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.
Monday, 11 October 2010
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.
Friday, 25 June 2010
A Seminal Paper
There are many external factors that we suspect may play a role in the growth and development of endometriotic lesions. The main contenders being environmental toxicants such as dioxin or bisphenols which are thought to disrupt the body’s normal hormonal balance. Other factors that have been suggested include metals like lead and cadmium, eating red meat or trans fats and alcohol consumption. However, a recent study has identified another potential candidate, semen.
Yes that’s right, a study from Japan has found that seminal fluid increases the growth of endometriotic cells in culture. The logic behind the original thinking is that seminal fluid contains a lot of macromolecules, a rather nonspecific term that in this context refers to factors which may lead to the growth of endometrial tissue. This study found that when seminal fluid plasma was added to endometrial cells from women with and without endometriosis it stimulated growth of these cells. What is interesting is the finding that normal endometrium from women with endometriosis displayed increased growth over normal endometrium from women without endometriosis. This suggests that even the normal endometrium from women with endometriosis is somehow more sensitive to growth signals. This lends some support to the retrograde menstruation theory. If endometrial cells are somehow ‘primed’ for increased growth capacity in some women, then when these cells are refluxed they will be more likely to implant, proliferate and eventually form endometriotic lesions.
The growth signals in question that are found in seminal fluid are hepatocyte growth factor (HGF), estrogen and prostaglandin E2 (PGE2). PGE2 in particular has been touted as a major factor regulating a number of processes essential for developing and sustaining endometriosis.
Now you may very well ask, as I did “how does seminal fluid come into contact with endometriotic lesions?” After all endometriotic lesions are found on the outside of the pelvic organs. Apparently seminal fluid can come into contact with endometriotic lesions via “hematogenous dissemination or direct tissue perfusion through the anterior or posterior vaginal formix after sexual intercourse” which basically means it can diffuse through the rear wall of the vagina much like water diffusing through a sponge. I need to point out though that this does not suggest endometriosis can be caused by unprotected sex, but it may irritate the existing endometriosis.
However, on the other side the macromolecules found in seminal fluid promotes the development and implantation of the embryo, which is good if you are trying to conceive. Of course, as with any new findings there is more work to be done before we draw any definitive conclusions, further studies may prove or dispose what has been found.
Yes that’s right, a study from Japan has found that seminal fluid increases the growth of endometriotic cells in culture. The logic behind the original thinking is that seminal fluid contains a lot of macromolecules, a rather nonspecific term that in this context refers to factors which may lead to the growth of endometrial tissue. This study found that when seminal fluid plasma was added to endometrial cells from women with and without endometriosis it stimulated growth of these cells. What is interesting is the finding that normal endometrium from women with endometriosis displayed increased growth over normal endometrium from women without endometriosis. This suggests that even the normal endometrium from women with endometriosis is somehow more sensitive to growth signals. This lends some support to the retrograde menstruation theory. If endometrial cells are somehow ‘primed’ for increased growth capacity in some women, then when these cells are refluxed they will be more likely to implant, proliferate and eventually form endometriotic lesions.
The growth signals in question that are found in seminal fluid are hepatocyte growth factor (HGF), estrogen and prostaglandin E2 (PGE2). PGE2 in particular has been touted as a major factor regulating a number of processes essential for developing and sustaining endometriosis.
Now you may very well ask, as I did “how does seminal fluid come into contact with endometriotic lesions?” After all endometriotic lesions are found on the outside of the pelvic organs. Apparently seminal fluid can come into contact with endometriotic lesions via “hematogenous dissemination or direct tissue perfusion through the anterior or posterior vaginal formix after sexual intercourse” which basically means it can diffuse through the rear wall of the vagina much like water diffusing through a sponge. I need to point out though that this does not suggest endometriosis can be caused by unprotected sex, but it may irritate the existing endometriosis.
However, on the other side the macromolecules found in seminal fluid promotes the development and implantation of the embryo, which is good if you are trying to conceive. Of course, as with any new findings there is more work to be done before we draw any definitive conclusions, further studies may prove or dispose what has been found.
Monday, 14 June 2010
Fat of the land
Talk of endometriosis and the role of diet is bound to crop up sooner or later. Some women have found that changes to their diet can help reduce the symptoms of endometriosis, some women find that certain foods make their symptoms worse, particularly if they have bowel symptoms.
Some studies have found that women who consume higher levels of fish oil experience less pain symptoms, although it could be that higher fish consumption is merely an indicator of a healthier lifestyle overall. Other studies agree that a diet high in green vegetables and fruit is associated with a decreased risk of endometriosis, whereas a diet high in red meat was found to increase the risk of developing endometriosis. Again though, these dietary factors are probably related to overall lifestyle health.
Recently a study from the Harvard Medical School found that consumption of certain types of fats was associated with an increased risk in endometriosis. This study used data from the Nurses’ Health Study II cohort, a very large repository of information on 116,607 registered female nurses in the US. Information has been collected from 1989 to 2001 and includes data on illness, environmental and lifestyle factors, so it’s a great source of information about the relationship between risk factors and illness. The aforementioned study looked at data on the 1199 cases of laparoscopically confirmed endometriosis and compared it with data from a food frequency questionnaire. This is what they found.
Total fat intake was not associated with any significant increased risk for developing endometriosis
There was a suggestion that animal fat intake may lead to an increased risk of developing endometriosis, which agrees with the studies mentioned previously that suggested increased consumption of red meat increases the risk of developing endometriosis. Although, intakes of the main components of animal fats i.e. saturated fat and monounsaturated fat were not associated with an increased risk of endometriosis.
Intake of trans-unsaturated fats was associated with a higher risk of endometriosis, with the risk becoming higher if protein intake was also increased.
Intake of long chain omega-3 fatty acids was associated with a decreased risk of endometriosis.
In this prospective study of US nurses the main sources of the seemingly protective long chain omega-3 fatty acids were salad dressing, tuna and dark fish. The major sources of trans-unsaturated fats were fried foods, margarine and crackers.
These results appear to show that a diet high in trans-fats increases the risk of developing endometriosis. However, it may be (and I’m probably sounding like a stuck record now) that a person who has a diet high in trans-fats, does not have a healthy lifestyle compared to someone who eats a lot of omega-3 containing foods. Therefore, the people who eat a lot of omega-3 are not necessarily at a decreased risk of endometriosis because they eat omega-3, but because their lifestyle is healthier overall. You may very well ask “if endometriosis is a disease you are born with, does diet really make that much difference?” Well it could be that having a consistently healthy lifestyle from an early age somehow suppresses the disease much in the same way as a healthy lifestyle can stave off cancer in those with a family history of the disease.
And, if nothing else, it’s another good reason to get trans-fats out of your diet, because although they taste delicious, they’ll make you fat and prone to heart attacks.
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.
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