New Study: migration of Endometriosis cells throughout the organs of mice

House_mouse

On April 6, 2017, Oncotarget published an article which I’ll be briefly discussing here today.

Researchers took mice and implanted Endometriosis cells inside of of their pelvic regions wanting to see if the Endometriosis cells would migrate to extra-pelvic organs.   They later analyzed the organs for microscopic Endometriosis-derived cells throughout the mice and found that it had migrated to the lungs, spleen, livers, and brains in many of the mice.

The authors suggest, “…that endometriosis in locations distant from the pelvis may be more common than previously recognized. Endometriosis should be considered a systemic disease that is often subclinical.”  They suggest that these Endometriosis-derived cells residing in other organs may influence symptoms of Endometriosis, such as fatigue, eating disorders, sociopsychological issues and other symptoms which lessen our quality of life.  It also discusses thoracic Endometriosis and Endometriosis on the liver, and those side effects.  Further research, of course, is always needed.

The entire published study is free for us to read and is very, very interesting.  I fully encourage you to click here and read the study and the conclusions.  And please feel free to correct me if you feel I’ve misread the science-y bits. ❤

Resources:

Oncotarget – (Article; April 2017) Micrometastasis of Endometriosis to Distant Organs in a Murine Model

 

~ Again, I am a layman.  I do not hold any college degrees, nor mastery of knowledge.  Please take what I say with a grain of salt.  If curious, do your own research 😉 Validate my writings.  Or challenge them.  And ALWAYS feel free to consult with your physician. Always.  Yours ~ Lisa

Endometriosis in the psoas major muscle

768px-psoas_major_muscle11

An article was published on October 30, 2016 in the International Journal of Clinical and Experimental Medicine, which caught my interest.  We know that Endometriosis can grow in a lot of places other than the reproductive organs and pelvis.  This study found Endometriosis growing within a muscle: the psoas major muscle.

The pso-what-is muscle? Well, that’s what I said.

Psoas_major.gif

It’s a pair of muscles that run from the lumbar spine, along the back of the abdomen, and end inside the hip area. It helps flex our hips, aids our walking and running, and can improve posture.  In some places, it’s as thick as a wrist!  As a side-note, weak psoas muscles can cause back pain, hip pain, limited movement in the hips, tight/deep pelvic pain, belly aches, constipation, and a twisted pelvis.  Dr. Axe offers some tips, tricks, and stretches to help strengthen your psoas muscles.

Okay, now back to the study!

A 49-year-old Chinese woman was admitted to the hospital because she had increased CA-125 levels.  If you’ve followed my previous blogs, you’ll remember this could be an indication of the presence of Endometriosis. Seven years prior, she had a hysterectomy and oopherectomy (removal of her right ovary) – she had a uterine myoma and ovarian Endometriosis.

After screening and testing, the doctors found a mass in the left side of her psoas muscle and thought she had a tumor.  She didn’t have any of the usual signs and symptoms of Endometriosis.  She was discharged from the hospital (at her insistance).

Three months later she returned for an MRI.  The mass had grown by 3cm and was also involved with her iliac vessels.  Her CA-125 levels were still increased.  And her physicians needed answers.  An exploratory laparotomy was performed and the mass was visualized in her psoas major muscle.  It was 10x10x8 cm and was inside the muscle tissue.  They continue to fear it was a tumor.

Rather than remove the mass in its entirety, a portion was removed and biopsied: confirmed as Endometriosis.  She received more than 3 months of Lupron Depot and the remaining mass decreased in size and her CA-125 levels stabilized.  The authors surmise the lesion may have transplanted during prior surgeries and hope this case report sheds further light on the illness.

Yet another example of extra-pelvic Endometriosis, as well as post-hysterectomy Endometriosis.  Here’s to hoping this case study continues to push the medical and scientific community into further research and greater funding toward better understanding Endometriosis – and one day finding that much-needed cure.

Resources:

Dr. Axe

International Journal of Clinical and Experimental Medicine – Article (Oct. 2016) Endometriosis in the Psoas Major Muscle: A Case Report

Yoga International

~ Again, I am a layman.  I do not hold any college degrees, nor mastery of knowledge.  Please take what I say with a grain of salt.  If curious, do your own research 🙂 Validate my writings.  Or challenge them.  And ALWAYS feel free to consult with your physician. Always.  Yours ~ Lisa

Blood Biomarkers & Endometriosis

Vacutainer_blood_bottles

You may have read some of my previous blogs about biomarkers…blood tests for things which may help doctors diagnose Endometriosis without surgery, such as CA-125 levels.  There are a lot of hopes that indicators may help save costly diagnostic surgeries, surgical risks, and painful recoveries.

A study published on May 1, 2016, reviewed 141 past studies and analyzed the data.

It does not look good for us, ladies and gents.  Well, not yet at least.  It concludes, “Overall, there is not enough evidence to recommend testing for any blood biomarker in clinical practice to diagnose endometriosis.”  If you’d like to read it for yourself, please click here.

A study published on July 27, 2016, however, holds hope that the CA-125 test may “rule in” Endometriosis.  You can read it here.  It is supported by a December 2016 study, which you can read here.  Unfortunately, a 2017 study (read it here) found that due to the fluctuating levels of CA-125 throughout a woman’s menstrual cycle, as well as the fact that CA-125 is not exclusive to Endomtriosis, does not make it a recommended diagnostic tool (yet).

A November, 2016 publication stated that women with Endometriosis may have elevated MiRNA (micro RNA) gene biomarkers.  Strides are being made to identify proteins and glycoproteins (like CA-125) that may be more prevalent in women with Endometriosis.  Although inflammation is a major syptom of Endometriosis, research into cytokines and chemokines (which may point to inflammation) appear equal in women with and without Endometriosis.  However, potential is being shown for using IL-8, TNF-α, and CA125 as a combined biomarker panel to help diagnose the presence of Endometriosis.  Research into identifying biomarkers in urine and peritoneal fluid is also ongoing.  All the science in this is waaaaaay over my head…but if it leads you to a specific conversation with your doctor, or delves you deeper into researching it yourself, my job here is done!  You can read it here.

Hoping that future research can continue to push forward on non-invasive diagnostic tools.

*Updated April 6, 2017*

~ Again, I am a layman.  I do not hold any college degrees, nor mastery of knowledge.  Please take what I say with a grain of salt.  If curious, do your own research 😉 Validate my writings.  Or challenge them.  And ALWAYS feel free to consult with your physician. Always.  Yours ~ Lisa

Inflammation & Endo

justlogoinflam

The Oxford Dictionary defines inflammation as, “a localized physical condition in which part of the body becomes reddened, swollen, hot, and often painful, especially as a reaction to injury and infection.”

An article which is slated to be published in June 2016’s Frontiers in Bioscience reviews previous studies and literature which discuss how inflammation may cause Endometriosis to develop.  It states, “…inflammation is crucial in the pathogenesis of endometriosis…” Pathogenesis is the development of a disease; the cellular events and mechanisms that lead to a disease.

It also discusses how estrogen can affect inflammation which, in turn, affects Endometriosis.  It points out that anti-inflammatory medication and GnRH analog drugs (such as the highly-controversial Lupron Depot which depletes our estrogen production) have been found to reduce inflammation in Endometriosis patients.

Remember our blog about stress and Endometriosis?  This June 2016 study identifies that stress hormones may also play a role in creating inflammation and aggravating Endometriosis.

The authors theorize that inflammation may not only play a role in the development of Endometriosis, but that Endometriosis may contribute to pelvic inflammatory disease.  Imagine if you will a snowball effect : stress = inflammation + estrogen = Endometriosis + more inflammation = pelvic inflammatory disease or other illnesses.

I may not have understood a lot of the science mumbo-jumbo of the article, but I did certainly walk away with one thing : inflammation is noooo bueno and I will do anything I can do to naturally reduce my body’s inflammation.

Diet plays a huge role in reducing inflammation.  You have to decide what aids and hinders your body…not just do what “works for everyone else.”  You may have heard this all before, but :

  • Omega-3 fatty acids, like those found in salmon or tuna, are great at reducing inflammation.  Don’t like fish but take fish oil caplets?  Be careful; Omega-6 fatty acids, which may be found in fish oil supplements, may spurn inflammation rather than quell it.
  • Nuts are also a great sort of antioxidants and Omega-3s.  Try walnuts or almonds.
  • Whole grains contain a lot of fiber, which may decrease inflammation.
  • Eat your fruits & veggies.  Leafy greens, broccoli, tomatoes, beets, garlic, onions, berries, and cherries (the tart ones) all have amazing properties that combat inflammation.
  • Ginger and turmeric, two very ugly roots which are common spices, also have properties which are well-known to fight inflammation.  Cinnamon has also been found to be anti-inflammatory.
  • Don’t forget about herbs!  Rosemary, thyme, sage, and oregano are among the top 10 herbs and spices for fighting inflammation.
  • Extra virgin olive oil has been found to have similar anti-inflammatory properties to NSAIDs (i.e, Ibuprofen, Naproxen Sodium).

Dr. Andrew Weil has created a fun graphic known as the Anti-Inflammatory Food Pyramid.  If you like visual aids, click here.

There’s also a list of foods that promote inflammation, which you may want to avoid (if you’re able to).  These include dairy, soy, red meat, and foods that are high in saturated fat and sugar. Some people are affected by a gluten sensitivity or intolerance, which flare up their inflammation and symptoms.

Also, try to reduce your stress levels.  In any way : stretching, meditation, yoga, medication, rest, a different job, removing toxic people from your life, etc.

I repeat : do what feels good and works well for you.  Pay no mind to someone else if they say “this works,” but you’ve tried it and it doesn’t make you feel any better…or if it makes you feel worse.  You, and only you, really know your body.

Resources:

Body Ecology10 Top Foods that Prevent Inflammation in Your Body

Center for Disease Control and Prevention – Pelvic Inflammatory Disease

Health.com14 Foods that Fight Inflammation

Mercola Top Anti-Inflammatory Food, Herbs, and Spices

U.S. National Library of Medicine (Abstract; June 2016) – Inflammation and Endometriosis; the full article is available for purchase from Frontiers in Bioscience

Women to WomenReducing Inflammation – The Natural Approach

A biiiig thank you to Gary for his help in securing the entire article for me to read.  I truly appreciate you.

~ Again, I am a layman.  I do not hold any college degrees, nor mastery of knowledge.  Please take what I say with a grain of salt.  If curious, do your own research 😉 Validate my writings.  Or challenge them.  And ALWAYS feel free to consult with your physician. Always.  Yours ~ Lisa

Endometriosis & Iron Levels

dumbbell
(…no, not that kind of iron)

So, if you’re reading this you probably already know a little bit about Endometriosis.  One of those facts is that the Endometriosis implants/lesions shed (or bleed) inside the pelvic cavity (or wherever else the Endo is located).  Another fact is that women with Endometriosis tend to have much longer and heavier periods than women who do not suffer from Endo.  Recently at our support group meeting, the question of iron levels and anemia came up.   With all that bleeding, can we suffer from anemia or an iron deficiency?

And, again, the topic of iron levels and Endo came up at our Endometriosis Awareness & Support Walk : could the blood left in my pelvic region from shedding Endo have caused the “abnormally high” iron levels during a blood test?

Just what does Endometriosis and iron do to our bodies?  Anemia? An iron deficiency?  High levels of iron? What does iron do?  Why do we need it?  All of these questions have been swimming around in my head and its’ time to get them out…and you know what that means : RESEARCH!

I don’t know about you, but every time I swallow a multivitamin with iron in it, I’m throwing up within five minutes.  When I spoke with my primary care physician a few years ago about iron making me throw up, he asked me why I was taking it.  My response was simply, “Because I thought I had to…”  He clucked his tongue, shook his head, and told me he generally only advised pregnant women to take iron.  So, I steer clear of iron supplements or vitamins that contain any iron.

Anyway, on with the research!

 

Iron Deficiency:

How do you know if you have an iron deficiency?  Symptoms may include shortness of breath while exerting, fatigue, weakness, dizziness, an urge to eat ice, headaches, depression, temperature sensitivity, a sore tongue, restless leg syndrome, an increase of infections, poor muscle coordination, and a decreased mental function.

Many women who are anemic suffer from an iron deficiency (without iron, enough red blood cells cannot be created/maintained and less oxygen is delivered throughout the body).   This deficiency may be due to blood loss, a lack of red meat in a diet, their bodies may have trouble absorbing iron, they may not take enough vitamins, GI issues, or some diseases such as fibroids or cancer.

According to the Iron Disorders Institute, blood loss may be due to heavy menstruation, Endometriosis, and fibroids, which may lead to anemia.  An average healthy woman’s body increases iron absorption during her period to make up for the loss of blood during her cycle.  With Endo, we tend to have lengthy or heavy periods and the iron regulatory systems in our bodies may not be able to properly regulate the amount of blood (and iron) we are losing, leading to anemia.  With that being said; however, a 2006 study claims to debunk the theory that heavy periods lead to anemia.

You can also not get enough iron into your body through diet and supplements, which can lead to anemia.  The Center for Disease Control estimates that only one-fourth of women between 12-49 years old meet the daily recommendation of iron intake.  Red meat is supposedly the best food-source for iron, which, for many following the Endo diet, is out of the question.  If you must eat red meat, try to get the organic, grass-fed beef.  Also, eggs, beans, fish, nuts, dried fruits, whole grains, and dark leafy vegetables are rich in iron.  A word of warning, calcium may inhibit the absorption of iron.  A healthy digestive system and nutrient-rich diet is critical to ensure good iron absorption.

Looking to restore your iron levels if you’re anemic?  Adjust your diet or talk to your physician about iron supplements (taking it orally, injecting it, or infusions) or, in extreme cases, a blood transfusion may be necessary.

Too Much Iron:

Too much iron may be indicated by chronic fatigue, joint pain, abdominal pain, skin color changes, the loss of your period, loss of libido, and even hair loss.

Women who no longer have their periods are at risk for having too much iron in their systems.  (This is interesting to me since I’m on the pill and haven’t bled since Sept. 25, 2014).  Other causes of heightened levels of iron could include hereditary factors, genetic mutations in the cells, autoimmune diseases, or an iron overload due to blood transfusions, excessive alcohol, or too much iron supplementation in the diet.

Some of the risks of having too much iron include premature heart attack (especially of interest given recent studies that women with Endo are at a higher risk of heart disease), diabetes, liver disease, osteoarthritis, and hormonal imbalances.

How Can I Know My Iron Levels?

You an ask your physician to order a blood panel.  Give up a vial or two of blood, lab work is done, and *presto* you have a magical piece of paper that only medical professionals can understand.  You may prod your doctor asking to check your ferritin, transferrin, iron,  TIBC (total iron-binding capacity), CBC (complete blood count), and reticulocyte count.  You may even want him/her to order a check on your thyroid levels, as these may come into play.

Or you can contact and pay Health e-Iron to test you with their FeGGT LifePro test.  (I don’t know or endorse these guys…just found them through the Iron Disorders Institute webpage).

Iron & Endometriosis

A study published in 2002 found that the iron concentrations in the peritoneal fluid of the pelvic cavity of women with Endometriosis was higher than women without, and that those high concentrations remained throughout each stage of the disease.  It also found that the higher iron concentrations were found alongside the lesions, suggesting a link between the two.  The study surmised that “…cellular defenses might be overwhelmed owing to repeated bleeding of lesions…” and further research was needed.

A study in 2006 proved that iron deposits and iron overload are found within the pelvic cavity where Endometriosis is present and may contribute to the growth and spread of the disease.  Lab rats who were treated with an “iron chelator” known as Desferoxamine (aka DFO) had less iron deposits, less cell growth, and less iron concentrations!  An iron chelator is a drug which removes excess iron from the body.  The study concluded that iron may contribute to the growth of the disease and the use of an iron chelator may be beneficial to help control iron levels in women with Endometriosis.  A 2009 study confirmed the findings that iron chelators may prove beneficial in reducing iron overload and controlling inflammation.

In 2008 several scientists from the 2006 study published another.  This time it was to review and discuss the potential consequences of iron overload in women with Endometriosis.  Again, they conclude that treatment using an iron chelator with Endometriosis patients should be considered to help lessen the effects of iron overload.  Table 1 of the 2008 study identifies 21 prior studies which demonstrate iron overload in women with Endometriosis (click here).   The study suggests that women with Endometriosis are unable to stabilize the amounts of iron in their bodies as easily as women who do not suffer from Endo.  These excess iron levels may contribute to the development of Endometriosis, add to inflammation, or even aggravate symptoms.

Now what?

I found it interesting reading different articles, blogs, and studies today.  In one corner, you have the “eat iron-rich foods and take supplements to make up for what you lose during your period” campaign – and in the opposite corner, you have the “women with Endometriosis have an iron overload.”  And throw in the 2006 study that blood loss during a period doesn’t lead to anemia.  So just what to do?

I think Step One is talk to your physician (well, I plan to).  My next appointment with my Endo doc/gyno is on April 12, 2016 for my annual exam & check-up.  I also want to ask him his opinion regarding menstruation and anemia and/or an iron deficiency.  After that appointment, he always orders my blood work so it works out perfectly : I’m going to ask him if he can test my iron & Vitamin B levels.  Depending on those results, I’ll think about Step Two.

Possible Step Two(s):

a.  Increase the amount of iron-rich foods in my diet (if I’m iron deficient);

b.  Find a good iron supplement that’s right for my body (if I’m iron deficient);

c.  Talk about iron chelators (if I have too much iron);

d.  Do nothing different than what I have been doing (assuming my numbers are juuuust fine).

What are you going to do?  And what are your thoughts on iron, anemia, and Endometriosis?

(and thanks for reading!)

 

Resources:

American Journal of Human Biology – (2006; Article) Menstruation Does Not Cause Anemia: Endometrial Thickness Correlates Positively with Erythrocyte Count and Hemoglobin Concentration in Premenopausal Women

American Red CrossIron Information for All Donors

Endometriosis.org Overload of Iron in the Pelvic Cavity May Promote Proliferation of Endometriosis Lesions’ Epithelial Cells

Every Day Health

Fertility & Sterility – (Oct. 2002, Article) Iron Overload in the Peritoneal Cavity of Women with Pelvic Endometriosis

Health e-Iron, LLC

Human Reproduction– (July 2006, Article) Iron Overload Enhances Epithelial Cells in Endometriotic Lesions Induced in a Murine Model

Iron Disorders InstituteIron Deficiency Anemia

Iron Disorders Institute – Iron Out-of-Balance in Women

Iron Disorders InstituteIron Overload

Lab Tests Online

Livestrong Iron-Rich Foods for Iron-Deficiency and Anemia

Mary Vance NC

Molecular Human Reproduction – (May 2008, Article) Potential Involvement of Iron in the Pathogenesis of Peritoneal Endometriosis

National Heart, Lung, and Blood Institute

NHS.uk

Scientific American – (July 2011, Article) Iron-Deficiency is Not Something You Get Just for Being a Lady

SelfGrowth.com

The Curriculum in Iron Metabolism & Related DisordersIron Chelation Basics

US National Library of Medicine – (Sept. 2006, Abstract) Menstruation Does Not Cause Anemia: Endometrial Thickness Correlates Positively with Erythrocyte Count and Hemoglobin Concentration in Premenopausal Women

US National Library of Medicine – (Dec. 2009, Article) Synthetic and Natural Iron Chelators: Therapeutic Potential and Clinical Use

US National Library of Medicine – (Jan. 2009, Abstract) The Role of Iron in the Pathogenesis of Endometriosis

~ Again, I am a layman.  I do not hold any college degrees, nor mastery of knowledge.  Please take what I say with a grain of salt.  If curious, do your own research 😉 Validate my writings.  Or challenge them.  And ALWAYS feel free to consult with your physician. Always.  Yours ~ Lisa

New Pill? Viagra for Women!

lilpinkpil

You may have heard in recent news that the an FDA advisory committee is pushing for the approval of a new drug, Flibanserin, which is being hailed as “viagra for women,”  and decision by the FDA is expected on or before August 18, 2015. Many women suffer from a low sex drive for many different reasons.  I myself have suffered with one since my Lupron Depot injections, which were immediately followed by a continuous birth control.  My libido is nearly non-existent nowadays. Blah.

But what is this drug? What are the potential side effects? How long were the clinical trials?  All of these questions come running to the tip of my tongue – will the pros outweigh the cons?  Will there be interactions with my birth control pill?  Less questions, MORE RESEARCH!

Flibanserin

In 2006, Flibanserin was first tested and developed by a German pharmaceutical company, Boehringer, as an anti-depressant medication. The drug lowers serotonin while raising dopamine, and norepinephrine levels in a woman’s brain.  The initial anti-depressant trials of the drug with women showed an increase in sexual desire, which prompted new studies with thousands of women.  The hope was to pass it off as a libido-increasing drug to combat the affects of hypoactive sexual desire disorder (HSDD).  However, due to it’s failed attempts at FDA approval to treat HSDD, Boehringer sold the rights of the drug to Sprout Pharmaceuticals in 2011. Sprout Pharmaceuticals filed their patent in 2014.

Sprout Pharmaceuticals was developed in 2011, solely for the purpose of creating a libido-enhancing drug for women.  They have not produced any drugs on the market, to date.  However, several of their executive team hail from other pharmaceutical companies such as Slate Pharmacueticals (manufactured Testopel), Halozyme Therapeutics (manufactured Hylenex), Actient Pharmaceuticals (a company which acquires pharmaceutical companies), Hyman Phelps & McNamara (a food & drug law firm), and AAI Pharma (a pharmaceutical testing company).

The suggested dosage for women would be 100mg per day, likely taken at night.  For some women in the clinical trials, it took 4-8 weeks before they felt any improved sexual response.

There is a huge lobbying campaign by several women’s groups to approve this drug, stating that men have a lot of approved libido-enhancing drugs, where women have zero.  I see their point…but…safety first!  The National Women’s Health Network strongly opposed the drug’s approval at the recent hearing due to concerns over side effects.

Potential Side Effects

Since 2010, the FDA rejected Flibanserin’s approval due to concerns over the side effects, which may include dizziness, fainting, sleepiness, low blood pressure, and nausea.  Sprout Pharmaceuticals has tried twice since 2013 to have the FDA approve the drug, and failed.

Side effects may be worsened by prescription drugs (particularly, birth control pills) and/or alcohol.  There were also concerns expressed at the advisory committee hearing over a potential for increased accidents (trips, falls, vehicle collisions, etc.) due to these side effects.  Reportedly, one woman reacted so poorly in a clinical trial that she had to be hospitalized.

However, the advisory committee feels that with proper warnings and labels, this drug has the potential to change the lives of a lot of women, and their significant others.   They are also hoping a bona fide, approved drug will help steer women clear of unsafe internet wonders and snake oil treatments for lowered libidos.

Studies

There are countless reports and studies regarding Flibanserin available to you through the interwebs.  I will discuss a few here, but for a comprehensive list, please click here.

Sprout Pharmaceuticals ran a 24-week trial, and the results showed that the Flibanserin had positive effects for 46-60% of the women taking that pill; however, the advisory committee altered those numbers once they figured in the placebo pill.  After the committee’s alterations, they found only 10% of women had positive feedback; which was about an increase of one sexually satisfying event per month.  The advisory committee stated that the drug had “marginal to moderate” results.

There was also a two-year cancer study on the effects of raised dosages in mice, which found an increased risk of breast cancer tumors (these mice received four-times the recommended dosage).  There are reports that studies of Flibanserin lasted anywhere from one year to 18 months, and the FDA is concerned over the lack of time taken to evaluate any potential cancer risks.  Sprout Pharmaceuticals reminded the advisory committee that just because studies in lab animals shows an increased potential for developing breast cancer, doesn’t mean those study results will transfer over to humans…

What Now?

The advisory committee has begun preparing their recommendation package to be presented to the FDA to aid in their decision.  This will include suggested warning labels, educational materials, training for professionals who will prescribe this medication, etc.

Some members of the advisory committee who voted against the pill’s approval are concerned over a lack of data and information, and feel the benefits do not outweigh the risks.

My 0.02

I hate taking pills.  I hate feeling ill from taking pills even more.  I especially run from pills that may potentially harm me, or come with ludicrous warning labels and side effects.  Just not worth it.

I’ve always felt that Big Pharma is lookin’ for that Next Big Thing to make a buck.  Many people do not agree that this pill is the “viagra for women” since the chemical and physical reactions of viagra versus Flibanserin are completely different: it does not increase blood flow to a sexual organ; it increases and decreases chemicals within the woman’s brain to alter sexual interest.  “Viagra for women” may be a general misleading and miscategorized statement.

So, if this pill hits the market, I’ll avoid it.  A little prompting by my very patient partner goes a long way in reminding me just how much I’ve missed sex.  Just because I don’t have a sense of initiation any further doesn’t mean I want it any less.  I just…forget…how much I want it.  However, that being said, I know there are a lot of women who may want to pursue this little pill route; and more power to them.

But I am curious and will continue to follow these stories as they break.

What are YOUR thoughts? I’d love to hear them…leave a comment below.

Resources:

AAI Pharma

Flibanserin-HSDD – timeline

Forbes – 6/4/15 article

Google Patents – September 2014 – Method for the Treatment of Premenstrual and other Female Sexual Disorders

Google Patents – June 2014 – Use of Flibanserin for the Treatment of Post Menopausal Sexual Desire Disorders

GTCR – re: Actient Pharmaceuticals

Halozyme

Hyman, Phelps & McNamara, P.C.

International Business Times – 6/8/15 article

MedCity News – 4/4/12 article

National Post – 6/5/15 article

National Women’s Health Network – 6/3/15 press release

Science 2.0 – 6/6/15 article

Sprout Pharmaceuticals – 2013 (Article) – Efficacy of Flibanserin in Women with Hypoactive Sexual Desire Disorder : Results from the Begonia Trial (the 24-week study)

Sprout Pharmaceuticals – 2/11/14 press release

Sprout Pharmaceuticals – 6/5/15 press release

Sprout Pharmaceuticals – executive leadership information

Tech Times – 6/8/15 article

Thomas Reuters – 2014 (Abstract) – Flibanserin for Female Sexual Dysfunction

US News – 6/3/15 article

~ Again, I am a layman.  I do not hold any college degrees, nor mastery of knowledge.  Please take what I say with a grain of salt.  If curious, do your own research 😉 Validate my writings.  Or challenge them.  And ALWAYS feel free to consult with your physician. Always.  Yours ~ Lisa

New Study : Endometriosis and Semen

OLYMPUS DIGITAL CAMERA So there’s an article that was recently published that has a lot of EndoSisters in an uproar today on Facebook.  The article was title, “How your sex life may influence endometriosis,” published on May 1, 2015, by MedicalXpress. My initial knee-jerk reaction last night was to be furious.

I interpreted the article as saying that sex can cause and affect Endometriosis growth; to be more precise: seminal fluid can affect Endo growth.  Semen.  Baby-MoJo.  I’ve had my Endo pain since my early years in high school.  And I did not have sex until I was 21.  And my cramps were pretty damn bad back then.  How dare a study suggest that sexual activity had anything to do to heighten my endo symptoms or progression.   And my outrage was further fueled by other EndoSisters’ reactions about the same conclusion.

I’ve decided to take my time, read the study slowly, and try to digest what it is the study is trying to tell us. Wait. Step back. Breathe, breathe.  Relax.  Now go read the study…

Prior Studies

There have long been studies of seminal fluid and any affects it may have on the female anatomy.  Some studies found that seminal fluid promotes an inflammatory response of the cervix, in order to facilitate fertilization.  One study concluded, “further studies are required to examine the duration of the response and whether seminal fluid signaling extends to the higher regions of the uterus to exert direct effects on embryo development and implantation, as well as to investigate the downstream effects of seminal fluid-induced immune responses on pathways affecting fertility and infertility, infection, and disease.”

A study published in 2010 was conducted to see if seminal fluid had any affect on the growth of endometrial cells in women who have endometriosis.  The study found that it “may promote the growth of endometrial cells derived from women with endometriosis. Our findings may suggest some detrimental effect of unprotected sexual intercourse in women with endometriosis.”

All the Hullaballoo

A new study published in The American Journal of Pathology in January of 2015, found that there may be a direct link between the contact of seminal plasma and endometrial cells, and the production of endometrial tissue and lesions. The study, conducted by the research staff at the University of Adelaide, found “these data suggest that seminal plasma enhances the formation of endometriosis-like lesion via a direct effect on endometrial cell survival and proliferation, rather than via macrophage-mediated mechanisms. These findings raise the possibility that endometrial exposure to seminal plasma could contribute to endometriotic disease progression in women.”

Associate Professor Louise Hull stated “the next stage of the research will look at what this means for women with and without endometriosis…we now need to apply these laboratory findings to real life and determine whether the exposure of seminal fluid that occurs naturally during intercourse puts women at increased risk of developing endometriosis. And if modifications to sexual activity could lower the severity of the disease in women with endometriosis,” (Courtesy of MedicalXpress.com)

A side note

A study published in 2009 suggests that a woman who has endometriosis may create a toxic and infertile environment for sperm.  Byproducts of our inflamed tissues and over-reactive immune system may produce toxic fluids which reach the uterus through the Fallopian tubes.  It concludes, “there was evidence of significantly higher sperm DNA damage in samples incubated with [peritoneal fluid] from patients with endometriosis compared with samples incubated with [peritoneal fluid] from healthy women and controls at the three incubation periods studied…We are proposing that endometriosis-induced sperm DNA damage may be one of the underlying causes of reduced natural fertility in these cases.” More studies, of course, are needed. It’s just frustrating for those EndoSisters who are striving to become pregnant.

My Two Cents

So, this new study is not saying that seminal fluid causes Endometriosis.  My knee-jerk reaction was done in poor taste. It is simply suggesting that seminal fluid may play a role in the development or progression of endo. However, it appears more studies will be necessary to determine if unprotected sex may influence the severity of symptoms in women with endometriosis, and if it may raise the risk of women developing endometriosis. On that note, there have been several Sisters on Facebook today stating they have had, and continue to have, protected sex using condoms, and the severity of their symptoms have always been severe. It will be interesting to watch how this develops.

Resources:

Examiner.com

Fertile Care for Women

MedicalXpress.com

ResearchGate : Article (2009) The Impact of Peritoneal Fluid from Healthy Women and from Women with Endometriosis on Sperm DNA and its Relationship to the Sperm Deformity Index

The American Journal of Pathology : Abstract (2015) Seminal Plasma Promotes Lesion Development in a Xenograft Model of Endometriosis

The Journal of Immunology : Article (2012) Seminal Fluid Induces Leukocyte Recruitment and Cytokine and Chemokine mRNA Expression in the Human Cervix after Coitus

U.S. National Library of Medicine : Abstract (2010) Effect of human seminal fluid on the growth of endometrial cells of women with endometriosis

~ Again, I am a layman.  I do not hold any college degrees, nor mastery of knowledge.  Please take what I say with a grain of salt.  If curious, do your own research 😉 Validate my writings.  Or challenge them.  And ALWAYS feel free to consult with your physician. Always.  Yours ~ Lisa

Ongoing Research Studies re Endometriosis

research

Figured I’d put together a list of facilities and companies that are presently conducting research studies about Endometriosis.  I’ll update this often (some of these studies may overlap)…

All of the descriptions about these studies is directly from their websites.  If interested in participating or want more information, click on the name of the study below:

Updated 07/11/16:

AbbVie: A randomized study evaluating the safety and efficacy of elagolix in the management of moderate to severe endometriosis-associated pain in adult premenopausal female subjects.  The study consists of 4 periods: 1) Washout Period (if applicable); 2) a Screening Period of up to 100 days prior to first dose; 3) a 6 month Treatment Period; and 4) a Post treatment Follow-up Period of up to 12 months (if applicable). An electronic diary will be dispensed and training provided to record endometriosis-associated pain, uterine bleeding, and analgesic medication use for endometriosis-associated pain on a daily basis. Pregnancy testing will be performed monthly throughout the study. Subjects will be required to use nonhormonal dual contraception during the study, and will be counseled on appropriate and effective forms of birth control to promote pregnancy prevention.

Aljazeera Hospital: Egypt.  The aim of this randomized controlled trial is to compare operative data and early postoperative outcomes of laparoscopic excision of endometrioma using barbed sutures with those of laparoscopic excision of endometrioma using conventional sutures.

Assistance Publique – Hospitaux de Paris: France. The investigators performed a prospective multicenter comparative study to assess the maternal and fetal risks related to endometriosis during pregnancy, regarding disease phenotype, This study will evaluate with sufficient power the risk of prematurity and obstetrical complications associated with endometriosis according to disease phenotype.  This study aims to provide new informations to pregnant women with endometriosis, guide the monitoring of pregnancy, optimize management strategies based on the nature of complications and ultimately to improve the health of women and their unborn child

Australian National University: Australia (online).  We are inviting you to complete an online Endometriosis Impact Questionnaire (EIQ) developed based on 10 focus group discussions with 35 women with endometriosis.  Your valuable participation will contribute towards better understanding of the impact of endometriosis on women’s lives and to better meet the needs of women with this condition.

Bayer: Purpose of the study is to test efficacy and safety of BAY98-7196 intravaginal ring as a new treatment option for patients with endometriosis-associated pelvic pain

Brigham and Women’s Hospital: Massachusetts. We are doing this research study to find out if intravenous (in your vein, “IV”) lidocaine can lessen pain from endometriosis. The U.S. Food and Drug Administration (FDA) has approved intravenous lidocaine to treat irregular heart beats, but the FDA has not approved intravenous lidocaine to treat pain from endometriosis. Intravenous lidocaine has been used for more than 25 years to treat different acute and chronic pain conditions but has not yet been studied for endometriosis pain. This is a cross-over trial over two months where one month you will receive the active medication (lidocaine) and one month you will receive the active placebo (diphenhydramine, commonly known as benadryl). We will compare the effect on pain from endometriosis of lidocaine to active placebo.

Center for Epidemiology and Health Research: Germany.  The study assesses safety aspects of Dienogest (DNG) 2mg/day (Visanne) used as endometriosis therapy and of other hormonal treatments for endometriosis.  This study investigates the safety of DNG for endometriosis with regard to medical interventions for anemia and worsening of depressive symptoms associated with the disease. It is a prospective, controlled, non-interventional cohort study with two cohorts: users of DNG and users of other medications for the treatment of endometriosis. The study will be implemented in several European countries.

Children’s Hospital Boston: Massachusetts.   The purpose of this study is to determine whether dietary supplementation with Vitamin D or Fish Oil can help to reduce physical and emotional symptoms in adolescent girls with endometriosis.

End to Endo: The purpose of this research study is to investigate the genes responsible for predisposing women to endometriosis. By identifying these genetic variants, our team of health professionals and scientists plan to develop noninvasive diagnostics and earlier and more effective therapies for this often-debilitating condition.  We will send you a saliva sample kit.  After completion, you will send these items back to our laboratory in the postage-paid envelope we’ve provided.

Esparios:  Pennsylvania.  Qualified individuals will receive the investigational study medication, study-related medical exams, and laboratory services at no charge. They will also receive compensation for time and travel.

Florida Hospital: Florida.  The purpose of this study is to evaluate the use of fluorescence imaging + Indocyanine Green (ICG) dye (“Firefly”), compared to standard white light imaging in 2D and 3D, for accurate visual diagnosis of endometriosis during a da Vinci robotically guided endometriosis resection procedure.  The ability to accurately visualize all the lesions of endometriosis, typical and atypical in appearance, and thus facilitate complete resection of the disease, may have a significant impact on symptomatic relief and disease recurrence. The Firefly Imaging System of fluorescence imaging + ICG dye may allow for more accurate visual diagnosis of endometriosis during a robotic-assisted endometriosis resection procedure, and therefore may have a positive impact for patients with this disease.

Highland Clinical Research: Utah.  We are conducting a clinical research study to investigate the effects and effectiveness of a new oral medication indicated for the treatment of endometriosis.

Institut Universitari Dexeus: Spain.  To study the recurrences After Surgery for Deep Endometriosis Depending on the Involvement of the Surgical Margins in the Specimen

Ipsen:  China.  The purpose of this study is to describe changes in the intensity of specific endometriosis symptoms from baseline pre-surgery to after surgery and subsequent continuous Diphereline (Triptorelin Acetate) treatment for up to 24 weeks.

Northwestern University: Illinois.   The aim of this research is to assess the benefit of a medication (ulipristal) for alleviation of symptoms in women with chronic, endometriosis-related pelvic pain.  25 patients with chronic, endometriosis-related pelvic pain refractory to medical and/or surgical therapies will receive 15mg ulipristal every other day (three times a week- Monday, Thursday, Saturday) for three months.

ObsEva SA: The primary objective of this study is to assess the efficacy and safety of a range of oral doses of OBE2109 versus placebo, in reducing endometriosis associated pain.

P3 Research:  New Zealand.  Elagolix is an oral medication being developed for the management of endometriosis-associated pain and other hormone-related disorders. This study is designed to look at the safety and efficacy of Elagolix.  Elagolix is oral tablets taken twice daily. The treatment period is for six months, with a follow-up of up to 12m. Subjects complete a daily electronic diary entry (provided) and attend monthly clinic visits.

Physicians’ Research Options: Utah, Colorado.  Do you suffer from the agonizing symptoms of endometriosis? A double-blind, placebo controlled study of an investigational GnRh antagonist (non-hormone) medication. A up to 18 month study (up to six months of study participation with a one-year extension study). Participant time and travel compensation up to $2,290.00.

Repros Therapeutics Inc.: The primary objective of this study is to determine the safety and efficacy of two oral doses of Proellex administered to premenopausal women with pelvic pain associated with endometriosis confirmed within the last seven years and using prescription analgesics for symptomatic pain.

Research OutSmarts Endometriosis (ROSE): New York.  Researchers involved in ROSE are using several approaches to study endometriosis. These include efforts to better understand the genetic basis of the disease and relate this what is occurring at the cellular level in the disease, with particular emphasis on the role of stem cells and the immune system. Women both living with and living without endometriosis can participate in the ROSE study to help us find answers for those who are suffering.

Royal Surrey County Hospital: To determine the quality of life following the radical excision of recto-vaginal endometriosis.

Solstice: This study is being conducted at approximately 200 research centers worldwide.  The purpose of the study is to evaluate the safety and effectiveness of an investigational drug for moderate to severe endometriosis pain symptoms.  The investigational drug is a tablet taken by mouth that is designed to reduce the production of estrogen in the ovaries, one of the hormones associated with endometriosis pain. This study will evaluate whether the investigational drug may help manage the painful symptoms associated with endometriosis. The investigational drug is not approved by regulatory agencies as a treatment for endometriosis pain.  In this study, the investigational drug will be compared to placebo. Placebo looks the same as the investigational drug but has no active drug in it.

The Women’s Health Study: Massachusetts.  We are trying to understand the factors that affect the health of girls and women. You would be helping us by giving us one piece of this huge jigsaw puzzle.  Volunteers are asked for participation once per year. Up to $35 gift cards from Target or a major online gift card retailer is provided each time you participate.

Universitaire Ziekenhuizen Leuven: Belgium.  The purpose of the study is to evaluate the value of MRI in preoperative stratification of endometriosis patients needing surgical approach by gynaecologists only or multidisciplinary approach by gynaecologists, urologists or/and abdominal surgeons.

University Hospital, Angers: France.  The aim of this multicenter, prospective, open study is to assess sensitivity of PET with [18F] -FES for diagnosing endometriosis compared to the gold standard (histological confirmation on biopsy or excision of lesions performed during laparoscopy) in women care for suspected endometriosis and for whom laparoscopy is already scheduled.

University Hospital, Montpellier: France. A prospective cohort study would give access to clinical data of patients followed in our center, so as to identify clinical factors predicting pregnancy and to help treatment decision for women with endometriosis suffering from infertility.

University Hospital, Rouen: France.  Information is obtained from surgical and histological records and from self-questionnaires completed before surgery. Standardized gastrointestinal questionnaires (KESS, GIQLI, WEXNER, FIQL and Bristol) are routinely used to assess bowel function. Data recording, patient contact and follow-up are carried out by a clinical research technician. Postoperative follow-up is based on data from the afore-mentioned questionnaires completed at 1, 3, 5 and 7 years.

University Hospital, Rouen: France.  The purpose of this study is to determine whether, in women with deep endometriosis involving the rectum and not intending to get pregnant, continuous hormonal treatment would be followed by better digestive functional outcomes than curative rectal surgery.

University of Aarhus: Denmark.  To investigate parameters related to fertility in women with endometriosis in relation to food items.

University of Aarhus: Denmark.  A subgroup of patients with DIE has an infiltration into the rectosigmoid bowel wall (4-37%). Knowledge of the growth pattern of rectosigmoid lesions related to subjective symptoms is mandatory in order to assess the need for follow-up with transvaginal ultrasound during medical treatment.  Two different cohorts of women, based on time of diagnosis of rectosigmoid endometriosis and treatment with hormonal intrauterine device or continuous oral contraceptives will receive a questionnaire and a transvaginal ultrasound scan (measuring size and volume) at inclusion, (6) and 12 months later.

University of Aarhus: This project will investigate worsening of symptoms in endometriosis patients undergoing artificial reproductive techniques (ART). The study compares patients with peritoneal/ovarian and deep infiltrating endometriosis to relevant reference groups. Symptoms are monitored with a questionnaire with the categories quality of life, pain and bowel habits. The EHP-30® questionnaire is included in the questionnaire.

University of Aarhus: Denmark.  This study evaluates the effects of psychological treatment on pain, quality of life and work ability among women with endometriosis related chronic pelvic pain in a three-armed, randomised study. One group will receive mindfulness-based psychological treatment, the second group will receive a non-specific general psychological treatment (a psychological placebo) and the third group will be a waiting list control (treatment as usual).

University of Athens: Greece.  To evaluate the efficacy of oral contraceptives in a continuous fashion versus the usual cyclic fashion in the recurrence of endometriosis related symptoms and endometriomas following fertility-sparing surgery.

University of Cagliari: Italy.  The aim of the present study is to validate the italian version of EPH 30, a self reported questionnaire, already used internationally, in order to determine the quality of life in women with endometriosis, assess their psychological health and the effectiveness of therapies.

University of North Carolina School of Medicine: North Carolina. The purpose of this study is to determine the effects of progesterone (a naturally occurring hormone) on the endometrium during the time when embryo attachment typically occurs.  This will be compared to women with endometriosis to improve clinical diagnostics and treatments for those suffering from the condition.

University of Zurich: Switzerland.  The current study investigates the quality of life and several risk factors for the development of endometriosis as well as satisfaction with medical support in a minimum of 600 women with different stages of endometriosis and the same number of control women matched for age (± 3 years) and nationality. To evaluate specific features of endometriosis-associated pain a second group of 100 women with chronic abdominal/pelvic pain not related to endometriosis is investigated. Recruitment takes place in different university clinics, and districts hospitals in Switzerland, Germany. And Austria. Control women i.e. women without any evidence for endometriosis presenting for annual routine gynaecological controls are collected at the same places.  A composition of different internationally validated questionnaires as well as specific questions on dealing with endometriosis is used to collect information on the quality of life and potential risk factors for endometriosis. Questions on sexuality and partnership are also distributed to women’s partners.

Women’s Health Care at Frost Street:  California.  Women’s Health Care Research is seeking volunteers to take part in a clinical trial. Qualified participant may receive study-related procedures and study medication at no cost. Compensation up to $1350.00 may also be provided.

Stress levels may affect Endo

StressSymptomsSo after a particularly stressful day at the office, I decided to do some writing and soul searching and (of course) research.  In all of the books and articles I’ve read, there has been a comment or chapter stating that stress may worsen Endometriosis.  But why?

How Stress Affects the Body:

Stress may trigger adrenal stress hormones, which may alter heart rates and blood flow.  It may also impair our white blood cell count, which can lower the body’s chances of fighting infection, reduce inflammation or even prevent/limit scarring. Gals with Endo know that inflammation and scarring are two critical components of a painful Endo day.  Stress may also cause or exacerbate problems such as headaches, high blood pressure, heart problems, stroke, diabetes, skin conditions, asthma, arthritis, depression, and anxiety.

Science!

In 2008, news reports state a study was conducted on seven female rats.  A team of investigators concluded that higher stress levels may, “affect the severity of endometriosis. We think there is likely a connection with the immune system because of the observed levels of mast cells in the colon and the increased levels of inflammatory cells in the peritoneum of the affected rats, since this has also been observed in patients with endometriosis.” (Caroline B. Appleyard, Ph.D.).  The study concludes with, “Endometriosis has been identified as a heterogeneous, complex disease, and it is highly plausible that the existence of ongoing stress may contribute to the development of this disease through disturbances created in the immune and neuroendocrine systems. As such, our results point to the importance of future research in this area to lead to a better understanding of this disease and the importance of the ‘brain–body–brain cross talk.’ This may help to establish psychological, behavioral, and stress-reduction interventions as part of multidisciplinary preventive and clinical management to better treat patients with this condition.”  It appears the study was published in 2012, and can be read here.

Again in 2014, Dr. Appleyard and a team of investigators e-published (hard print is pending) another study regarding stress and Endometriosis.  This time it was to investigate whether being able to control stress would affect Endometriosis’s progression.  It concludes, “[i]n summary, the level of stress controllability appears to modulate the behavior and pathophysiology of endometriosis and offers evidence for evaluating therapeutic interventions.”  An abstract of the study can be read here. Also, I have the entire study provided by Dr. Appleyard.  Contact me if you’d like to read it…

I have since had the pleasure of interviewing Dr. Appleyard and Dr. Flores Caldera.  If you’d like to read them, you can click here.

An abstract from the 2016 Experimental Biology meeting references Dr. Appleyard’s recent efforts regarding stress and Endometriosis.  She and a team studied the affects of stress on Vitamin D receptors and how they may influence Endometriosis.  They found that “stress exacerbates development of cysts…suggesting an impact on the local inflammatory environment.”

 Techniques We Can Use to Alleviate Stress:

Breathing: Deep, focused breathing has been shown to reduce anxiety, and calm emotions and thoughts.  There are several techniques for deep breathing, and I personally will begin using the 4-7-8 Technique (you can read more about it here).

Exercise: Physical exercise pumps up endorphins…the “feel goods.”  It may also help us forget the stresses of the day, shedding calories and stress! A win-win!

Listen to Music: Soothing music can decrease heightened cortisol levels (aaaugh, STRESS!), which may lead to relaxation and less tension.

Massage: Massage has been known to relax muscles, increase endorphin production, ease tension, and relieve headaches.  Massage also releases serotonin and dopamine into the body, which deepen a sense of relaxation and calm.

Meditation: A 5-minute meditation may quickly restore the peace you were feeling prior to the stressful environment.  Just get away for a few minutes in a quiet place. Sit or lay down, close your eyes, take a deep breath, exhale slowly.  Imagine yourself in one of your favorite places, feel the ground beneath your feet, imagine the scents and sounds around you.  Steady your breathing and relax your tense muscles. Let it go, calm down, relax.  Calm, collected, and ready to face what’s next.

Professional Help: If you so desire, seek the advice of a professional, such as a psychologist.  Sometimes it helps to talk to someone, and sometimes it helps to talk to a neutral, unbiased party.

TARP Method: Tune into your body’s signals, triggers, and early warning signs to help realize when your stress levels are rising.  Analyze the source of the stress. Respond by dealing with the cause of your stress, and helping calm its effects on your body (aka calm down). Prevent future stresses by developing an earlier response to stress, calming faster, and even cutting the cause of the out of your life.

Yoga: Yoga not only stretches and maintains a limber body, but also includes breathing exercises which further decrease heightened cortisol levels and helps bring a sense of peace and calm.  However, yoga for women with Endometriosis can be tricky, based on the placement of adhesions inside the pelvic area or anywhere inside the body.  Melissa Turner and Allannah Law have developed a yoga program that is intended to ease any adhesion-stress and help those who suffer from Endometriosis.  You can view her page here.

Personal Resolve

After reading all about the ways stress can affect our bodies and Endometriosis, and all of the *simple* ways we can reduce stress, I am most certainly going to give my own stress relief (and avoidance) a grand effort this year.  I’ve altered my diet, I’m taking medications, and now it’s time to help my body with stress relief.  I can do this.

We can do this!

Resources (updated 5/12/16):

Chinese-Holistic-Health-Exercises.com

Ehealthmd.com

Ezinearticles.com

Learntomeditatetoday.com

Massageenvy.com

Mayoclinic.org

Moffitt.org

Ncbi.nlm.nih.gov

Pdrhealth.com

Psychologytoday.com

Sciencedaily.com

Stress.about.com

The FASEB Journal – Experimental Biology 2016 Meeting abstract

Webmd.com

Yoga4endometriosis.com

~ Again, I am a layman.  I do not hold any college degrees, nor mastery of knowledge.  Please take what I say with a grain of salt.  If curious, do your own research 😉 Validate my writings.  Or challenge them.  And ALWAYS feel free to consult with your physician. Always.  Yours ~ Lisa