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Management of Endometriosis – Beyond hormonal therapies and OCP’s

Endometriosis is a common gynecological condition that affects women of reproductive age and is a major cause of pain and infertility. Medical and surgical treatments have remained the mainstay in the management of endometriosis. Treatment for endometriosis is expected to fulfill some objectives like:

1.Control on endometriosis symptoms and pain relief from prolonged periods.
2.Prevent progression of endometriosis and post-surgical recurrence.
3.For helping women who wish to conceive/get pregnant.

All these considerations can be fulfilled by treatment options such as surgery, hormonal therapy, oral contraceptives, IVF as well as through nutraceutical supplementation.
Hormonal therapy and oral contraceptives are one of the approaches your doctor might recommend to help ease the pain related with endometriosis.

A. Hormonal therapy
Hormonal therapy is an option that is quite common in the treatment of the symptoms associated with endometriosis. We know that different hormones may be responsible for altering the perception of pain in different women. However, hormone therapy can only help to reduce or manage the pain symptoms in endometriosis but do not offer long-term benefits without the associated side-effects. Hormones are available in the forms of pills, injectable or nasal sprays. This treatment option stops the production of hormones and prevents ovulation. This way the further growth of endometrial lesions are restricted. Hormonal therapy prevents the growth of new areas & scars but does not make any existing adhesions/growth to disappear.

Healthcare providers usually suggest one of the hormone therapies mentioned below

1. Progesterone
These improve the symptoms of endometriosis by reducing periods or stopping them completely. These also help to prevent pregnancy.

Side-effects: Weight gain, depression, breast tenderness or swelling, severe mood swings, irregular vaginal bleeding.

2. Gonadotropin – releasing hormone (GnRH) agonist
They stop the production of certain hormones to prevent menstruation, ovulation & growth of endometriotic lesions and help in managing the pain associated with endometriosis. They almost create a ‘menopause like scenario.’

Side-effects: Hot flashes, extreme tiredness, insomnia, depression, headaches, joint and muscle pain and stiffness, bone loss, risk of heart complications and vaginal dryness.

3. Danazol
Danazol works by stopping the release of hormones that are involved in menstrual cycle. It works by lowering the amount of hormones that are produced by the ovaries. However, Danazol has more side effects as compared to all other hormonal treatment options.

Side-effect: Oily skin, acne, weight gain, muscle cramps, tiredness, smaller and sore breasts, headache, dizziness, weakness, hot flashes, cause harm to the developing fetus. Side-effect: Oily skin, acne, weight gain, muscle cramps, tiredness, smaller and sore breasts, headache, dizziness, weakness, hot flashes, cause harm to the developing fetus.

Note: After stopping the hormonal therapies mentioned above, pregnancy is possible again.

B. Oral contraceptives pills (OCP)
OCP’s are yet another option that your doctor might recommend for the management of pain associated with endometriosis. OCP’ provide relief from the pain but does not cure the underlying health condition i.e. endometriosis. They control the hormones responsible for the buildup of endometriotic tissues each month. Usually the therapy contains two hormones viz. estrogen and progestin. Progestin is a progesterone like hormone.

Side-effects: Long-term use of OCP’s exert side-effects such as
1.Spotting: It is when contraceptives are used continuously. It causes the endometrium to remain inactive which results in reduction in the monthly blood loss.
2.Other side-effects such as nausea, breast tenderness, amenorrhea, headaches, weight gain, and decreased bone mass density are also observed.

Note: Not all contraceptives are equal and what works for one woman might not work for the other.

The important thing to note is that hormonal therapy and OCP’s are not curative. They may only help to alleviate pain symptoms related to endometriosis. Yet another problem with the above treatment options is the associated side-effects, especially, with their long-term use. Novel treatment options using novel ingredients such as curcumin, resveratrol, vitamin D can successfully help to manage endometriosis but without the undesired side-effects.

C. Non-Hormonal management of endometriosis
1. Curcumin
Curcumin is well-known for centuries as one of the best natural anti-inflammatory and anti-oxidant. This has been confirmed through several scientific studies.

Curcumin is known to have beneficial effects in the successful management of endometriosis:
1.It plays a crucial role in reduction of inflammation by inhibition of cytokines.
2.Curcumin also inhibits the invasion, attachment and angiogenesis of endometrial lesions.
3.It helps to inhibit endometrial cell proliferation and increases apoptosis thus reducing size and number of endometrial lesions.
4.It also acts on the MMP-2 and tissue inhibitors of metalloproteinase (TIMP)-2
5.Levels of other inflammatory mediators like NF-kB and IL-8 have been reduced after treatment with curcumin.

2. Resveratrol
In endometriosis, levels of pro-inflammatory cytokines like IL-1 and TNF are usually elevated. Additionally, IL-1β also increases expression of cyclooxygenase (COX) -2 and concomitant prostaglandin level which are responsible for the pain and inflammation in endometriosis.

Resveratrol is a plant based phenolic compound which is mainly present in many dietary sources such as grapes, wine, peanuts, soy, berries, and stilbenes. Many evidences have shown that resveratrol is able to prevent and treat endometriosis due to its excellent anti-inflammatory activity. Its anti-inflammatory activity has been demonstrated through

1.Inhibition of prostaglandin synthesis via the inhibition of COX enzyme synthesis
2.Inhibition of activated immune cells
3.Inhibition of pro-inflammatory cytokines

Resveratrol also exhibits anti-inflammatory properties by inhibiting NF-kappaB activation and its translocation to cell nuclei. It also has anti-proliferative properties and exhibit apoptosis-inducing activities.

3. Vitamin D
A biologically active form of Vitamin D i.e. Vitamin D3, is known to have immunomodulatory properties.

1.It effectively controls endometriosis through cytokine production, which eventually decreases pro-inflammatory factors and increases anti-inflammatory factors.
2.It also induces apoptosis within the endometriosis lesions.

On the other hand, Vitamin D deficiency is one of the pre-disposing factors for endometriosis. It regulates cycling endometrium, hence supports normal growth and regulation of endometrial cells. Therefore, supplementation with vitamin D can be helpful in patients with endometriosis.

Surgical and other medical treatment options remain the mainstay when it comes to managing endometriosis. However, adding evidence-based nutritional supplements can further amplify the treatment approaches and help women manage their health problems better.

DISCLAIMER: The information published above is for educational purposes only and should not be used in any other manner. The information is not intended to substitute medical/professional advice. The information should not be used to diagnose or treat a health problem or disease without consulting a qualified healthcare practitioner.

References:

1. https://www.medicalnewstoday.com/articles/290196.php#risks, Last accessed, 5th Feb 2020
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5683134/pdf/oajc-6-105.pdf, Last accessed, 5th Feb 2020
3. https://endometriosis.org/treatments/oral-contraceptive-pill/, Last accessed, 5th Feb 2020
4. https://theconversation.com/what-happens-to-endometriosis-when-youre-on-the-pill-89035, Last accessed, 5th Feb 2020
5. https://obgyn.onlinelibrary.wiley.com/doi/pdf/10.1111/aogs.12036, Last accessed, 5th Feb 2020
6. https://www.openaccessjournals.com/articles role-of-immunologic-and-inflammatory-factors-in-the-development-of-endometriosis-indications-for-treatment-strategies.pdf, Last accessed, 5th Feb 2020
7. https://www.preventmiscarriage.com/turmeric-spice-fights-endometriosis.html, Last accessed, 5th Feb 2020
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