LYCOS RETRIEVER
Endometriosis: Diseases
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Endometriosis can become cancerous in less than 1% of women. Most of the cancers found with the condition... appear not to be associated with the implants, but rather occur independently of the disease.
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In China, endometriosis is called neiyi, meaning internal lump. Laparoscopy, as needed to detect these lumps, was introduced into China around 1960, and reports about this disease first appeared in the literature soon after that. The incidence of endometriosis in China, like that in the U.S., is reportedly increasing (2). China had adopted a policy of recommending women do not have children until at least age 26, with a maximum of one child per family in most cases, a likely contributor to the increased incidence of the disorder. Up to 30% of patients undergoing pelvic laparotomies for any reason are found to have endometrial cysts, and these procedures have increased during the past three decades from 3.8% to more than 10% of admissions to the large Beijing Union Medical College Hospital. About 13% of women in China between the ages of 18 and 25 suffer from dysmenorrhea, of which a substantial portion-perhaps half-is due to endometriosis.
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Stress reduction techniques, such as physical exercise, yoga, or meditation, may improve the ability to cope with endometriosis. Studies confirm that stress has a negative effect on disease. In patients with endometriosis, stress may trigger excess adrenal stress hormones. These hormones have a direct effect on heart rate and blood flow, and high levels can impair the body's ability to limit scarring and inflammation. Fortunately, stress reduction activities like yoga and meditation can help promote a sense of calm, slow heart rate, relax tense muscles (which often contribute to pain), and foster a sense of well-being. Likewise, physical exercise, in addition to reducing the amount of estrogen circulating in the body, can help relieve stress.
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Even with very successful surgery, endometriosis usually recurs within a period of between 2 months and several years. In one study, the risk for recurrence after conservative surgery was highest in women who have had previous surgery or who have stage IV disease (large endometriotic cysts). Other factors including age, pregnancy, or the number of cysts, did not seem to influence the degree of risk. An earlier study indicated that women who became pregnant after surgery for endometriosis had a lower risk for recurrence, but pregnancy itself does not cure endometriosis. The use of GnRH agonists after surgery may delay recurrence without affecting fertility.
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Many women are told that pregnancy is a cure for endometriosis. Unfortunately, this is a myth. The reality is that pregnancy seldom 'cures' endometriosis and the effect of pregnancy varies widely. In the majority of women pregnancy leads to an improvement or a disappearance of the disease, particularly during the latter months of pregnancy. However, the beneficial effects are usually only temporary and many women will experience a recurrence of their disease within a few years.
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Recent work has focused on studying the differences between eutopic endometrium and endometriosis. In endometriosis, an aberrantly expressed factor SF-1 activates the expression of the enzyme aromatase, which converts C19 steroids to estrogens. Consequently, estrogen increases the synthesis of prostaglandin E2, which exerts a positive feedback effect, resulting in increased aromatase activity. Additionally, endometriotic tissue is deficient in the enzyme 17-beta hydroxy steroid dehydrogenase type 2, which converts E2 in eutopic endometrium to the less potent E1 under the direction of progestins. A recent study found a higher number of endometriomas, more bilateral disease, and a higher incidence of significant pain in women with aromatase positive disease.23However, recent studies have shown increased cyclooxygenase-2 (COX-2) expression in the stromal cells24 and aberrant aromatase expression25 in eutopic endometrium of women with endometriosis.
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