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Dx Endometriosis: New Discoveries; No Surgery:


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The JAMA 2015 article entitled An Overview of Treatments for Endometriosis states:
Limitations: There is limited evidence to guide clinical decisions for endometriosis therapy. Evidence is especially limited for preventing recurrence. There are insufficient data to reach definitive conclusions about the superiority of any one treatment for endometriosis.


The Merck Manual Home Edition states:
"Endometriosis is a chronic disorder that may be painful. Exactly how many women have endometriosis is unknown because it can usually be diagnosed only by directly viewing the endometrial tissue (which requires a surgical procedure). About 6 to 10% of all women have endometriosis. The percentage of women who have endometriosis is higher among women who are infertile (25 to 50%) and women who have pelvic pain (75 to 80%). The average age at diagnosis is 27, but endometriosis can develop in adolescents.
  Endometriosis sometimes runs in families and is more common among first-degree relatives (mothers, sisters, and children) of women with endometriosis. It is more likely to occur in women who have their first baby after age 30, who have never had a baby, who have short menstrual cycles (less than 27 days), or who have certain structural abnormalities of the uterus.
  Endometriosis seems to occur less often in women who have had several pregnancies, who use low-dose oral contraceptives, or who exercise regularly (especially if they started before age 15, exercise more than 4 hours a week, or both).
  The cause of endometriosis is unclear, but there are several theories:
*Small pieces of the lining of the uterus (endometrium) that are shed during menstruation may flow backward through the fallopian tubes toward the ovaries into the abdominal cavity, rather than flow through the vagina and out of the body with the menstrual period. [Sampson theory]
*Cells from the endometrium (endometrial cells) may be transported through the blood or lymphatic vessels to another location.
*Cells located outside the uterus may change into endometrial cells.

*[Editor] The most recent research by Linda Guidice, M.D. and the Editor shows that environmental toxins called endocrine disrupting chemicals (EDCs) can induce endometriosis in exposed animals because the plastics, DDT and polyposate are synthetic xeno-estrogens. In the Editor's Endometriosis lecture, he describes how he has been able to counteract some of these EDCs effects and may be able to reverse endometriosis in even the worse cases with F.D.A. medications from the 1960's.

Medications Used in Treatment:
1. Progestins: Depo-Provera®/MPA-medroxyprogesterone, Provera®,/MPA, Augestin®/norethindrone acetate
2. Progesterone: Prometrium®,/progesterone /
3. Gonadotropin Releasing Hormone Agonists: Lupron®/luprolide acetate, Synarel®/nafarelin,Zoladex®/goserelin/ Orilissa®/ elagolix
4. Androgens: Danazol®/danocrine, testosterone, nandrolone, oxandrolone, stanozolol

Testimonial: Sheri was diagnosed at 31 with the most severe Endometriosis (Stage IV). As no medication including months of Lupron® had stopped her pain, she was scheduled to complete her removal of her reproductive organs with bilateral oophorectomy and removal of her left colon (hemicolectomy) at John Hopkin's Hospital in Baltimore, Maryland. Seen by the Editor in consultation, Danazol did not work, nor had Luprolide, Megace or oral contraceptives. However, by eliminating the testosterone in the mixed androgen injection, the patient soon became pain free and has remained so for 4 years.
*[Editor] The medical literature is not as supportive of the listed medications.
* The Cochrane Database from 2012 stated "there is only limited evidence to support the use of progestagens and anti-progestagens (gestrinone in Europe) for pain associated with endometriosis...There was no evidence of a benefit with depot administration."
* Luprolide acetate was associated with skeletal deficits at the spine in almost one-third of subjects.
* The oral contraceptive pill taken continuously is as effective as GnRH-a, while causing far less side-effects.
* Danazol, in a Cochrane Database Review, "is effective in treating the symptoms and signs (pain) of endometriosis...Laparoscopic scores were improved. However, it use is limited by the occurrence of androgenic side effects" [Editor: because they did not add-back spirolactone in the danazol studies].

The newest evidence is that the endometriosis shows extreme sensitivity to SHBG levels, implying that SHBG-bound estrogen "thereby assisting the development of the pelvic endometriosis."
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