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Endometriosis – How can you keep it under check

Endometriosis has been estimated to affect 10-15% of all reproductive-age women and 70% of women with chronic pelvic pain.

Although the onset of symptoms is reported during adolescence, diagnosis is often delayed. Many times the diagnosis of endometriosis is difficult and delayed, and hence treatment for symptoms is started later in life.

Adolescents with pelvic pain present a diagnostic challenge as they may present with atypical symptoms of endometriosis. This makes it tricky to diagnose endometriosis early.

General menstrual problems vs. endometriosis
General menstrual symptoms include cramps in the lower abdomen, low back pain, leg pain, nausea, vomiting, diarrhea, headache, irritability, moodiness, and weakness.

The American College of Obstetricians and Gynecologists state that “more than one-half of women who menstruate have some pain [usually] for 1–2 days each month.” The challenge for any physician is to differentiate regular menstrual pain from endometrial pain.

The most common symptom of endometriosis is severe pelvic (lower abdominal) pain which may be occasional or constant or associated with menstruation.

Most women get pain and slight cramps before or during a menstrual period but the pain of endometriosis is so severe that they may impact their day to day life.

Other possible symptoms include pelvic pain, a very heavy period, low back pain, constipation, diarrhea, etc.

Symptoms that shouldn’t be ignored
Beyond disruption in their day-to-day lives, women may be misdiagnosed with conditions like pelvic inflammatory disease and inflammatory bowel syndrome, which can lead to inappropriate treatment and even adverse psychological impact.

The symptom which cannot be ignored is severe pelvic pain that was refractory to medical treatment. Sometimes women show atypical symptoms of endometriosis like vague abdominal symptoms, gastrointestinal distress or genitourinary symptoms.

Other symptoms noted in are endometriosis are dysmenorrhea, menorrhagia, abnormal/irregular uterine bleeding, gastrointestinal symptoms, and genitourinary symptoms.

Laparoscopy may be carried out in women with chronic pelvic pain not responding to medical treatment.

Going beyond the conventional treatment methods
Although the actual cause of endometriosis is unknown, at least two-thirds of women with chronic pelvic pain or dysmenorrhea who are unresponsive to hormonal therapies and NSAIDs, will be diagnosed with endometriosis at the time of diagnostic laparoscopy.

Recommended treatment for endometriosis is usually conservative surgical therapy for diagnosis and treatment combined with ongoing suppressive medical therapies to prevent endometrial proliferation.

In early stage endometriosis, novel complementary treatment with highly-researched natural ingredients can not only reduce the pain symptoms but also help prevent further progression of the issue. For women who are suffering from advanced endometriosis, such ingredients provide a lot of relief and help in the long-term management of the condition.

Curcumin, Resveratrol & NAC can restrict the progression of the disease
There is an unmet medical need in endometriosis treatment, especially with the objective to avoid undesirable side effects. Women with endometriosis often benefit from ongoing education and support and integration of other multidisciplinary services such as biofeedback, pain management teams, and natural therapy

Recent studies have shown the importance of natural therapy for endometriosis treatment. These new agents promise a new and revolutionary perspective in the treatment of endometriosis.

Resveratrol
Resveratrol is a natural phytoalexin, synthesized by plants due to ultraviolet radiation. Several studies indicate that resveratrol possesses various beneficial actions, including anti-inflammatory, anti-oxidative and anti-angiogenic properties.

Resveratrol exerts different effects on various molecular pathways involved in inflammation, such as arachidonic acid, Nf-kB, Ah receptor or AP-1.

A review of studies demonstrated that the anti-inflammatory effect of this natural compound can contribute to the prevention of endometriosis.

Curcumin
Curcumin is a naturally occurring phytochemical and an extract of turmeric which has been used in the prevention and treatment of many diseases since ancient times. Curcumin has anti-inflammatory, antioxidant, anti-tumor, anti-angiogenesis, and anti-metastatic activities. Curcumin has demonstrated the ability to inhibit endometriosis in vivo and may help in the management of endometriosis by reducing estradiol production.

N-acetylcysteine (NAC)
N-acetylcysteine (NAC) is the acetylated form of the amino acid cysteine and has demonstrated anti-antiproliferative, anti-inflammatory and antioxidant action.

It is effective in treating ovarian endometriosis. By targeting various molecular and biochemical pathways involved in the initiation and maintenance of this disease, NAC effectively treats ovarian endometriosis.

Vitamin D
Vitamin D in a study has shown prompt response in terms of pain resolution in patients with deep endometriosis. This showcases the biological plausibility of VIT D3 and its receptor in suppressing inflammation in both eutopic and ectopic endometrium. Also, a VDR agonist was shown to reduce the development and recurrence of endometriosis lesions.

References
1.JSLS. 2015 Apr-Jun; 19(2): e2015.00019, doi: 10.4293/JSLS.2015.00019
2.https://www.metro-obgyn.com/blog/whats-the-difference-between-severe-menstrual-pain-and-endometriosis
3.Eur J Obstet Gynecol Reprod Biol. 2006 Apr 1;125(2):248-50. Epub 2005 Sep 26
4.https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Adolescent-Health-Care/Dysmenorrhea-and-Endometriosis-in-the-Adolescent
5.Evid Based Complement Alternat Med. 2013; 2013: 240702
6.Efficacies of vitamin D and omega-3 polyunsaturated fatty acids on experimental endometriosis