PREVENTION OF ENDOMETRIOSIS presented in ICE
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there is no clear guideline regarding prevention.
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PREVENTION OF ENDOMETRIOSIS presented in ICE
- 1. CAN WE PREVENT ENDOMETRIOSIS DR. JHEELAM MUKHOPADHYAY HELATH WORLD HOSPITAL DURGAPUR
- 4. Introduction
- 6. AETIOLOGY: THEORIES Sampson ‘s theory : retrograde menstruation Coelomic metaplasia theory Lymphatic and vascular metastases theory Genetic Immunological factors Inflammation
- 7. Prevention Primary level Life style Food Exercise Secondary(progression of disease) After conservative surgery After complete surgery Early Diagnosis TERTIARY level SCAR ENDOMETRIOSIS
- 8. CLINIC DISPLAY (life style) Eat more green. Wrap yourself in warmth Cut the booze Chill out Get a massage Try acupuncture Get emotional support Avoid pullutants
- 9. Endocrine-disrupting chemicals (EDCs) Cosmetics and personal care products (benzophenone (BP) and paraben (PB) families BPs include BP-1, BP-3, and 4-hydroxybenzophenone (4-OH- BP) and are used as UV blockers in suntanning creams. polychlorinated biphenyls (PCBs) (congeners 118, 138, 153, and 156) dioxins (2,3,7,8-TCDD, 1,2,3,7,8-PeCDD, 1,2,3,4,7,8-HxCDD, and 1,2,3,6,7,8-HxCDD).(histone modification, DNA methylation,+ expression of non-coding RNA (ncRNA).
- 10. Exercise & Manage Stress Encouraging the circulation of blood Maintaining nutrients and oxygen flow Decreasing estrogen production Reducing stress Releasing endorphins in the brain
- 11. Complementary and alternative medicine Autogenic training. , Progressive muscle relaxation. Visualization. Deep breathing. Accupunture Endogenous opioids /cortisol Deactivation of brain areas linked to pain perception Lacally adenosin release, local blood flow to modulate pain
- 12. Diet : Alcohol :MORE ESTROGEN Omega-6 fatty : PRO INFLAMATORY Decrease Methylation changes Antioxidant : VIT D,C,E,A CURCUMIN Diet : RED MEAT, TRANS-US FATTY ACID
- 13. (Folic acid, vitamin B12, zinc and choline) deficiency Alters the expression or silencing of certain CpG(cytosine- phosphate-guanine) genes Overexpression of steroidogenic factor 1 (SF1) or estrogen receptor β (ER- β), inflammation and cell growth. Estradiol and prostaglandin E2 (PGE2) Diet Contd.
- 14. Diet Fasting preserve energy time to regenerate and heal Increased hormonal modulation reduced inflammation increased stress resistance. FODMAPS & IBS Soy and phytoestrogens : Gluten-free diet and coeliac disease Avoid High-fat diet
- 19. Early diagnosis ……find out risk factors • Early menarche : menarche after 14 years age less chances( Nnoaham et al,2012) • Family history : 1st degree relative 25 to 30 % • Obstructive type of mullerian abnormality and early correction. CLINICAL : H/O and EXAMINATION, Biomarker (CA 125) RADIOLOGICAL : USG MRI
- 20. Early diagnosis – is there non invasive test ?
- 22. Recurrence rate of endometriosis to be 21.5% at 2 years and 40%–50% at 5 years OCs. Type of progestin in OC: Cyclic or continuous Progestins /LNG IUS Combinations of short-term GnRHa and Ocs A Paradigm Shift from ‘‘Short- term Treatment with Strong Drugs’’ to ‘‘Long-term Treatment with Drugs with Fewer Adverse Effects and Higher Compliance’’ is Recommended for Prevention of Recurrence
- 23. Based on the findings of the present systematic review and meta-analysis, long-term postoperative OC use may be considered a real therapeutic advance for patients with endometriosis.In addition, it has been demonstrated that prolonged postoperative OC use protects not only from relapse of endometriotic lesions but also from recurrence of postoperative pain symptoms
- 25. TERTIARY level • The impact on mind • Improvement of quality of life • Reducing the health care cost
- 26. CONCLUSION • PREVENTION IS NOT POSSIBLE • FEW FACTORS CAN BE MODIFIED TO REDUCE SYMPTOMS ESHRE 2022
- 27. Reduce retrograde menstruation Reduce inflammation Reduce flow- OCP, IUS Take home message
Editor's Notes
- Good afternoon respected chairperson , my teachers and seniors and my colleagues. I am thankful to the endometriosis society for giving me this opportunity. My topic for today is CAN WE PREVENT ENDOMETRIOSIS
- BUT AFTER PROLONGED SEARCH I REALIZED THE topic is telling me that CATCH ME IF U CAN. SO WE NEER TO catch endometriosis and prevent it if we can. There is no screening test or guideline for prevention as such.
- We all know about incidence , symptoms and treatment by now. At present, there is no known way to prevent endometriosis. So the key is Enhanced awareness, followed by early diagnosis and management, may slow or halt the natural progression of the disease and reduce the long-term burden of its symptoms.
- There are many theories as we all know but recently emphasis has been given to genetic-epigenetic link with mutation of endometriotic tissue. and it is poven that Impaired steroid biosynthesis (e.g., hypoestrogenism, progesterone resistance, or aromatase over-expression) increases the endometrial invasive potential associated with neo angiogenesis, endometrial neurogenesis, and a pro-inflammatory profile in endometrial tissue compared with disease-free endometrium.
- As the disease cant be prevented as such , it can be modified by taking few steps. I decided to divide it as primary prevention in view of lifestyle or food,with exercise. Also by early diagnosis ,the progression of the disese can be prevented with various treatment. Preventing the progression after either conservative surgery or complete surgery as secondery prevention . And by taking care of the impact of the disease on quality of life as tertiary prevention.
- Endocrine-disrupting chemicals enter the human body with food, water, dust by inhalation, with the inspired air, and via the transdermal route after using cosmetics and cream . Dioxins may be responsible for the pathogenesis of this condition, as they affect
- ry and based on the current literature, no recommendation can be made about physical therapies or exercise and their benefit with regards to improving quality of life and reducing pain in women with endometriosis. As such, no recommendation was formulated on physiotherapy, massage, and trigger point release therapy. For exercise and activity,
- With regards to acupuncture in particular, a number of studies have proven its positive effects. It is assumed that the release of endogenous opioids and endogenous cortisol (anti-inflammatory), deactivation of brain areas linked to pain perception and local effects such as adenosine release and local blood flow to modulate the pain.
- . Resveratrol, a polyphenol found in the skin of dark grapes and Brazilian grape . Omega-6 fatty : precursors of the pro-inflammatory prostaglandins PGE2 and PGF2α, which likely increase uterine cramps. Antioxidant vitamins (D, E, and B-group vitamins), calcium and omega-3 fatty acids (salmon, flaxseeds, and walnuts ) : protective. Women with endometriosis have a higher concentration of lipid peroxidation markers in the blood and peritoneal fluid, which promotes cell adhesion and activation of macrophages. These, in turn, release reactive oxygen and nitrogen species, leading to oxidative stress.9
- We sometimes advise outpatients to eat lightly or to fast prior to their menstrual cycles in order to lessen the activity of the gastrointestinal (GI) tract, thereby reducing the uncomfortable and painful GI symptoms associated with endometriosis. There is similarities of s/p between endometriosis and IBS. So the modification of diet may help to prevent symptoms.
- The fermentable oligo-, di-, and mono-saccharides and polyols (FODMAPs) comprise a group of carbohydrates resistant to digestion that are found in a broad range of foods. FODMAPs play a substantial role in initiating the symptoms of IBS. Now gluten-free diet is efficient in improving endometriosis symptoms after 12 months of treatment and plays an antagonist role by decreasing IFN-γ and IL-6 .
- Early menarche ,short menstrual cycle, severe dysmenorrhea are the people with increase chance of developing endometriosis. 25 to 30 % chance of having familial trend. Known mullerian abnormalities. clinical examination will be difficult for adolescent girls.
- Diagnostic accuracy of transvaginal ultrasound for detection of endometriosis using International Deep Endometriosis Analysis (IDEA) approach: MRI reaches sensitivity up to 88%, specificity up to 99% and diagnostic accuracy of about 98% for the diagnosis of bladder endometriosis
- Although still unproven, it is logical to assume that decreasing oxidative stress by preventing retrograde menstruation or changing the peritoneal and upper genital tract microbiome will decrease the risk of initiating endometriosis. Both can be achieved with continuous oral contraception or progestogens, decreasing menstruation and the risk of ascending infections. Moreover, vaginal infections merit more attention.
- No recommendations can be made regarding the effectiveness of psychological approaches to improve pain and quality of life in women with endometriosis. However, it is vital that clinicians are aware of the psychological impact of living with pain, infertility and functional pelvic issues and consider what access there is to psychological support.
- It is well established that inflammatory mediators promote angiogenesis and interact with the sensory neurons inducing the pain signal; the threshold of pain varies and it depends on the state and location of the diseaseAlthough the regulation of inflammatory mediators in endometriosis is an active field of research, the mechanism of inflammation-induced pain is unclear, and the profile of cytokines’ expression and their location is contradicting. In this review, we present recent research regarding the expression and role of inflammatory mediators of pain and aim to highlight new targets for the treatment of pain in endometriosis..