Endometrial Endometriosis

Thus, our attention should shift from the concern of potential adverse effects to the health benefits imparted by hormonal contraceptives. The use of oral contraceptives for at least 12 months reduces the risk of developing endometrial cancer by 50%. Furthermore, the risk of epithelial ovarian cancer in users of oral contraceptives is reduced by 40% compared with that on nonusers. This kind of protection is already seen after as little as 3-6 months of use. Oral contraceptives also decrease the incidence of ovarian cysts and fibrocystic breast disease. They reduce menstrual blood loss and thus the incidence of iron-deficiency anemia. A decreased incidence of pelvic inflammatory disease and ectopic pregnancies has been reported as well as an ameliorating effect on the clinical course of endometriosis. 

Taking the contraceptive hormones provides health benefits not related to contraception, such as regulating the menstrual cycle and decreased blood loss, and incidence of iron deficiency anemia, and dysmenorrhea Health benefits related to the inhibition of ovulation include a decrease in ovarian cysts and ectopic pregnancies. hi addition, there is a decrease in fibrocyctic breast disease, acute pelvic inflammatory disease endometrial cancer, ovarian cancer, maintenance of bone density, and symptoms related to endometriosis in women taking contraceptive hormones. Newer combination contraceptives such as norgestimate and ethinyl estradiol... 

Endometriosis is an estrogen-dependent disorder mostly occurring in reproductive-age women characterized by a growth of the endometrium outside the uterine cavity (Oral et al. 1997 Child et al. 2001). Explanations of how the tissue stains this abnormal placement are controversial, although the predominant theory is that retrograde menstruation is the cause (Oral et al. 1997 Child et al. 2001). Additional factors that maybe pivotal in the disease s pathogenesis include immunologic abnormalities, endometrial disorders, and peritoneal dysfunction (Oral et al. 1997 Child et al. 2001). 

Recently, a Japanese research group published preclinical safety and efficacy data of an oral antiestrogen (TZE-5323) (Saito et al. 2003). This drug has been shown to have a strong affinity for human ERa and ER/i and a dose-dependent capacity to inhibit estradiol-stimulated transcriptional activation (Saito et al. 2003). In the experimental endometriosis model in rats, TZE-5323 dose-dependently reduced the volume of the endometrial implant with an effectiveness similar to that of danazol and leuprorelin acetate without causing significant changes in bone mineral density and in serum estradiol levels (Saito et al. 2003). 

In the same way as estrogens, progestogens are used in the treatment of several other conditions such as infertility, endometriosis, in the management of certain breast and endometrial cancers, and either alone or in combination with estrogens in the treatment of menstrual disorders, among others. The therapeutic doses required in the treatment of many of these diseases are often significantly larger than those employed in contraception. 

Endometriosis refers to the abnormal presence of endometrial tissue growing outside the uterus in places such as the abdomen, the peritoneum, ovary and... 

Progestins are nsed for varions menstmal cycle disorders, for functional uterine bleeding of various origins, and as a contraceptive. Progestin therapy is also used to treat endometriosis and endometrial carcinomas. Progesterone is not effective when taken orally due to intensive metabolism, and therefore it is used by either parenteral or transvaginal introduction. 

Endometriosis - In endometriosis, danazol alters the normal and ectopic endometrial tissue so that it becomes inactive and atrophic. 

The major uses of progestogens are for hormone replacement therapy and for hormonal contraception where they suppress ovulation and make the cervical mucus impenetrable to spermatozoa. Other indications include secondary amenorrhea, dysmenorrhea, infertility and habitual abortion and endometrium suppression in endometriosis. Progestogens are also used for palliation in metastasized endometrial and breast carcinoma. Medrogestone has been used in the treatment of fibroid uterine tumors. 

Danazol is an isoxazole derivative of 17alpha-ethinyl testosterone. It has weak androgenic activity. It inhibits gonadotrophin secretion and is used to suppress ovarian function. It induces endometrial atrophy and has found its major use in the management of endometriosis. Gestrinon has the same indication and acts via a similar mechanism. Danazol has also been used in the management of benign breast disorders such as fibrocystic disease. 

Endometriosis is abnormal growth of endometrial tissue in the peritoneal cavity. Women with this disorder have dysmenorrhea, dyspareunia, chronic pelvic pain, and infertility. Danazol (Danocrine) is a 2,3-isoxazol derivative of 17a-ethynyl testosterone (ethisterone) that has weak virilizing and protein anabolic properties. It is effective in endometriosis through its negative feedback... 

Mechanism of Action A testosterone derivative that suppresses the pituitary-ovarian axis by inhibiting the output of pituitary gonadotropins. Causes atrophy of both normal and ectopic endometrial tissue in endometriosis. Follicle-stimulating hormone (FSH) and luteinizing hormone (LH) are depressed in fibrocystic breast disease. Inhibits steroid synthesis and binding of steroids to their receptors in breast tissues. Increases serum levels of esterase inhibitor. Therapeutic Effect Produces anovulation and amenorrhea, reduces the production of est rogen, corrects biochemical deficiency as seen in hereditary angioedema. 

It is indicated as contraceptive, in hormone replacement therapy, primary and secondary amenorrhoea, dysfunctional uterine bleeding, endometriosis, postponement of menstruation, premenstrual syndrome, uterine hypoplasia, threatened or habitual abortion and premenstrual tension. It is also useful in endometrial carcinoma. 

It is indicated in dysfunctional uterine bleeding, amenorrhoea, dysmenorrhoea, hypo and hypermenorrhoea, delay of menstrual period, oligo and polymenorrhoea, benign breast disease, endometriosis, metrorrhagia and endometrial carcinoma. 

Indications Palliative treatment of advanced carcinoma of the prostate and in combination with flutamide for the management of locally confined Stage T2b-T4 (Stage B2-C) carcinoma of the prostate, and the management of endometriosis. Zoladex is also used as an endometrial-thinning agent... 

Recommended dosage and monitoring requirements The 3.6mg implant administered every 28 days is indicated for prostate cancer, endometriosis, breast cancer, and endometrial thinning. The 10.8 mg implant administered every 12 weeks is only indicated in prostate cancer. For the management of endometriosis, the recommended duration of administration is 6 months. 

It has become apparent that reduction in the dose of the constituents of oral contraceptives has markedly reduced mild and severe adverse effects, providing a relatively safe and convenient method of contraception for many young women. Treatment with oral contraceptives has also been shown to be associated with many benefits unrelated to contraception. These include a reduced risk of ovarian cysts, ovarian and endometrial cancer, and benign breast disease. There is a lower incidence of ectopic pregnancy. Iron deficiency and rheumatoid arthritis are less common, and premenstrual symptoms, dysmenorrhea, endometriosis, acne, and hirsutism may be ameliorated with their use. 

S. Safe, Environmental and Dietary Estrogens and Human Health —Is There a Problem Environ. Health Perspect. 105 (1995) 546-51 U. G. Ahlborg et al., Organochlorine Compounds in Relation to Breast Cancer, Endometrial Cancer, and Endometriosis An Assessment of the Biological and Epidemiological Evidence, Crit. Rev. Toxicol. 25 (1995) 465-551. 

Very recently, clinical assessments of an IUD releasing danazol for the treatment of endometrial hyperplasia and endometriosis-related pelvic pain have been reported [86,87]. 

Braun, D.P., H. Gebel, and W.P. Dmowski. 1994. Effect of danazol in vitro and in vivo on monocyte-mediated enhancement of endometrial cell proliferation in women with endometriosis. Fertil Steril 62 89. 

Chin, K., et al. In vitro augmentative effect of danazol on apoptosis of endometrial cells. Abstract of 18th Annual Meeting of Japan Endometriosis Society, p. 17, 1997. 

Endometriosis Endometriosis, which was formerly treated by surgical removal of the ovaries and uterus, is now treated with the continuous administration of progestin, or with progestin combined with estrogen. In addition, progestin may be useful in the management of endometrial carcinoma. 

In contrast, Foster et al. (1997) found that 2,3,7,8-TCDD exposure diminished endometrial tissue growth in mice. These studies used different models of surgically induced endometriosis and highlight the... 

In fact, the most widely recognized adverse effects of tamoxifen are those related to the stimulatory effects on the endometrium. These effects include proliferation of the endometrium (Dijkhuizen et al., 1996 Hann et al., 1997 Lahti et al., 1993), formation of endometrial polyps (Cohen et al., 1997 Hann et al., 1997 Kedar et al., 1994a Lahti et al., 1993), hyperplasia (Cohen, 1997 Lahti et al, 1993), and cancer (Fisher et al, 1994 Rutqvist et al., 1995 Stearns and Gelmann, 1998 Wilking et al, 1997). Other reproductive side effects of tamoxifen are worsening of endometriosis (Buckley, 1990 Hajjar et al, 1993 Ismail and Maulik, 1997), adenomyosis (Cohen etal, 1997), and proliferation of benign uterine tumors (Cohen, 1997 Kang et al, 1996). 

The endometrium is the tissue that lines the inside of the uterus. Endometriosis is a condition where endometrial tissue is found outside the uterus. It is trapped in the pelvic area and lower abdomen. The exact cause is unknown. A reflux of menstruation occurs in many women but in endometriosis refluxed cells implant in the pelvis, bleed in response to cyclic hormone stimulation and increase in size. Patches of endometriosis can cause adhesions and form into cysts which can fill with thick fluid and are known as chocolate cysts. 

Options are medical hormonal treatments and/or surgery. Surgical treatment by laparoscopic ablation of endometriotic lesions plus adhesiolysis may improve fertility. Hormonal treatments should not be used for endometriosis in women with fertility problems as they tend to lead to ovarian suppression. Laparoscopic ablation of endometrial deposits may relieve pain in some women. Radical surgery (e.g. total abdominal hysterectomy, salpingo-oophorectomy or both) is reserved for women who have completed their family and in whom other treatments have failed. It is usually curative although... 

Progestogens are the oldest treatment for endometriosis. They induce endometrial atrophy and reduce oestrogen levels by inhibiting ovulation. 

Q8 Endometriosis is a painful condition in which endometrial cells are found outside the uterus, within the abdominal cavity. Because these ectopic cells are sensitive to the hormonal changes which occur in each menstrual cycle, they proliferate during the cycle in the same manner as the cells lining the uterus. Proliferation of endometrial cells located on organs outside the uterus causes considerable pain and discomfort in the abdomen. 

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