Study of the month February 2013
Resveratrol potentiates effect of simvastatin on inhibition of mevalonate pathway in human endometrial stromal cells.
J Clin Endocrinol Metab 2013 Mar;98(3)
Dr. J.A. Villanueva (USA)
In previous studies, this group of investigators have reported that certain cholesterol lowering drugs (statins) may suppress endometriosis growth. This study evaluates the effects of resveratrol (a substance in red wine) on mechanisms affected by statins. The suggestion here is that resveratrol may increase the effect of statins in their suppression of endometriosis.
What this means to you: Not a lot right now. However, in time, this may lead to a new way of medically treating endometriosis.
Study of the month January 2013
Intraoperative detection of subtle endometriosis: a novel paradigm for detection and treatment of pelvic pain associated with the loss of peritoneal integrity.
J Vis Exp. 2012 Dec 21
Dr. B.A. Lessey (USA)
This group of investigators from North Carolina describe a preliminary study in which they find that detection of endometriosis is made easier by the use of a blue dye. The dye (methylene blue) is sprayed into the pelvis during laparoscopy. Areas that then appear blue are more likely to have endometriosis and can be treated surgically.
What this means to you: Sometimes during laparoscopy, endometriosis can be difficult to see. This can be because they are in unusual locations, the lesions are too small to see easily or because the lesions do not look like typical endometriosis. This strategy, if confirmed by further study, may provide a way to better detect the presence of endometriosis in difficult situations. Better diagnosis should mean better treatment!
Study of the month December 2012
Translation and psychometric evaluation of the simplified Chinese version Endometriosis Health Profile-30.
Hum Reprod. 2012 Dec 18.Dr. S.Z. Jia (China)
The title of this may sound a little difficult to comprehend at first, so here goes... Before a new questionnaire is used, it should first undergo evaluation to confirm that it is a reliable and reproducible way of assessing whatever it is designed to assess. This process is called validation. Makes sense, right? Well, the Endometriosis Health Profile 30 (EHP 30) is a questionnaire that was developed in England to assess quality of life (QOL) in women with endometriosis. The EHP 30 constitutes 30 questions that assess physical and mental well being. I like this questionnaire and at CERT (www.cert.ucsd.edu), we will use it to assess our patients' quality of life over time. In this report, the authors have developed a Chinese version of the EHP 30 and describe how they validated it.
What this means to you: Many endometriosis studies and some clinical endometriosis centers such as ours at UCSD incorporate the EHP 30 to assess QOL. You may well come across it if you attend one of these centers or participate in endometriosis studies. Now also in China.
Study of the month November 2012
An unusual cause of acute appendicitis: Appendiceal endometriosis.
Int J Surg Case Rep. Sep 19, 2012; 4(1):54-57
Dr. A. Emre (Turkey)
This study highlights the need to consider appendix disease in women with chronic abdominal/pelvic pain that is thought to be due to endometriosis. A few years ago, we published a study showing that women with endometriosis often have disease affecting the appendix and that the appendix should probably be removed at the time of endometriosis surgery more commonly than it currently is. This study outlines two cases of surgical appendix removal in whom endometriosis was unexpectedly found in the surgical specimen.
What this means to you: It can be difficult to distinguish chronic appendicitis from endometriosis pain. If you are undergoing surgery for endometriosis, make sure that your doctor is going to at least examine the appendix, if not remove it. Conversely, if you are going to have your appendix removed, have your surgeon look around in the pelvis for endometriosis.
Study of the month October 2012
Diagnostic delay for endometriosis in Austria and Germany: causes and possible consequences.
Human Reproduction. Sep 17, 2012
Dr. G. Hudelist (Austria)
Prior studies from the USA and Europe have indicated that there is roughly 8-12 years delay in the diagnosis of endometriosis. This study reports similar findings of a mean duration of about 10.4 years from onset of symptoms to actual diagnosis! The study reports findings from Germany and Austria, both of which are affluent countries with well established and comprehensive healthcare systems. One implication of this study is therefore, that the delay in diagnosis is not merely a function of healthcare availability, but perhaps linked to other aspects of endometriosis such as awareness. One of the major hurdles in the diagnosis and therefore the management of endometriosis is that surgery is required. Wouldn't it be fabulous if we had a blood or urine test for endometriosis!
What this means to you: If you have symptoms suggestive of endometriosis, bad menstrual pain, pain on intercourse or long term pelvic pain at other times, do discuss the possibility of endometriosis with your Doctor. Don't just assume its a part of being a woman.... I don't think men would put up with a decade of pain prior to being diagnosed!
Study of the month September 2012
Outcome of In Vitro Fertilization in endometriosis-associated infertility: A 5-year database cohort study.
Chin Med J. 2012 Aug;125(15):2688-93
Dr. X. N. Lin (China)
This is the latest of many, many studies to evaluate the efficacy of IVF in women with endometriosis. The group evaluated their 5 year data for IVF and found that women with a diagnosis of endometriosis had lower pregnancy rates than women without a diagnosis of endometriosis. For many reasons, this sort of study design is not great and can led to inaccurate results. However, based on this and other better designed studies, I think it is clear that women with endometriosis have lower success rates with IVF than women with most other fertility diagnoses.
What this means to you: Although many women with endometriosis have no trouble conceiving, others can have a very hard time. We know that, in general, women with endometriosis are more likely to need aggressive fertility therapies such as IVF. However, even with advanced therapies such as IVF, their success is likely to be lower than for women without endometriosis. So, if you have endometriosis or suspect endometriosis and are having difficulty conceiving - don't delay - See your doctor!
Study of the month - August 2012
"I Can't Get No Satisfaction": deep dyspareunia and sexual functioning in women with rectovaginal endometriosis.
Fertility and Sterility. Aug 18, 2012
Dr. P. Vercellini (Italy)
This study confirmed that women with endometriosis are more likely to have pain during intercourse than women without endometriosis. These investigators also compared the impact of endometriosis in different locations in the pelvis on the likelihood of painful intercourse. Contrary to common belief, they found no significant increase in painful intercourse in women who have endometriosis between the rectum and vagina compared to those that only have endometriosis elsewhere in the pelvis such as on the ovaries.
What this means to you: Be cautions having complex and risky surgery on endometriosis between the rectum and vagina because of painful sex. Your symptoms may be merely from having endometriosis rather than because the disease involves the rectovaginal area.
Study of the month July 2012
Effect of laparoscopic excision of endometriomas on ovarian reserve: serial changes in the serum antimüllerian hormone levels.
Fertility and Sterility June;97(6):1472-8. 2012
Dr. H. Celik (Turkey)
It is common for women with endometriosis cysts (endometriomas) to have them surgically removed. This study determined if surgical removal of endometriomas led to a decrease in the number of eggs left in the ovary. The investigators assessed anti-mullerian hormone (AMH) levels before and after surgical removal of the cysts. AMH, which correlates with the number of eggs in the ovaries, decreased after surgery to remove the endometriomas. The decrease in AMH was greatest in cases when the endometriomas removed were either 5cm or more in size or on both ovaries.
What this means to you: If you are interested in fertility either currently or sometime in the future and you have ovarian cysts from endometriosis in your ovary or ovaries, having the cyst removed surgically will likely lead to you being left with fewer eggs after the surgery. Fewer eggs means decreased fertility - you won't get them back! Incidentally, mere drainage of endometriomas is inadequate and has been shown to lead to early recurrence. Although medical shrinkage of endometriomas has so far not been shown to work, we are evaluating a new treatment that seems promising!
Study of the month June 2012
What motivates women to take part in clinical and basic science endometriosis research?
Bioethics. June 2007: 21(5): 263-9.
Dr. S. K. Agarwal (USA)
What this means to you: As a group, it seems that women with endometriosis see this disease as an affront on women and want to make a difference. This is good news and will hopefully lead to a speedier understanding of this disease and much needed improved treatment options. Why don't you find out who in your community is trying to make a difference for women with endometriosis and join in. They can't do it without you!
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