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Endometriose

Endometriose is een chronische ziekte waarbij slijmvlies, dat normaal alleen in de baarmoeder zit, verdwaald en op verschillende plekken in de buikholte gaat zitten. Het slijmvlies kan bijvoorbeeld op de eierstokken, eileiders, buikvlies en op de ophangbanden van de baarmoeder gaan zitten. Deze plekken buiten de baarmoeder, noem je endometriumhaarden. Deze haarden kunnen, tijdens de menstruatiecyclus, klachten opleveren.

Prévention / Peut-on prévenir?

Les chercheurs s’intéressent à l’effet de l’exercice physique et de l’alimentation sur le risque d’endométriose. Il s’agit d’hypothèses encore à l’étude.

Des études ayant comparé de façon rétrospective des femmes souffrant d’endométriose et d’autres n’en souffrant pas (études cas-témoins) laissent croire que l’exercice physique est associé à une réduction du risque d’endométriose de 40 % à 80 %1. Toutefois, il n’est pas certain qu’il s’agisse d’un lien de cause à effet. Il est possible que les femmes atteintes d’endométriose soient moins portées à être actives en raison de leurs douleurs, même des années avant de recevoir le diagnostic.
L’analyse des données provenant d’une importante étude épidémiologique, la Nurses’ Health Study II, a relevé une légère réduction du risque d’endométriose en comparant les femmes les plus actives à celles qui l’étaient le moins1. Les chercheurs concluent que l’exercice pourrait avoir un effet protecteur modeste.

L’alimentation pourrait également influencer le risque d’être atteinte d’endométriose. Pour l’instant, les résultats des études sont variables et cela demeure une hypothèse.
Les experts s’intéressent particulièrement au type de gras consommé, car certains acides gras sont des précurseurs de molécules pro-inflammatoires (oméga-6) et pourraient ainsi accentuer les douleurs, tandis que d’autres ont un effet anti-inflammatoire (oméga-3)2.
- Des données tirées de la Nurses’ Health Study II indiquent que les femmes consommant le plus d’acides gras oméga-3 risquaient moins de recevoir un diagnostic d’endométriose que celles en consommant le moins3.
- Selon une analyse des résultats de 2 études de cas-témoins menées en Italie4, les femmes consommant le plus de légumes verts et de fruits frais risquaient moins de souffrir d’endométriose que celles qui en mangeaient le moins. En outre, celles qui ingéraient beaucoup de viande de boeuf, d’autres viandes rouges et du jambon couraient un risque plus élevé de souffrir de ce trouble. Les autres composantes du régime alimentaire ne semblent pas en lien avec l’endométriose. Par exemple, la consommation d’alcool et de café n’a pas été associée à la maladie.

Therapie

Gestion de la douleur. La pratique d’exercices, comme le tai-chi ou le yoga, aide certaines femmes à mieux vivre avec leurs douleurs9.

Huile de ricin (Ricinus communis). Cette huile végétale, appelée « castor oil » en anglais, peut aider à réduire les douleurs pelviennes10. Imbiber une compresse d’huile de ricin. L’appliquer sur le bas-ventre. Mettre par-dessus une bouillotte ou un « sac magique » chaud. S’étendre sur le dos et laisser agir durant au moins 30 minutes. Si nécessaire, répéter chaque jour.

Médecine traditionnelle chinoise. La Médecine traditionnelle chinoise (MTC) est l’une des méthodes non classiques les plus utilisées par les femmes pour traiter l’endométriose8. Elle est suggérée, entre autres, par le Dr Andrew Weil. Les traitements consistent généralement à tonifier les Reins et le Qi (flux énergétique), et à favoriser la circulation sanguine pour contrer la stagnation du sang dans l’abdomen. Elle combine à la fois l’acupuncture et l’utilisation de plantes, telles que la corydalis, le buplèvre chinois ou l’angélique chinoise8. Quelques études cliniques réalisées en Chine laissent croire que la MTC permet de soulager les symptômes ou même de soigner la stérilité de certaines femmes11-14. Cependant, ces études n’ont pas été réalisées avec un contrôle placebo et leur la qualité méthodologique est jugée faible. Le traitement nécessite un suivi par un spécialiste.

Changements à l’alimentation. Pour atténuer les symptômes d’endométriose ou éviter qu’ils s’accentuent, le médecin américain Andrew Weil conseille de suivre un régime aux propriétés anti-inflammatoires15. Ce régime s’apparente au régime méditerranéen.
Voici ses principes de base :
- manger une grande variété d’aliments;
- inclure le plus d’aliments frais possible;
- réduire au minimum la quantité d’aliments raffinés et de malbouffe;
- manger en abondance des fruits et des légumes.

Pour en savoir plus sur ce régime et connaître l’avis de notre nutritionniste Hélène Baribeau à ce sujet, consulter : Dr Weil: le régime anti-inflammatoire. Le Dr Weil recommande aussi d’éviter de consommer de la viande et des produits laitiers provenant d’élevages industriels, et de privilégier les produits issus d’un élevage biologique, qui n’ont pas reçu d’hormones.

Bibliographie

Ask DrWeil, Polaris Health (Ed). Q & A Library – Ending Endometriosis?, DrWeil.com. [Consulté le 14 janvier 2011]. www.drweil.com
InteliHealth (Ed). Diseases and Conditions - Endometriosis, Aetna Intelihealth. [Consulté le 14 janvier 2011]. www.intelihealth.com
Mayo Foundation for Medical Education and Research (Ed). Women's Health Center Endometriosis, MayoClinic.com. [Consulté le 14 janvier 2011]. www.mayoclinic.com
National Library of Medicine (Ed). Medline Plus Health Information, Health topics - Endometriosis, Medline plus. [Consulté le 14 janvier 2011]. www.nlm.nih.gov
National Library of Medicine (Ed). PubMed, NCBI. [Consulté le 14 janvier 2011]. www.ncbi.nlm.nih.gov
Natural Standard (Ed). Medical Conditions - Endometriosis, Nature Medicine Quality Standards. [Consulté le 14 janvier 2011]. www.naturalstandard.com
O'Callaghan D. Endometriosis--an update. Aust Fam Physician. 2006 Nov;35(11):864-7. Texte intégral : www.racgp.org.au
Sleiman L et Shahid NA. Le traitement de l’endométriose, Les cahiers de MedActuel, vol. 7, no 21, 13 juin 2007.
The Natural Pharmacist (Ed). Natural Products Encyclopedia, Conditions - Endometriosis, ConsumerLab.com. [Consulté le 14 janvier 2011]. www.consumerlab.com
UpToDate. Patient Information, Endometriosis, UpToDate. [Consulté le 17 janvier 2011]. www.uptodate.com
Women’s College Hospital. Centres de santé, Santé pelvienne – Endométriose, Femmes en santé. [Consulté le 14 janvier 2011]. www.femmesensante.ca

Notes

1. Adult physical activity and endometriosis risk. Vitonis AF, Hankinson SE, Hornstein MD, Missmer SA. Epidemiology. 2010 Jan;21(1):16-23. Texte intégral : www.ncbi.nlm.nih.gov
2. Endometriosis, dysmenorrhea and diet--what is the evidence? Fjerbaek A, Knudsen UB. Eur J Obstet Gynecol Reprod Biol. 2007 Jun;132(2):140-7. Epub 2007 Jan 8. Review.
3. A prospective study of dietary fat consumption and endometriosis risk. Missmer SA, Chavarro JE, et al. Hum Reprod. 2010 Jun;25(6):1528-35. Epub 2010 Mar 23.
4. Parazzini F, Chiaffarino F, et al. Selected food intake and risk of endometriosis. Hum Reprod. 2004 Aug;19(8):1755-9. Epub 2004 Jul 14.
5. Carpenter SE, Tjaden B, et al. The effect of regular exercise on women receiving danazol for treatment of endometriosis. Int J Gynaecol Obstet. 1995 Jun;49(3):299-304.
6. Bergström I, Freyschuss B, et al. The effect of physical training on bone mineral density in women with endometriosis treated with GnRH analogs: a pilot study. Acta Obstet Gynecol Scand. 2005 Apr;84(4):380-3.
7. Sleiman L et Shahid NA. Le traitement de l’endométriose, Les cahiers de MedActuel, vol. 7, no 21, 13 juin 2007.
8. The Natural Pharmacist (Ed). Natural Products Encyclopedia, Conditions - Endometriosis, ConsumerLab.com. [Consulté le 14 janvier 2011]. www.consumerlab.com
9. Endometriosis Health Centre. Women’s College Hospital. [Consulté le 14 janvier 2011]. www.femmesensante.ca
10. WholeHealthMD.com (Ed). Healing Centers - Endometriosis, wholehealthmd.com. [Consulté le 14 janvier 2011]. www.wholehealthmd.com
11. Li J, Zheng J, Wang D. [Clinical observation on treatment of endometriosis by tonifying qi and promoting blood circulation to remove stasis and purgation principle]. Zhongguo Zhong Xi Yi Jie He Za Zhi. 1999 Sep;19(9):533-5. [Article en chinois]
12. Liu J, Li X, Hu X. [Clinical observations on treatment of endometriosis by tonifying kidney and removing blood stasis]. Zhongguo Zhong Xi Yi Jie He Za Zhi. 1998 Mar;18(3):145-7. [Article en chinois]
13. Wang DZ, Wang ZQ, Zhang ZF. [Treatment of endometriosis with removing blood stasis and purgation method]. Zhong Xi Yi Jie He Za Zhi. 1991 Sep;11(9):524-6, 515. [Article en chinois]
14. Zhu WX, Cheng XA. [Clinical study of the treatment of endometriosis with promoting blood circulation and stasis removing method].Zhongguo Zhong Xi Yi Jie He Za Zhi. 1993 Jan;13(1):16-8, 4. [Article en chinois]
15. Ask DrWeil, Polaris Health (Ed). Q & A Library – Ending Endometriosis?, DrWeil.com. [Consulté le 14 janvier 2011]. www.drweil.com



Een aangepast dieet, waarbij zoveel mogelijk dierlijke eiwitten (vlees, vis, zuivel), alcohol, tarwe- en sojaproducten, cafeïne, suiker- en andere zoetstoffen (ook aspartaam, sacharose, e.d.), chocolade en gefrituurd voedsel vermeden wordt. De nadruk bij een endometriose-dieet ligt op gedroogde en verse vruchten en groenten (en dan vooral peulvruchten en zeewieren) en suikervrije dranken (zoals kruidenthee en verse vruchtensappen). Een aangepast dieet kan mogelijk symptomen verminderen, maar het is en blijft erg persoonlijk of het helpt.



J Ethnopharmacol. 2014 Feb 12;151(3):1218-1225. doi: 10.1016/j.jep.2013.12.047. Epub 2014 Jan 2.
Combination use of ferulic acid, ligustrazine and tetrahydropalmatine inhibits the growth of ectopic endometrial tissue: a multi-target therapy for endometriosis rats.
Tang Q1, Shang F1, Wang X1, Yang Y1, Chen G2, Chen Y1, Zhang J1, Xu X3.
ETHNOPHARMACOLOGICAL RELEVANCE:
Ferulic acid (FA), ligustrazine (LZ) and tetrahydropalmatine (THP) are separately isolated from Chinese Angelica, Szechwan Lovage Rhizome and Rhizoma in the Jiawei-Foshou-San formula, a popular traditional Chinese medicine for irregular menses. It has been reported that the combination use of FA+LZ+THP has similar effect on endometriosis, but the underlying mechanisms are unclear. This study was to investigate the combination effects and mechanisms of FA+LZ+THP on endometriosis rats.
MATERIALS AND METHODS:
Fifty endometriosis rats were intragastricly treated with FA+LZ+THP for 4 wk. The volume of ectopic endometrial tissue was measured to evaluate the effects. Then the changes in hypothalamic-pituitary-ovarian axis and ERE pathway were indicated by the levels of E2, GnRH, FSH and LH, and the expressions of ER, HSP90 and COX-2, respectively. In addition, peritoneal macrophages of each rat were cultured in vitro and treated with (FA+LZ+THP)-medicated serum for 24h. The proliferation and phagocytosis abilities, the levels of IL-1β and TNF-α, and the expression of IκBα were then measured for the changes of peritoneal macrophage activities.
RESULTS:
Combination use of FA+LZ+THP diminished the volume of the ectopic endometrial tissues (P<0.05 or P<0.01). It also decreased the E2 level, suppressed the expression of GnRH, FSH and LH, and decreased the protein expression of ER, HSP90 and COX-2 (all P<0.05 or P<0.01). The phagocytosis ability of peritoneal macrophage was enhanced by (FA+LZ+THP)-medicated serum (P<0.05) with no change of proliferation (P>0.05). Moreover, IL-1β and TNF-α were downregulated (both P<0.05 or P<0.01) and IκBα was upregulated by the (FA+LZ+THP)-medicated serum (P<0.01).
CONCLUSIONS:
The combination use of FA, LZ and THP could inhibit the growth of ectopic endometrial tissue in endometriosis rats. It might be related to the down-regulation of hypothalamic-pituitary-ovarian axis, the amelioration in ERE pathway and the improvement of peritoneal macrophage activities.

Am J Epidemiol. 2013 Mar 1;177(5):420-30. doi: 10.1093/aje/kws247. Epub 2013 Feb 3.
Dairy-food, calcium, magnesium, and vitamin D intake and endometriosis: a prospective cohort study.
Harris HR1, Chavarro JE, Malspeis S, Willett WC, Missmer SA.
The etiology of endometriosis is poorly understood, and few modifiable risk factors have been identified. Dairy foods and some nutrients can modulate inflammatory and immune factors, which are altered in women with endometriosis. We investigated whether intake of dairy foods, nutrients concentrated in dairy foods, and predicted plasma 25-hydroxyvitamin D (25(OH)D) levels were associated with incident laparoscopically confirmed endometriosis among 70,556 US women in Nurses' Health Study II. Diet was assessed via food frequency questionnaire. A score for predicted 25(OH)D level was calculated for each participant. During 737,712 person-years of follow-up over a 14-year period (1991-2005), 1,385 cases of incident laparoscopically confirmed endometriosis were reported. Intakes of total and low-fat dairy foods were associated with a lower risk of endometriosis. Women consuming more than 3 servings of total dairy foods per day were 18% less likely to be diagnosed with endometriosis than those reporting 2 servings per day (rate ratio = 0.82, 95% confidence interval: 0.71, 0.95; P(trend) = 0.03). In addition, predicted plasma 25(OH)D level was inversely associated with endometriosis. Women in the highest quintile of predicted vitamin D level had a 24% lower risk of endometriosis than women in the lowest quintile (rate ratio = 0.76, 95% confidence interval: 0.60, 0.97; P(trend) = 0.004). Our findings suggest that greater predicted plasma 25(OH)D levels and higher intake of dairy foods are associated with a decreased risk of endometriosis.

Transl Res. 2013 Mar;161(3):189-95. doi: 10.1016/j.trsl.2012.05.001. Epub 2012 May 31.
Antioxidant supplementation reduces endometriosis-related pelvic pain in humans.
Santanam N1, Kavtaradze N, Murphy A, Dominguez C, Parthasarathy S.
We previously suggested that women with endometriosis have increased oxidative stress in the peritoneal cavity. To assess whether antioxidant supplementation would ameliorate endometriosis-associated symptoms, we performed a randomized, placebo-controlled trial of antioxidant vitamins (vitamins E and C) in women with pelvic pain and endometriosis. Fifty-nine women, ages 19 to 41 years, with pelvic pain and history of endometriosis or infertility were recruited for this study. Patients were randomly assigned to 2 groups: vitamin E (1200 IU) and vitamin C (1000 mg) combination or placebo daily for 8 weeks before surgery. Pain scales were administered at baseline and biweekly. Inflammatory markers were measured in the peritoneal fluid obtained from both groups of patients at the end of therapy. Our results indicated that after treatment with antioxidants, chronic pain ("everyday pain") improved in 43% of patients in the antioxidant treatment group (P = 0.0055) compared with the placebo group. In the same group, dysmenorrhea ("pain associated with menstruation") and dyspareunia ("pain with sex") decreased in 37% and 24% patients, respectively. In the placebo group, dysmenorrhea-associated pain decreased in 4 patients and no change was seen in chronic pain or dyspareunia. There was a significant decrease in peritoneal fluid inflammatory markers, regulated upon activation, normal T-cell expressed and secreted (P ≤ 0.002), interleukin-6 (P ≤ 0.056), and monocyte chemotactic protein-1 (P ≤ 0.016) after antioxidant therapy compared with patients not taking antioxidants. The results of this clinical trial show that administration of antioxidants reduces chronic pelvic pain in women with endometriosis and inflammatory markers in the peritoneal fluid.

Iran J Reprod Med. 2013 May;11(5):415-22.
Curcumin inhibits endometriosis endometrial cells by reducing estradiol production.
Zhang Y1, Cao H2, Yu Z1, Peng HY1, Zhang CJ1.
BACKGROUND:
Endometriosis is a complex estrogen-dependent disease that is defined as the presence of endometrial gland and stroma outside the uterine cavity. Although the exact mechanism for the development of endometriosis remains unclear, there is a large body of research data and circumstantial evidence that suggests a crucial role of estrogen in the establishment and maintenance of this disease.
OBJECTIVE:
This study is an attempt to assess the effect of curcumin on inhibiting endometriosis endometrial cells and to investigate whether such an effect is mediated by reducing estradiol production.
MATERIALS AND METHODS:
Endometriotic stromal cells, normal endometrial stromal cells, endometriotic epithelial cells and normal endometrial epithelial cells were isolated and cultured. E2 value of cells and the effect of curcumin on cell proliferation were evaluated. Finally, effect of curcumin on E2 assay was detected.
RESULTS:
Electrochemiluminescence immunoassay results showed that E2 value of endometriotic epithelial cells was higher than the endometriotic stromal cells (p=0.037), while the expression of E2 in normal endometrial stromal and epithelial cells was extremely low. WST-8 result showed, compared with endometrial stromal cells, ectopic endometriotic stromal cells had a higher growth rate. After intervene with curcumin (10μmol/L, 30μmol/L and 50μmol/L) for 0-96h, the number of endometriotic stromal cells was reduced and cells growth slowed, compared with 0μmol/L group. Compared with 0μmol/L group, E2 level was lower after treatment with curcumin, especially in 30μmol/L and 50μmol/L group.
CONCLUSION:
In summary, in this study we found that E2 is important in ectopic endometrium, and epithelial cell is in dominant position with E2 secretion. Curcumin was able to suppress the proliferation of endometrial cells by reducing the E2 value.

Epidemiology. 2007 May;18(3):402-8.
Effect of soy isoflavones on endometriosis: interaction with estrogen receptor 2 gene polymorphism.
Tsuchiya M1, Miura T, Hanaoka T, Iwasaki M, Sasaki H, Tanaka T, Nakao H, Katoh T, Ikenoue T, Kabuto M, Tsugane S.
BACKGROUND:
Progression of endometriosis is considered estrogen-dependent. Dietary soy isoflavones may affect the risk of endometriosis, and polymorphisms in estrogen receptor genes may modify this association. We examined associations among soy isoflavone intake, estrogen receptor 2 (ESR2) gene polymorphisms and risk of endometriosis.
METHODS:
We recruited women age 20-45 years old who had consulted a university hospital for infertility in Tokyo, Japan in 1999 or 2000. A total of 138 eligible women were diagnosed laparoscopically and classified into 3 subgroups: control (no endometriosis), early endometriosis (stage I-II) and advanced endometriosis (stage III-IV). We measured urinary levels of genistein and daidzein as markers for dietary intake of soy isoflavones, and genotyped ESR2 gene RsaI polymorphisms.
RESULTS:
Higher levels of urinary genistein and daidzein were associated with decreased risk of advanced endometriosis (P for trend = 0.01 and 0.06, respectively) but not early endometriosis. For advanced endometriosis, the adjusted odds ratio for the highest quartile group was 0.21 (95% confidence interval = 0.06-0.76) for genistein and 0.29 (0.08-1.03) for daidzein, when compared with the lowest group. Inverse associations were also noted between urinary isoflavones and the severity of endometriosis (P for trend = 0.01 for genistein and 0.07 for daidzein). For advanced endometriosis, ESR2 gene RsaI polymorphism appeared to modify the effects of genistein (P for interaction = 0.03).
CONCLUSIONS:
Dietary isoflavones may reduce the risk of endometriosis among Japanese women.

Transl Res. 2013 Mar;161(3):189-95. doi: 10.1016/j.trsl.2012.05.001. Epub 2012 May 31.
Antioxidant supplementation reduces endometriosis-related pelvic pain in humans.
Santanam N1, Kavtaradze N, Murphy A, Dominguez C, Parthasarathy S.
We previously suggested that women with endometriosis have increased oxidative stress in the peritoneal cavity. To assess whether antioxidant supplementation would ameliorate endometriosis-associated symptoms, we performed a randomized, placebo-controlled trial of antioxidant vitamins (vitamins E and C) in women with pelvic pain and endometriosis. Fifty-nine women, ages 19 to 41 years, with pelvic pain and history of endometriosis or infertility were recruited for this study. Patients were randomly assigned to 2 groups: vitamin E (1200 IU) and vitamin C (1000 mg) combination or placebo daily for 8 weeks before surgery. Pain scales were administered at baseline and biweekly. Inflammatory markers were measured in the peritoneal fluid obtained from both groups of patients at the end of therapy. Our results indicated that after treatment with antioxidants, chronic pain ("everyday pain") improved in 43% of patients in the antioxidant treatment group (P = 0.0055) compared with the placebo group. In the same group, dysmenorrhea ("pain associated with menstruation") and dyspareunia ("pain with sex") decreased in 37% and 24% patients, respectively. In the placebo group, dysmenorrhea-associated pain decreased in 4 patients and no change was seen in chronic pain or dyspareunia. There was a significant decrease in peritoneal fluid inflammatory markers, regulated upon activation, normal T-cell expressed and secreted (P ≤ 0.002), interleukin-6 (P ≤ 0.056), and monocyte chemotactic protein-1 (P ≤ 0.016) after antioxidant therapy compared with patients not taking antioxidants. The results of this clinical trial show that administration of antioxidants reduces chronic pelvic pain in women with endometriosis and inflammatory markers in the peritoneal fluid.
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