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Ovarian Endometriosis / Ovarian cyst

What is Ovarian Endometriosis?

About 25 million women in India suffer from endometriosis, which is difficult to treat. It is the most common cause of chronic pelvic pain. Delay in the diagnosis of endometriosis results in unnecessary suffering and reduced quality of life.

The common sites of endometriosis are the ovaries, fallopian tubes, pelvic peritoneum, and uterosacral ligaments. Apart from the impact of endometriosis on the quality of life of these patients, it also can have an impact on the potential of these women to have a family.

Ovarian endometriosis affects a substantial proportion of women of reproductive age. Endometriosis may occur on the surface of one or both ovaries or deep within them. Ovarian endometrioma is a benign, estrogen-dependent cyst found in women of reproductive age. It is also called ‘chocolate cyst’ and can also lead to infertility. The cyst in the ovary contains thick, old blood that appears as a brown fluid hence ‘chocolate cyst’. Ovarian endometriomas can be complicated by adhesions. They respond poorly to medical treatment.

What effect does endometriosis have on ovary?

When endometriosis affects the ovary, blood can get embedded in the normal ovarian tissue, forming a “blood blister” surrounded by a fibrous cyst – endometrioma. Both superficial endometriosis and ovarian endometriomas have an adverse effect on the ovulation rates, markers of ovarian reserve, and response to ovarian stimulation.

Surgery is one of the most preferred choices in the management of endometriosis but it may sometimes lead to inadvertently removing healthy ovarian tissues or compromising vascular supply to the ovary. It has been shown that endometriosis alters the composition of the peritoneal fluid, deregulating a number of immunologic factors and increasing the level of reactive oxygen species. These changes may alter folliculogenesis and lead to poorer quality oocytes with reduced fertilization rates and poorer embryonic development and implantation. Management options include expectancy, medical treatment, surgery, in vitro fertilization (IVF), or a combination of the above.

The ovarian reserve

Ovarian reserve is defined as a woman’s total ovarian follicle pool, which includes the primordial and growing follicles. In general, ovarian reserve declines with age, and a low ovarian reserve is associated with a decreased chance of pregnancy. Women with endometriosis (both those who have had ovarian surgery and those who haven’t) have lower levels of anti-müllerian hormone AMH in their blood – a sign of diminished ovarian reserve.

Diminished Ovarian Reserve (DOR) – is defined by women of reproductive age who have regular menses, but whose ovarian function, whether or not stimulated by Assisted Reproductive Technology (ART), is decreased, compared to women of comparable age, according to the American Society for Reproductive Medicine (ASRM). It has been noted that the reduction of ovarian reserve after ovarian cystectomy for endometriomas is inevitable.

Role of Curcumin, Resveratrol & NAC

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.

Oxidative stress leads to an ovarian failure by inhibiting nuclear and cytoplasmic maturation of oocytes and inducing apoptosis.

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. Experimental data indicate that resveratrol could protect against the reduction of fertility owing to oxidative stress-related ovarian damage.
NAC is regarded as one of the best natural anti-oxidants. It plays a pivotal role in the effective management of ovarian endometriosis by reducing angiogenesis which leads to a significant reduction in cyst size.

References:
1. Lee, H., Park, Y., Jee, B., Kim, Y. and Suh, C., 2015. Various anatomic locations of surgically proven endometriosis: A single-center experience. Obstetrics & Gynecology Science, 58(1), p.53.
2. Mavrelos, D. and Saridogan, E., 2015. Treatment of Endometriosis in Women Desiring Fertility. The Journal of Obstetrics and Gynecology of India, 65(1), pp.11-16.
3. Melekoglu, R., Ciftci, O., Eraslan, S., Cetin, A. and Basak, N., 2018. Beneficial effects of curcumin and capsaicin on cyclophosphamide-induced premature ovarian failure in a rat model. Journal of Ovarian Research, 11(1).
4. Parasar, P., Ozcan, P. and Terry, K., 2017. Endometriosis: Epidemiology, Diagnosis and Clinical Management. Current Obstetrics and Gynecology Reports, 6(1), pp.34-41.
5. https://ovarianresearch.biomedcentral.com/articles/10.1186/s13048-016-0241-z