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!
Wednesday, 17 February 2010
Friday, 29 January 2010
Now ruining your enjoyment of a sunny day
If, like me, you live in England then over exposure to sunlight is not high on your list of worries, however I imagine that for some people the sun can be a bit of a worry. Well according to a growing body of research, women with endometriosis are joining the ranks of those who shouldn’t venture into the sun very often. The most recent article on this subject found that women with endo are more sensitive to the sun than women who don’t have endo. This may tie in with other findings which suggest women with endometriosis have more moles and freckles than controls. This further makes sense of other research that found that women with endo are more at risk of developing skin cancer.
So in order to break it down further:
1) If you have endometriosis you are more likely to have fair skin and more moles and freckles
2) Thus you are more sensitive to the sun’s radiation and more likely to burn quicker and more easily when exposed to the sun
3) Thus you are at a higher risk of skin cancer
I’m not sure why this appears to be the case, maybe there are genetic traits that come with fair skin and freckles that make a woman more susceptible to developing endometriosis. I should probably point out as well that the current research does not suggest sun exposure causes endo. I firmly believe endometriosis is something you are born with and therefore, unlike melanoma, no amount of sunscreen can avoid.
So in order to break it down further:
1) If you have endometriosis you are more likely to have fair skin and more moles and freckles
2) Thus you are more sensitive to the sun’s radiation and more likely to burn quicker and more easily when exposed to the sun
3) Thus you are at a higher risk of skin cancer
I’m not sure why this appears to be the case, maybe there are genetic traits that come with fair skin and freckles that make a woman more susceptible to developing endometriosis. I should probably point out as well that the current research does not suggest sun exposure causes endo. I firmly believe endometriosis is something you are born with and therefore, unlike melanoma, no amount of sunscreen can avoid.
Thursday, 24 December 2009
The Puerto Rican Connection
There have been several studies that have examined the way in which endometriosis effects the lives of women throughout a few different countries. However, most of these studies have come from Western nations, mainly the UK and the USA. Data on the incidence and symptoms of endometriosis throughout the rest of the world is fairly scarce and it would be presumptuous to assume that endometriosis affects people in the same way all over the world. So it is excellent news to find a recent study published by the Ponce school of medicine in Puerto Rico. Just in case you were wondering Puerto Rico is an island nation (although technically an archipelago) just to the East of the Dominican Republic and North of Venezuela. What is very interesting is that this is one of the few studies I have come across that deals with endometriosis in a predominately Hispanic population.
It is of great importance to collect as much data as possible on endometriosis from as many countries as possible. There are several reasons why this is so important, for example it lets politicians and world leaders recognise that this disease exists everywhere and is not the sole burden of a select few countries. Also imagine if it was found that women in a certain population or country were found to have a very low incidence of endometriosis. a finding such as this may finally tell us why some women are more susceptible to the disease than others and may even provide clues on how to prevent the disease.
But I digress, back to the Puerto Rican study. I’ll give you a brief overview of what the study found and highlight points of interest. This study surveyed 108 women with endometriosis and these were the main findings.
40% of the women reported a family history of endometriosis. This is interesting as it is much larger than other countries. For example in Brazil it was reported as 8.9%, Japan 8.8% and the United States 8.1%.
The menstrual characteristics of the women surveyed seemed fairly normal, starting their periods at around 11 ½ years old and with an average cycle length of 28.5 days, 5.5 days of menstruation.
The symptoms of endometriosis in these women seem to echo those found around the world. The majority of women experienced dysmenorrhoea (94.4%), incapacitating pain (74.3%), Dyspareunia (70.1%) and sub infertility (63.6%).
Other symptoms that coexisted with those mentioned above included: Back and leg pain (75.7%), gastrointestinal upsets (69.2%), dizziness/headaches (60.7%), depression (51.4%), fatigue (44.9%), dyschezia (painful bowel movements, 44.9%), vaginal pain (35.5%) and dysuria (painful urination, 22.4%).
Depressingly the length of time to diagnosis seems no different in Puerto Rico, with the average time to be diagnosed around 8.9 years, which is quite typical, sadly.
Although this is an enlightening study, it is not without its faults. From a surveying point of view not many people took part, and those that did have more severe forms of endometriosis (although it has long been recognised that stage of the disease bares little correlation to the severity of symptoms). Also as with any survey you are relying on people judging things from memory, which if they happened a long time ago, may not be entirely accurate. Despite this we are in desperate need for more studies such as this from countries all over the world and it is also interesting to see that even in countries as far away as the UK and Puerto Rico, women’s experiences of endometriosis remain very similar.
It is of great importance to collect as much data as possible on endometriosis from as many countries as possible. There are several reasons why this is so important, for example it lets politicians and world leaders recognise that this disease exists everywhere and is not the sole burden of a select few countries. Also imagine if it was found that women in a certain population or country were found to have a very low incidence of endometriosis. a finding such as this may finally tell us why some women are more susceptible to the disease than others and may even provide clues on how to prevent the disease.
But I digress, back to the Puerto Rican study. I’ll give you a brief overview of what the study found and highlight points of interest. This study surveyed 108 women with endometriosis and these were the main findings.
40% of the women reported a family history of endometriosis. This is interesting as it is much larger than other countries. For example in Brazil it was reported as 8.9%, Japan 8.8% and the United States 8.1%.
The menstrual characteristics of the women surveyed seemed fairly normal, starting their periods at around 11 ½ years old and with an average cycle length of 28.5 days, 5.5 days of menstruation.
The symptoms of endometriosis in these women seem to echo those found around the world. The majority of women experienced dysmenorrhoea (94.4%), incapacitating pain (74.3%), Dyspareunia (70.1%) and sub infertility (63.6%).
Other symptoms that coexisted with those mentioned above included: Back and leg pain (75.7%), gastrointestinal upsets (69.2%), dizziness/headaches (60.7%), depression (51.4%), fatigue (44.9%), dyschezia (painful bowel movements, 44.9%), vaginal pain (35.5%) and dysuria (painful urination, 22.4%).
Depressingly the length of time to diagnosis seems no different in Puerto Rico, with the average time to be diagnosed around 8.9 years, which is quite typical, sadly.
Although this is an enlightening study, it is not without its faults. From a surveying point of view not many people took part, and those that did have more severe forms of endometriosis (although it has long been recognised that stage of the disease bares little correlation to the severity of symptoms). Also as with any survey you are relying on people judging things from memory, which if they happened a long time ago, may not be entirely accurate. Despite this we are in desperate need for more studies such as this from countries all over the world and it is also interesting to see that even in countries as far away as the UK and Puerto Rico, women’s experiences of endometriosis remain very similar.
Wednesday, 11 November 2009
Runaround
It may be a lot of effort and I know sometimes it’s hard to be bothered, but we all know a decent amount of exercise does you the world of good. Exercise, in combination with a good diet, reduces the risk of all sorts of unpleasant diseases and prolongs your life. So it comes as little surprise that some reports have said that regular exercise can reduce your risk of endometriosis by up to 40-80%. The rationale behind this theory comes from evidence showing regular exercise reduces the amount of estrogen in the body. However, as a recent study rightly points out, if a woman is experiencing the debilitating pain and fatigue associated with endometriosis prior to diagnosis she is much less likely to be inclined to pop down the gym for a training session, thereby skewing the aforementioned results.
The latest study on endometriosis and exercise comes from the Harvard Medical School in Boston, which conducted a prospective cohort study from 1989 onwards on a total of 102,197 women, of which 2703 were laparoscopically confirmed with endometriosis. The study followed the women’s amount and level of exercise over the years and also took into consideration factors such as BMI, smoking, parity (number of children), contraceptive use, menstrual history etc.
The overall results of the study found that regular exercise did not decrease the risk of endometriosis as much as previously thought. That said, regular exercise did appear to reduce the risk of endometriosis, just by a more modest factor. So in conclusion exercise is a good thing, there is no substitution for it, you can’t buy it in pill form so try and do it whenever possible. Of course I’m not talking about running marathons (although kudos to you if you can!). Even gentle exercise, done regularly, will grant you benefits, it may not reduce your risk of endometriosis by as much as 80% but as one particular faceless, all consuming ubiquitous supermarket chain says “every little helps”.
The latest study on endometriosis and exercise comes from the Harvard Medical School in Boston, which conducted a prospective cohort study from 1989 onwards on a total of 102,197 women, of which 2703 were laparoscopically confirmed with endometriosis. The study followed the women’s amount and level of exercise over the years and also took into consideration factors such as BMI, smoking, parity (number of children), contraceptive use, menstrual history etc.
The overall results of the study found that regular exercise did not decrease the risk of endometriosis as much as previously thought. That said, regular exercise did appear to reduce the risk of endometriosis, just by a more modest factor. So in conclusion exercise is a good thing, there is no substitution for it, you can’t buy it in pill form so try and do it whenever possible. Of course I’m not talking about running marathons (although kudos to you if you can!). Even gentle exercise, done regularly, will grant you benefits, it may not reduce your risk of endometriosis by as much as 80% but as one particular faceless, all consuming ubiquitous supermarket chain says “every little helps”.
Wednesday, 28 October 2009
Update
Just wanted to say sorry for not posting anything for a while, between my day job and writing my thesis I haven’t had much time to do much else. Anyway, enough of my excuse making, I thought I’d give a quick update on what has been going on in the field of endometriosis research in the past couple of weeks. Here is a quick selection of some of the more interesting articles published.
Since my last post on the 8th of September there have been 96 papers published on endometriosis with a wide variety of subjects (according to PubMed).
There have been several publications on the link between ovarian cancer and endometriosis. There have even been a few papers on the involvement of epigenetic mechanisms in endometriosis (my specialist field).
There was also a paper which found 30% of the patients with endometriosis they examined also had irritable bowel syndrome or constipation.
Aromatase inhibitors were found to be effective at reducing the proliferation of endometriotic implants in a mouse model.
Phthalates, which are artificial compounds thought to act as an oestrogen and very hard to pronounce, were found to be no higher in the urine of Japanese women with endometriosis when compared to controls. However, this study falls into a trap that is a personal pet peeve of mine, which is analysing the levels of these compounds in women who already have the disease. A better study design would be to analyse the frequency of endometriosis either in the children of women exposed to artificial oestrogenic compounds or in women exposed at a very young age.
Contrary to the above, levels of another type of synthetic oestrogen, Bisphenol A and B, were found to be higher in the blood serum of women with endometriosis.
IVF treatment does not increase the risk of endometriosis recurrence.
Endometriosis was diagnosed in two sisters with Glanzmann's thrombasthenia (GT), a very rare blood clotting disorder which leads to prolonged bleeding. This is considered significant as women with GT are more likely to have prolonged periods of menstrual bleeding, a factor which is thought to increase the susceptibility to endometriosis. This perhaps garnishes some support for the retrograde menstruation origin theory of endometriosis.
Apparently marmosets (a type of small New World monkey) can develop endometriosis.
If you have are of the type A blood group, you are 2.9 fold more at risk of endometriosis. The relationship between blood groups and endometriosis remains to be explained.
It appears that the normal endometrium of women with endometriosis has increased proliferative activity, meaning that it grows quicker than normal. What could be causing this increased proliferation remains to be found.
Pregnant women with endometriosis are apparently more at risk of suffering spontaneous hemoperitoneum (bleeding into the peritoneal cavity). However, I should point out that hemoperitoneum is rare.
Interesting case report of a 42 year old woman who, even after a hysterectomy and right oopherectomy, still presented with monthly bleeding. The cause was found to be an endometriotic cyst on the left ovary.
That is the news for now, hopefully I’ll get to post more soon.
Since my last post on the 8th of September there have been 96 papers published on endometriosis with a wide variety of subjects (according to PubMed).
There have been several publications on the link between ovarian cancer and endometriosis. There have even been a few papers on the involvement of epigenetic mechanisms in endometriosis (my specialist field).
There was also a paper which found 30% of the patients with endometriosis they examined also had irritable bowel syndrome or constipation.
Aromatase inhibitors were found to be effective at reducing the proliferation of endometriotic implants in a mouse model.
Phthalates, which are artificial compounds thought to act as an oestrogen and very hard to pronounce, were found to be no higher in the urine of Japanese women with endometriosis when compared to controls. However, this study falls into a trap that is a personal pet peeve of mine, which is analysing the levels of these compounds in women who already have the disease. A better study design would be to analyse the frequency of endometriosis either in the children of women exposed to artificial oestrogenic compounds or in women exposed at a very young age.
Contrary to the above, levels of another type of synthetic oestrogen, Bisphenol A and B, were found to be higher in the blood serum of women with endometriosis.
IVF treatment does not increase the risk of endometriosis recurrence.
Endometriosis was diagnosed in two sisters with Glanzmann's thrombasthenia (GT), a very rare blood clotting disorder which leads to prolonged bleeding. This is considered significant as women with GT are more likely to have prolonged periods of menstrual bleeding, a factor which is thought to increase the susceptibility to endometriosis. This perhaps garnishes some support for the retrograde menstruation origin theory of endometriosis.
Apparently marmosets (a type of small New World monkey) can develop endometriosis.
If you have are of the type A blood group, you are 2.9 fold more at risk of endometriosis. The relationship between blood groups and endometriosis remains to be explained.
It appears that the normal endometrium of women with endometriosis has increased proliferative activity, meaning that it grows quicker than normal. What could be causing this increased proliferation remains to be found.
Pregnant women with endometriosis are apparently more at risk of suffering spontaneous hemoperitoneum (bleeding into the peritoneal cavity). However, I should point out that hemoperitoneum is rare.
Interesting case report of a 42 year old woman who, even after a hysterectomy and right oopherectomy, still presented with monthly bleeding. The cause was found to be an endometriotic cyst on the left ovary.
That is the news for now, hopefully I’ll get to post more soon.
Tuesday, 8 September 2009
Mysterious bowels
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.
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, 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.
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