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Endometriosis and people of color

While awareness of endometriosis has increased recently, it has been historically considered “a disease of white and affluent women,” according to a preprint paper examining racial differences in when people receive endometriosis diagnosis. A meta-analysis from 2019 found that Black people receive an endometriosis diagnosis less often than white people.

“It takes twice as long for women of color, specifically Black women to get that diagnosis of endometriosis because of the widely-held, inaccurate belief that Black women are automatically more fertile,” Julia Mandeville, 32, a doctoral student in public health at George Mason University, told TODAY. “Then with the stigma associated with us being fantasized as sexual beings — it could be that you’re too sexually active so you have an STI, which is contributing to your pelvic pain.” More about Endo Black here.

Endometriosis Awareness Month – activities at endometriosis.com

Check the program endometriosis.com is organizing globally to present new research and treatments of endometiosis.

Recognizing Endo Awareness Month

The Center for Endometriosis Care from Atlanta, GA calls for better education, awareness and support for those with disease. Learn more of the Center and their activities here.

Diagnosing Endometriosis – comprehensive report

ccording to Hugh S. Taylor, MD, of Yale University School of Medicine in New Haven, Connecticut, endometriosis should now be considered a whole-body disease that has consequences well beyond the pelvic region and these can facilitate and complement clinical diagnosis. “We have to look at all its manifestations and the totality of its effects on the patient,” said Taylor, co-author of a recent paper on clinical challenges in the diagnosis of endometriosis.

Read here.

New research seeks to improve heart health for individuals with endometriosis

Endometriosis and heart disease are both disorders of inflammation in the body, but research has not yet explained the link between the two. Troublingly, heart disease risk in women is typically treated with estrogen, but estrogen exacerbates the symptoms of endometriosis. In fact, endometriosis is typically treated by suppressing estrogen production in women, according to the researchers. This means that endometriosis treatment actually may be increasing the risk of heart disease for women who already live with elevated risk.

The researchers will examine the link between estrogen suppression and cardiovascular disease risk in women with endometriosis.

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No link between preterm birth and endometriosis

In this study, the researchers observed no difference in the rate of preterm deliveries before 37 weeks 0 days of gestation between the endometriosis and control groups (7.2 versus 6.0 percent). Endometriosis was not associated with preterm birth before 37 weeks of gestation when adjusting for other factors (adjusted odds ratio, 1.07; 95 percent confidence interval, 0.64 to 1.77). Similar results were seen for different disease phenotypes (6.2, 7.2, and 7.4 percent for superficial peritoneal endometriosis, ovarian endometrioma, and deep endometriosis, respectively).

“The findings suggest that modification of pregnancy monitoring or management strategies to prevent preterm birth for women with endometriosis may not be needed,” the authors write.

More here

Ending the endometriosis stigma in the workplace

The key point of the discussion was that endometriosis affects so many women yet is still unrecognised or even stigmatised within the workplace. Paul Scully, MP, Parliamentary Under-Secretary of State for Business, Energy and Industrial Strategy UK, confirmed that the governments strategy on women’s health was to be published during 2022. This strategy is set to focus on workplace health as one of its six priority areas and will include a chapter on ‘menstrual health and gynaecological conditions’. The chapter will include ways to improve awareness, care and treatment of those suffering from endometriosis and other similar conditions.

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A national strategy to fight endometriosis will be launched, announces Macron

A national strategy to fight endometriosis will be launched, announces Macron January 11, 2022.

“It’s not a women’s problem. It is a social problem.” With these words, President Emmanuel Macron announced on Tuesday the launch of a national strategy to combat endometriosis in order to raise awareness, diagnose and take charge of this inflammatory and chronic disease of the reproductive system from which one in 10 women in France suffers.

“They are called Sandrine, Lola, Charlotte or Enora,” says the head of state in a video posted on social networks. “They are exhausted, worn out by pain that can go as far as fainting,” said the president about this disease which affects more than two million French women and is the leading cause of infertility in France.

This subject “which is close to my heart (…) leads today to the launch of our first national strategy to fight against endometriosis”, declared Emmanuel Macron. It will aim to “better understand this disease and its causes, and find therapeutic treatments,” said the Head of State, announcing that resources will be released “up to the challenges” for research.

Finally, “we must develop what we could call an endometriosis reflex to all audiences: at school, at university, at home, at the office, and even, and above all I would say, in medical circles, “said Emmanuel Macron.

More here.

Exploring the connection between endometriosis and the gut microbiome

Although bacteria are altered in endometriosis, there is no definitive consensus on specific microbiota compositions linked to the disease, according to a review in Human Reproduction Update.

However, bacterial vaginosis-associated bacteria and lactobacillus depletion in the cervicovaginal microbiome are associated with endometriosis and infertility in the majority of included studies.

“We want to encourage more robust microbiome research for endometriosis because it is an incredibly burdensome condition that warrants additional attention and research,” said senior author Melissa Herbst-Kralovetz, Ph.D., director of the Women’s Health Research Program and Microbiome Initiative at The University of Arizona College of Medicine-Phoenix.

More here.

Pelvic floor tenderness and pressure pain sensitivity with endometriosis

Testing for pelvic floor tenderness during routine pelvic exams for women with chronic pelvic pain or endometriosis may help identify women who have heightened overall pain sensitivity, according to a cross-sectional study in the European Journal of Obstetrics & Gynecology and Reproductive Biology.

“A substantial proportion of women with chronic pelvic pain and endometriosis do not respond to conventional treatments that are targeted at treating pain in the pelvic cavity or the peripheral nervous system, such as hormonal medications or surgery,” said first author Amy Shafrir, ScD, a research scientist at Boston Children’s Hospital in Massachusetts.

Women who have overall heightened pain sensitivity can be directed to more appropriate treatment options that target the central nervous system, such as integrated behavioral therapy, physical therapy, or medications.

More here.

Banned Pesticides Associated with Endometriosis

Women exposed to metabolites of the banned insecticide chlordane are over three times more likely to develop endometriosis, finds research published in the journal Environment International. The study is the latest to find links between persistent organic pollutants (POPs), still lingering in our environment and in our bodies, and chronic disease. According to an economic analysis conducted in 2016, exposure to endocrine (hormone) disrupting chemicals, often implicated in considerable damage to the body’s reproductive system, results in billions of dollars of health care costs from female reproductive disorders.

The analysis revealed two compounds to be positively associated with endometriosis – trans-nonachlor, a breakdown product of the banned organochlorine insecticide chlordane, and PCB 114 (there are 209 different PCB compounds), with odds ratios of 3.38 and 1.83, respectively. Compared to the control group, those with endometriosis also had higher total levels of PCB in their blood. Scientists also identified cytokine biomarkers, determining that women with higher levels of these compounds in their bodies were more likely to have endometriosis with endometrioma. According to the study, “Results suggest the role of certain POPs in promoting pro-inflammatory metabolic conditions which may be involved in the development of severe endometriosis.”

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World Endometriosis Society consensus on the classification of endometriosis

Classification systems of endometriosis, developed by several professional organizations, traditionally have been based on lesion appearance, pelvic adhesions, and anatomic location of disease. One system predicts fertility outcome and none predicts pelvic pain, response to medications, disease recurrence, risks for associated disorders, quality of life measures, and other endpoints
important to women and health care providers for guiding appropriate therapeutic options and prognosis.

The authors imply that, until better classification systems have been developed, surgeons should use a toolbox for surgical classification of endometriosis (that includes the r-ASRM system and, where appropriate, the Enzian and EFI staging systems) to maximise the information available to women following their surgery.
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Four Common Gynaecological Problems Every Woman Should Know About

Worth repeating. A brief insight into the common gynaecological problems many women face in their day to day lives.

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Endometriosis natural treatments: The eight supplements to take for endometriosis

They won’t cure your endo. But they might make you feel less miserable. This info has been around the endo sphere for a long time. Never helped me. Let me know if there was any improvement with your symptoms.

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Holistic ways to manage endometriosis

Again, nice try. But read on anyway.

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How Tampons Could Be Used To Diagnose Endometriosis

Many patients can attest that the journey to getting an endometriosis diagnosis and finding specialists that understand your condition and symptoms can be long and emotionally draining. However, data-centered healthcare company NextGen Jane is working with Harvard to establish how the diagnostic process could be made much quicker and less invasive. 

They are currently studying how menstrual blood squeezed from tampons could be used to diagnose conditions like endometriosis. Their website reads, “We look at genomic signals from the cells in your tampon to discover early signs of disease that may affect your fertility and quality of life.”

More here.

Watch Letitia Kiu’s YT channel to learn more about endometriosis

Infertility and Endometriosis explained

Endometriosis can affect fertility in several ways by causing: distorted pelvic anatomy, adhesions, scarred fallopian tubes, inflammation of the pelvic structures, altered immune system functioning, changes in the hormonal environment of the eggs, impaired implantation of a pregnancy, and altered egg quality.

Women with severe endometriosis which is associated with significant scarring, blocked fallopian tubes, and damaged ovaries experience problems while trying to conceive and often require advanced fertility treatment.

More here.

Endometriosis: targeting a different type of pain may be key in improving treatment – new research

Most current pain treatments for endometriosis have focused on targeting what’s known as “nociceptive pain”.

This is pain that’s associated with potential or actual tissue damage. Generally, nociceptive pain responds well to standard painkillers, so most endometriosis treatments contain ibuprofen or paracetamol.

But given that only some women with endometriosis respond to these types of pain treatments, researchers are now beginning to investigate a different type of treatment based around what is called neuropathic pain.

This is pain that happens because of damage to the nerves themselves — and it often doesn’t respond to painkillers like ibuprofen. Neuropathic pain conditions can cause great psychological distress and intense pain.

Could neuropathic pain explain why some women weren’t responding to traditional endometriosis pain treatments. And we found that 40 per cent of people with the condition can be classified as experiencing this kind of pain.

More here.

Treatment of endometriosis: a review with comparison of 8 guidelines

The aim of this review is to give an overview on therapeutical approaches of eight national and international widely used guidelines. All the above-mentioned guidelines agree that the combined oral contraceptive pill, progestogens are therapies recommended for endometriosis associated pain. 

The treatments involve surgical treatments, medical treatment and complementary therapies. Regarding pharmacological therapies of endometriosis associated pain, the most of the included guidelines suggest progestins, either in the form of dienogest or of medroxyprogestetrone acetate, and combined oral contraceptives as first line therapy with a great evidence grade. GNRH-agonists and levonorgestrel intrauterine system could be considered as second line treatment. 

More here.

AAGL announces new endometriosis classifications

The launch of this new classification was created based on scientific research Abrão led along with his fellow researchers.

The AAGL endometriosis classification is as follows:

  • Level A- Excision or desiccation of superficial implants, and simple thin avascular adhesions.
  • Level B- Stripping of ovarian endometriomas, appendectomy, deep endometriosis nonevolving the bowel, vagina, ureter, or bladder (not requiring suture), dense adhesions not involving the bowel or the ureter.
  • Level C: Dense adhesions involving the bowel or the ureter; bladder surgery requiring suture, ureterolysis, bowel surgery without resection.
  • Level D: Bowel resection or ureteral reimplantation or anastomosis.

“[This is] the news that will impact the world positively, changing, from now on, the journey of the treatments and the diagnosis of endometriosis,” said Abrão.

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Organic pollutants and endometriosis

Women exposed to pesticides containing trans-nonachlor were 3.38 times more likely to develop endometriosis (P <0.0001), and for PCB 114 the increased risk was 1.83 (=0.009).

“The contribution of each individual chemical from a complex mixture of endocrine-disrupting chemicals becomes elusive in current observational research methods; however, it is likely that complex interactions may occur, especially in light of reported synergistic interactions between endogenous oestrogen (and oestrogenic chemicals) on endometriosis progression,” wrote the authors.

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Botulinum toxin for endometriosis pelvic pain

Women with endometriosis-related chronic pelvic pain (endo-CPP) were more likely to report benefits with botulinum toxin (BoNT) compared to placebo, according to new research in Fertility and Sterility.

Technical issues, such as whether multiple injection sites in the pelvic floor muscles are needed or if a single injection site is sufficient, also need to be clarified.

“For most other conditions, toxin needs to be reinjected roughly every 12 weeks to maintain benefit.

Source

Targeting a different type of pain may be key in improving treatment

Most current pain treatments for endometriosis have focused on targeting what’s known as “nociceptive pain”. This is pain that’s associated with potential or actual tissue damage. Generally, nociceptive pain responds well to standard painkillers, so most endometriosis treatments contain ibuprofen or paracetamol.

researchers are now beginning to investigate a different type of treatment based around what is called neuropathic pain. This is pain that happens because of damage to the nerves themselves – and it often doesn’t respond to painkillers like ibuprofen. Neuropathic pain conditions can cause great psychological distress and intense pain. This research claims around 40% of people with endometriosis experience this kind of pain. This helps to address the specific pain and treat it accordingly.

Source