% accuracy and the other stated 91% accuracy, but they did use different methods.
Although these are encouraging results they were only small studies, much more investigation in larger groups of women is needed before this test can be widely adopted. The other problem is that this new test cannot replace a laparoscopy. This test will only be able to tell you if you have endometriosis, a laparoscopy would still have to be performed to tell what the stage the endometriosis is at, where the endometriosis is, and if there are any adhesions or other complications. Nevertheless I can see a promising future for this new test as a screening method. It could be used in women who have only just started presenting with symptoms, or for young women with a family history of endometriosis, allowing for earlier medical intervention, hopefully drastically reducing the delay in diagnosis.
Wednesday, 12 August 2009
Trial and Error
I’ve noticed at the time of writing this that there seems to be a bit of buzz going round the internet concerning Chinese herbal medicine (CHM) for the treatment of endometriosis. In particular there are some less than credible sources suggesting that CHM is better than conventional medicine for treating endometriosis related symptoms. The report on the NaturalNews.com website is perhaps one of the worst offenders, starting as they do the title “Vitamins and Chinese Herbs Prove More Effective than Drugs for Endometriosis”. A bold statement I think you’ll agree, so you’d expect they have some serious evidence to back up their claim, well let’s see.
But before I go into the report, I’d like to take a bit of time to show you a few things from that same NaturalNews.com website. They have some cartoons on this website, fair enough I like cartoons I draw them myself, so let’s see what they’ve drawn. Well take a look at this one and this one if you would like to see the true face of this website. They compare the use of chemotherapy to the gassing of the Jews during the holocaust. I am literally stunned (Oh and they lazily recycled that one from this one about mental health medication). This is just so you know what sort of people we’re dealing with here, so let’s move onto their article on endometriosis before I rupture something.
The article starts off by reporting on a recent publication from the Cochrane Database of Systematic Reviews. The Cochrane group is a large group of people from a wide variety of backgrounds who take in large amounts of studies on a particular subject (including a large amount of studies on drug effectiveness) and thoroughly review the evidence for and against, in an unbiased and methodological manner. It is for this reason that a Cochrane review is thought by many, including myself, to be a definitive source of accurate information. In this instance the Cochrane group have reviewed the evidence for the use of CHM for the treatment of endometriosis, the abstract from which you can find here. NaturalNews.com reports that “Chinese herbs were found to relieve post-surgical symptoms more effectively than the conventional hormone-based drug therapies, with a nearly 96% success rate of complete symptom relief, as compared to only 10% with danazol. The herbs caused virtually no side effects, while a significant number taking hormone medication suffered increased period pain and irregular periods, acne, fatigue, weight gain and evidence of liver damage.” I’m not sure where they are getting those statistics, because there is nothing like that on the Cochrane review.
If you would like to hear what the review actually said, here it is. The review only focussed on two clinical trials of CHM for endometriosis treatment and even these had major flaws in them. For example, although the trials were randomised, neither of them was placebo controlled or double blind, which leaves huge gaps for errors to creep in. Just in case you aren’t familiar with clinical trials here is the criteria a clinical trial has to fulfil in order to be deemed accurate and unbiased.
Large sample size: This means that the more patients you enrol to test a new medicine the better, and more accurate your conclusions will be.
It has be placebo controlled: This means that the people trying the medicine are divided into two groups, one group gets the real medicine, the other group gets a dummy medicine (placebo). This is to make sure any effects people get from the medicine aren’t just random effects you could get from a placebo.
It has to be randomised: This means that patients are randomly assigned to the real medicine or placebo group. This is to stop doctors selecting the patients they think will respond best to the real medicine.
It has to be double blind: This means that neither the doctors nor the patients know whether they are getting the real medicine or the placebo.
These are not just arbitrary rules dreamed up one day by some guy in his garden shed either. These criteria are the result of hundreds of years of clinical trial and error and much personal suffering.
So let’s move on to what these CHM trials found, I’ll quote directly from the abstract so as not to put any personal spin on things “There was no evidence of a significant difference in rates of symptomatic relief between CHM and gestrinone administered subsequent to laparoscopic surgery”.
Ok so what about the effect on fertility, NaturalNews.com claimed “Women taking the Chinese herbal treatments were also 10% more likely to become pregnant following surgery than those taking prescription medication”.
This is what the Cochrane review actually said “There was no significant difference between the CHM and gestrinone groups with regard to the total pregnancy rate”.
And here is what the Cochrane review said about the effects of CHM compared to Danazol “Oral plus enema administration of CHM showed a greater reduction in average dysmenorrhoea pain scores than did danazol”. So there is some positive news about the effect of CHM, however we must remember that these trials were neither placebo controlled nor double blind, so can we really take them seriously?
Naturalnews.com doesn’t stop at CHM either, so neither shall I. They go on to report on the use of Pycnogenol, an extract from the French maritime pine bark for the treatment of endometriosis. NaturalNews.com proudly states “Pcynogenol, was found to decrease symptoms of endometriosis by 33% when used for nearly a year after surgery. In the study, patients took 30 mg capsules of Pycnogel twice daily for 48 weeks immediately after morning and evening meals. The treatment was found to have reduced all symptoms from severe to moderate within four weeks”. That is a direct copy and paste from the website, by the way its spelt ‘Pycnogenol’.
Here is a link to the abstract from the paper they are referencing, which compared the use of Pycnogenol with a Gn-RHa (leuprorelin). There is no mention of Pycnogenol decreasing symptoms by 33% or being effective after 4 weeks. This is what the paper does say though “Treatment with Pycnogenol slowly but steadily reduced the symptom scores. Treatment with Gn-RHa reduced the scores more efficiently; however, 24 weeks after the end of treatment, the scores suggested a recurrence of signs”. Not a very convincing incitement to use Pycnogenol I think you’ll agree.
NaturalNews.com goes on the talk about the use of vitamins for the treatment of endometriosis. They say “Vitamin combinations have also been shown to be an effective therapy for endometriosis. Also in 2007, Italian researchers enrolled 234 women to assess the effectiveness of nutrition versus drug treatment for six months after surgery.Both the nutritional treatment, which included vitamins (B6, A, C and E), minerals (calcium, magnesium, selenium, zinc and iron), omega-3 and omega-6 fatty acids, as well as probiotic bacteria preparations, and the drug treatment were found to be effective in reducing menstrual pain, pelvic pain and pain during sexual intercourse. However, only the drug treatment was found to increase the risk of bone thinning and menopausal symptoms.”
Again here is a link to the article they are referencing, which compared the use of hormone therapy, dietary therapy or placebo therapy for postoperative symptoms. This is what they found “Patients treated with postoperative hormonal suppression therapy showed less visual analogue scale scores for dysmenorrhoea than patients of the other groups. Hormonal suppression therapy and dietary supplementation were equally effective in reducing nonmenstrual pelvic pain. Surgery plus placebo showed significative decrease in dyspareunia scores. Postoperative medical and dietary therapy allowed a better quality of life than placebo”. Look back at the quote from NaturalNews.com, especially the part where they mention dietary therapy and hormonal therapy were equally as good at reducing menstrual pain. Then re-read the second sentence from the quote directly above, notice anything innacurate? Also notice that in no instance was dietary therapy alone better than hormone therapy. Another very interesting point is the comparative cost of both hormonal and dietary therapy. Take into consideration that the hormone therapy is just one tablet a day, whereas dietary therapy consists of tablets and pills for vitamins, minerals, fish oils and pro-biotic bacteria. Guess which one costs you more. Oh and NaturalNews.com kindly provides you with links to its affiliates who sell books on vitamins and nutritional supplements for you to buy, how kind.
I should probably point out that I am in no way against the use of Chinese herbal medicine or other natural medicines, if you have tried it and it works for you, that’s fantastic. What I am against is people or organisations manipulating or fabricating information in order to garnish support for their own twisted propaganda or to increase their own profits. Something that conventional and alternative medicine is both guilty of. Because when ideological one-upmanship and profiteering takes precedent over patient wellbeing do you know who loses out? You, the sufferer, that’s who.
But before I go into the report, I’d like to take a bit of time to show you a few things from that same NaturalNews.com website. They have some cartoons on this website, fair enough I like cartoons I draw them myself, so let’s see what they’ve drawn. Well take a look at this one and this one if you would like to see the true face of this website. They compare the use of chemotherapy to the gassing of the Jews during the holocaust. I am literally stunned (Oh and they lazily recycled that one from this one about mental health medication). This is just so you know what sort of people we’re dealing with here, so let’s move onto their article on endometriosis before I rupture something.
The article starts off by reporting on a recent publication from the Cochrane Database of Systematic Reviews. The Cochrane group is a large group of people from a wide variety of backgrounds who take in large amounts of studies on a particular subject (including a large amount of studies on drug effectiveness) and thoroughly review the evidence for and against, in an unbiased and methodological manner. It is for this reason that a Cochrane review is thought by many, including myself, to be a definitive source of accurate information. In this instance the Cochrane group have reviewed the evidence for the use of CHM for the treatment of endometriosis, the abstract from which you can find here. NaturalNews.com reports that “Chinese herbs were found to relieve post-surgical symptoms more effectively than the conventional hormone-based drug therapies, with a nearly 96% success rate of complete symptom relief, as compared to only 10% with danazol. The herbs caused virtually no side effects, while a significant number taking hormone medication suffered increased period pain and irregular periods, acne, fatigue, weight gain and evidence of liver damage.” I’m not sure where they are getting those statistics, because there is nothing like that on the Cochrane review.
If you would like to hear what the review actually said, here it is. The review only focussed on two clinical trials of CHM for endometriosis treatment and even these had major flaws in them. For example, although the trials were randomised, neither of them was placebo controlled or double blind, which leaves huge gaps for errors to creep in. Just in case you aren’t familiar with clinical trials here is the criteria a clinical trial has to fulfil in order to be deemed accurate and unbiased.
Large sample size: This means that the more patients you enrol to test a new medicine the better, and more accurate your conclusions will be.
It has be placebo controlled: This means that the people trying the medicine are divided into two groups, one group gets the real medicine, the other group gets a dummy medicine (placebo). This is to make sure any effects people get from the medicine aren’t just random effects you could get from a placebo.
It has to be randomised: This means that patients are randomly assigned to the real medicine or placebo group. This is to stop doctors selecting the patients they think will respond best to the real medicine.
It has to be double blind: This means that neither the doctors nor the patients know whether they are getting the real medicine or the placebo.
These are not just arbitrary rules dreamed up one day by some guy in his garden shed either. These criteria are the result of hundreds of years of clinical trial and error and much personal suffering.
So let’s move on to what these CHM trials found, I’ll quote directly from the abstract so as not to put any personal spin on things “There was no evidence of a significant difference in rates of symptomatic relief between CHM and gestrinone administered subsequent to laparoscopic surgery”.
Ok so what about the effect on fertility, NaturalNews.com claimed “Women taking the Chinese herbal treatments were also 10% more likely to become pregnant following surgery than those taking prescription medication”.
This is what the Cochrane review actually said “There was no significant difference between the CHM and gestrinone groups with regard to the total pregnancy rate”.
And here is what the Cochrane review said about the effects of CHM compared to Danazol “Oral plus enema administration of CHM showed a greater reduction in average dysmenorrhoea pain scores than did danazol”. So there is some positive news about the effect of CHM, however we must remember that these trials were neither placebo controlled nor double blind, so can we really take them seriously?
Naturalnews.com doesn’t stop at CHM either, so neither shall I. They go on to report on the use of Pycnogenol, an extract from the French maritime pine bark for the treatment of endometriosis. NaturalNews.com proudly states “Pcynogenol, was found to decrease symptoms of endometriosis by 33% when used for nearly a year after surgery. In the study, patients took 30 mg capsules of Pycnogel twice daily for 48 weeks immediately after morning and evening meals. The treatment was found to have reduced all symptoms from severe to moderate within four weeks”. That is a direct copy and paste from the website, by the way its spelt ‘Pycnogenol’.
Here is a link to the abstract from the paper they are referencing, which compared the use of Pycnogenol with a Gn-RHa (leuprorelin). There is no mention of Pycnogenol decreasing symptoms by 33% or being effective after 4 weeks. This is what the paper does say though “Treatment with Pycnogenol slowly but steadily reduced the symptom scores. Treatment with Gn-RHa reduced the scores more efficiently; however, 24 weeks after the end of treatment, the scores suggested a recurrence of signs”. Not a very convincing incitement to use Pycnogenol I think you’ll agree.
NaturalNews.com goes on the talk about the use of vitamins for the treatment of endometriosis. They say “Vitamin combinations have also been shown to be an effective therapy for endometriosis. Also in 2007, Italian researchers enrolled 234 women to assess the effectiveness of nutrition versus drug treatment for six months after surgery.Both the nutritional treatment, which included vitamins (B6, A, C and E), minerals (calcium, magnesium, selenium, zinc and iron), omega-3 and omega-6 fatty acids, as well as probiotic bacteria preparations, and the drug treatment were found to be effective in reducing menstrual pain, pelvic pain and pain during sexual intercourse. However, only the drug treatment was found to increase the risk of bone thinning and menopausal symptoms.”
Again here is a link to the article they are referencing, which compared the use of hormone therapy, dietary therapy or placebo therapy for postoperative symptoms. This is what they found “Patients treated with postoperative hormonal suppression therapy showed less visual analogue scale scores for dysmenorrhoea than patients of the other groups. Hormonal suppression therapy and dietary supplementation were equally effective in reducing nonmenstrual pelvic pain. Surgery plus placebo showed significative decrease in dyspareunia scores. Postoperative medical and dietary therapy allowed a better quality of life than placebo”. Look back at the quote from NaturalNews.com, especially the part where they mention dietary therapy and hormonal therapy were equally as good at reducing menstrual pain. Then re-read the second sentence from the quote directly above, notice anything innacurate? Also notice that in no instance was dietary therapy alone better than hormone therapy. Another very interesting point is the comparative cost of both hormonal and dietary therapy. Take into consideration that the hormone therapy is just one tablet a day, whereas dietary therapy consists of tablets and pills for vitamins, minerals, fish oils and pro-biotic bacteria. Guess which one costs you more. Oh and NaturalNews.com kindly provides you with links to its affiliates who sell books on vitamins and nutritional supplements for you to buy, how kind.
I should probably point out that I am in no way against the use of Chinese herbal medicine or other natural medicines, if you have tried it and it works for you, that’s fantastic. What I am against is people or organisations manipulating or fabricating information in order to garnish support for their own twisted propaganda or to increase their own profits. Something that conventional and alternative medicine is both guilty of. Because when ideological one-upmanship and profiteering takes precedent over patient wellbeing do you know who loses out? You, the sufferer, that’s who.
Monday, 13 July 2009
Round in Circles
That’s what it feels like sometimes when dealing with endometriosis, like you’re in a boat with an oar on only one side, just paddling away but ultimately going no-where. Then hurray! Someone throws you another oar, but it’s bigger than the other one so you end up moving forward slightly but still round in circles. What you really need is an outboard motor of some kind, or maybe some sails....sorry I seem to have lost where I was going with that metaphor. Anyway, the oars in this case represent the two big conflicting ideas about where endometriosis comes from, namely retrograde menstruation and coelomic metaplasia. I’ve spoken about these conflicting notions before along with the theory of mullerianosis back in May and how there is evidence for both cases.
In one corner we have the stalwart theory of retrograde menstruation, which is generally accepted as how endometriosis comes into being, and there is evidence to support this. The fact that endometriosis bares such resemblance to normal endometrium, that endometriosis is found most frequently on the pelvic organs and experimental evidence which reported that forced surgical induction of retrograde menstruation in monkeys led to the development of endometriosis in 50% of cases.
In the other corner is coelomic metaplasia, which suggests that there are cells that already exist all throughout the body that can transform into functional endometrium given the correct stimulus. This theory best explains how endometriosis can arise in organs such as the brain and lungs and even the rare cases of endometriosis in males.
A body blow has just been dealt to retrograde menstruation in the form of a study that has just been published in the Journal of Paediatric and Adolescent Gynaecology. This study reported a case of endometriosis in a 20 year old girl who complained of serious pelvic pains. That’s nothing exceptional in itself, until you know that the girl also had Mayer-Rokitansky-Küster-Hauser syndrome, mercifully also known as MRKH. MRKH is characterised by the incomplete development of the female reproductive organs, in this case the girl did not have a uterus. Therefore, retrograde menstruation would have been impossible and cannot account for the development of her endometriosis, but coelomic metaplasia could. This round goes to coelomic metaplasia.
You’ll be glad to hear that this story has a happy ending though. The girl in question underwent electrocautery to destroy her endometriosis and was placed on oral contraceptives to reduce her symptoms, which significantly reduced her pain.
So the retrograde menstruation/coelomic metaplasia debate looks like it will have no resolve just yet. Nevermind, just keep on paddling.
In one corner we have the stalwart theory of retrograde menstruation, which is generally accepted as how endometriosis comes into being, and there is evidence to support this. The fact that endometriosis bares such resemblance to normal endometrium, that endometriosis is found most frequently on the pelvic organs and experimental evidence which reported that forced surgical induction of retrograde menstruation in monkeys led to the development of endometriosis in 50% of cases.
In the other corner is coelomic metaplasia, which suggests that there are cells that already exist all throughout the body that can transform into functional endometrium given the correct stimulus. This theory best explains how endometriosis can arise in organs such as the brain and lungs and even the rare cases of endometriosis in males.
A body blow has just been dealt to retrograde menstruation in the form of a study that has just been published in the Journal of Paediatric and Adolescent Gynaecology. This study reported a case of endometriosis in a 20 year old girl who complained of serious pelvic pains. That’s nothing exceptional in itself, until you know that the girl also had Mayer-Rokitansky-Küster-Hauser syndrome, mercifully also known as MRKH. MRKH is characterised by the incomplete development of the female reproductive organs, in this case the girl did not have a uterus. Therefore, retrograde menstruation would have been impossible and cannot account for the development of her endometriosis, but coelomic metaplasia could. This round goes to coelomic metaplasia.
You’ll be glad to hear that this story has a happy ending though. The girl in question underwent electrocautery to destroy her endometriosis and was placed on oral contraceptives to reduce her symptoms, which significantly reduced her pain.
So the retrograde menstruation/coelomic metaplasia debate looks like it will have no resolve just yet. Nevermind, just keep on paddling.
Wednesday, 8 July 2009
Bloodlust
Endometriosis, like most living things and vampires, needs blood to survive. Those patches of endometriosis that grow within people need a constant blood supply because they grow at an accelerated rate. If you look at this picture you can see a blackish endometriotic implant and lots of little blood vessels leading up to it like some sanguine road map. The tricky thing about endometriosis is that it can form its own blood supply, generating new blood vessels from existing ones, a process called angiogenesis. This is one of the reasons endometriosis is so persistent, it’s one of the same tricks tumours use to survive.
Of course knowing this means it may be possible to use drugs that inhibit angiogenesis to effectively ‘starve’ the endometriosis of its blood supply. This has been the focus of quite a bit of research over the last few years with some studies looking at drugs that inhibit the growth of new blood vessels as a possible new therapy for endometriosis. Actual data on human trails is hard to come by, but what has been done is quite positive. One study found that treating women with a combination of Goserelin (a GnRH analogue) and Thalidomide (yes, thalidomide) caused regression of ovarian endometriotic cysts in 8 out of 10 cases after a 6 month course of treatment. Now I will be the first to admit this is a very preliminary and quite small study and I do have some reservations about the design of the study, but the results are encouraging nevertheless.
Most other work testing angiogenesis inhibitors for endometriosis is done on animal models, usually mice or rats. The results of these studies has also been supportive of the use of angiogenesis inhibitors for the treatment of endometriosis, most recently there’s been a study published very recently that reported the use of a drug called Fenofibrate (drug that is normally used to treat liver disease and high cholesterol ) reduced the growth of endometriosis in rats.
This also illustrates a cause that I am very supportive of, using drugs that already exist for the treatment of other diseases as possible novel therapies for endometriosis. This has several advantages, for example if a drug is already being used to treat something else then we know it is safe to use on humans and we know the side effects (angiogenesis inhibitors are something you should definitely not take when pregnant for example). Drugs can often have effects that are unforeseen by their developers, sometimes these effects can be very negative (such as the case of Thalidomide) or sometime they can be positive (such as the case of Thalidomide).
If you would like to read more on angiogenesis inhibitors and endometriosis there is a page on the World Endometriosis Society website about this very subject.
Of course knowing this means it may be possible to use drugs that inhibit angiogenesis to effectively ‘starve’ the endometriosis of its blood supply. This has been the focus of quite a bit of research over the last few years with some studies looking at drugs that inhibit the growth of new blood vessels as a possible new therapy for endometriosis. Actual data on human trails is hard to come by, but what has been done is quite positive. One study found that treating women with a combination of Goserelin (a GnRH analogue) and Thalidomide (yes, thalidomide) caused regression of ovarian endometriotic cysts in 8 out of 10 cases after a 6 month course of treatment. Now I will be the first to admit this is a very preliminary and quite small study and I do have some reservations about the design of the study, but the results are encouraging nevertheless.
Most other work testing angiogenesis inhibitors for endometriosis is done on animal models, usually mice or rats. The results of these studies has also been supportive of the use of angiogenesis inhibitors for the treatment of endometriosis, most recently there’s been a study published very recently that reported the use of a drug called Fenofibrate (drug that is normally used to treat liver disease and high cholesterol ) reduced the growth of endometriosis in rats.
This also illustrates a cause that I am very supportive of, using drugs that already exist for the treatment of other diseases as possible novel therapies for endometriosis. This has several advantages, for example if a drug is already being used to treat something else then we know it is safe to use on humans and we know the side effects (angiogenesis inhibitors are something you should definitely not take when pregnant for example). Drugs can often have effects that are unforeseen by their developers, sometimes these effects can be very negative (such as the case of Thalidomide) or sometime they can be positive (such as the case of Thalidomide).
If you would like to read more on angiogenesis inhibitors and endometriosis there is a page on the World Endometriosis Society website about this very subject.
Wednesday, 1 July 2009
It Came From Outer Space
I’ve been going through some of the older papers on endometriosis recently and I’ve come across some rather peculiar reports, particularly this one, this one and this one. It would appear that years ago it was quite in vogue to get animals (monkeys in particular) and expose them to huge amounts of radiation and see what happened. Well the results weren’t that hard to predict, the animals died. However, what was interesting and slightly unexpected is that some of these animals developed endometriosis, apparently as a consequence of being exposed to radiation.
Various types of radiation were used, such as single energy protons, mixed energy protons, x-rays and electrons and the whole point of this seemed to be judging the affect of radiation exposure on women flying into space or in very high orbit around the earth. So the question to be asking really is unless you were one of these unfortunate monkeys how is a woman likely to be exposed to this radiation? Well unless you’re an astronaut or a high altitude pilot chances are you won’t get much exposure as this type of radiation can come from things called solar flares. Solar flares are massive releases of energy at the suns surface which shoot huge amounts of radiation into the solar system.
Now it’s generally thought that earth’s atmosphere protects us from the most harmful effects of this radiation, however some studies have indicated that solar activity can be related to the incidence of heart attacks and autoimmune disease. Therefore it may be that solar activity has some bearing on human health. So could it be that endometriosis is caused by exposure to radiation from outer space? Well I wouldn’t go adhering to any such theory yet. For a start I couldn’t get access to the full versions of the aforementioned papers that link endometriosis to radiation exposure, so it’s hard to judge the quality of their methods and analysis. Without being able to properly critique a study’s methods it’s impossibly to tell whether it’s worth taking it seriously or not. Nevertheless, it may be something that is worth looking into in more detail. Does anyone know where I can get a gamma ray emitter and some monkeys?
Various types of radiation were used, such as single energy protons, mixed energy protons, x-rays and electrons and the whole point of this seemed to be judging the affect of radiation exposure on women flying into space or in very high orbit around the earth. So the question to be asking really is unless you were one of these unfortunate monkeys how is a woman likely to be exposed to this radiation? Well unless you’re an astronaut or a high altitude pilot chances are you won’t get much exposure as this type of radiation can come from things called solar flares. Solar flares are massive releases of energy at the suns surface which shoot huge amounts of radiation into the solar system.
Now it’s generally thought that earth’s atmosphere protects us from the most harmful effects of this radiation, however some studies have indicated that solar activity can be related to the incidence of heart attacks and autoimmune disease. Therefore it may be that solar activity has some bearing on human health. So could it be that endometriosis is caused by exposure to radiation from outer space? Well I wouldn’t go adhering to any such theory yet. For a start I couldn’t get access to the full versions of the aforementioned papers that link endometriosis to radiation exposure, so it’s hard to judge the quality of their methods and analysis. Without being able to properly critique a study’s methods it’s impossibly to tell whether it’s worth taking it seriously or not. Nevertheless, it may be something that is worth looking into in more detail. Does anyone know where I can get a gamma ray emitter and some monkeys?
Monday, 15 June 2009
Associations
There have been a few studies published of late concerning what other conditions endometriosis is associated with.
First up is a study from Brazil which looked at the frequency of celiac disease in women with and without endometriosis. Just to give you a brief overview, celiac disease is a digestive disorder that leads to poor absorption of nutrients through the gut due to damage of the small intestine. Celiac disease can result in people not being able to tolerate things like gluten and presents with a variety of symptoms (For more information on celiac disease follow this link). The study found that 0.66% of women without endometriosis had celiac disease, whereas 2.5% of women with endometriosis had celiac disease. So although the numbers were relatively small women with endometriosis were more likely to have celiac disease. This is interesting because, from my experience, a lot of women with endometriosis also have food allergies or intolerances.
Next is a study from Australia that looked at the frequency of pre-eclampsia in women with endometriosis. Pre-eclampsia is a condition whereby during pregnancy a woman suffers from hypertension. This can be a very serious problem if left untreated for both the mother and child. However, the overall result of this study was that there is no increased chance of suffering from pre-eclampsia if you have endometriosis. In fact there is some evidence to suggest that if you have endometriosis you are less likely to suffer from pre-eclampsia, which is good news, for a change.
First up is a study from Brazil which looked at the frequency of celiac disease in women with and without endometriosis. Just to give you a brief overview, celiac disease is a digestive disorder that leads to poor absorption of nutrients through the gut due to damage of the small intestine. Celiac disease can result in people not being able to tolerate things like gluten and presents with a variety of symptoms (For more information on celiac disease follow this link). The study found that 0.66% of women without endometriosis had celiac disease, whereas 2.5% of women with endometriosis had celiac disease. So although the numbers were relatively small women with endometriosis were more likely to have celiac disease. This is interesting because, from my experience, a lot of women with endometriosis also have food allergies or intolerances.
Next is a study from Australia that looked at the frequency of pre-eclampsia in women with endometriosis. Pre-eclampsia is a condition whereby during pregnancy a woman suffers from hypertension. This can be a very serious problem if left untreated for both the mother and child. However, the overall result of this study was that there is no increased chance of suffering from pre-eclampsia if you have endometriosis. In fact there is some evidence to suggest that if you have endometriosis you are less likely to suffer from pre-eclampsia, which is good news, for a change.
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