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- 1 Outdated information - Endometriosis is actually common in teenagers and young girls
- 2 Primary sources, original research, WP:MEDRS
- 3 Notable cases
- 4 Sources
- 5 Reference list
- 6 New source
- 7 Risk among relatives
- 8 Etymology
- 9 Conservative treatment
- 10 JAMA evidence synopsis
- 11 Pronunciation?
- 12 Problems with recent edits
- 13 New text
- 14 Improvement to introductory paragraph
Outdated information - Endometriosis is actually common in teenagers and young girls
- (from the article) "It is most common in those in their thirties and forties."
This information is wrong and outdated. I propose removing and replacing it. It is a common endometriosis myth that young girls and teenagers do not have the disease when in fact they do: http://endometriosis.org/resources/articles/myths/
- "Before the introduction of laparoscopy in the 1970s, endometriosis could only be diagnosed during a laparotomy, major surgery involving a 10–15 cm incision into the abdomen. The risks and costs of a laparotomy meant it was usually done only as a last resort in women with the most severe symptoms who were past childbearing age. Because only women in their 30s or 40s were operated on, the disease was only found in women of that age. Subsequently ‘the fact’ arose that endometriosis was a disease of women in their 30s and 40s."
- "Most recently the Global Study of Women’s Health, conducted in 16 centres in ten countries, showed that two thirds of women sought help for their symptoms before the age of 30, many experiencing symptoms from the start of their first period ."
I myself had to wait nearly 20 years from the onset of symptoms at 13 years old. Possibly due to this erroneous belief among gynaecologists and was diagnosed laparoscopically in my 30's only after the disease had progressed and ruined my career and life so far. The diagnostic delay of this illness is a serious problem in the medical field and for those affected and should be acknowledged as such. Similar stories are common in support groups.
- Here is the scientific source: http://www.ncbi.nlm.nih.gov/pubmed/10509296
- If you get the NIH to update their page here  that would help.
- I am not seeing were it says endo is most common in this age group here http://www.ncbi.nlm.nih.gov/pubmed/10509296 Doc James (talk · contribs · email) 06:10, 2 August 2016 (UTC)
Primary sources, original research, WP:MEDRS
Sections moved to here to see if anyone has sources compliant with Wikipedia's medical sourcing guidelines. All of this text is based on primary studies or non-MEDRS sources; please locate secondary reviews per WP:MEDRS. Wikipedia:Wikipedia Signpost/2008-06-30/Dispatches explains how to locate secondary reviews, and this template filler can be used to generate citations from a PMID. SandyGeorgia (Talk) 03:44, 20 April 2012 (UTC)
- Some of the entries below are from reliable primary sources, and as such may be included as adjuncts to information in secondary literature. I think it may apply to the ones describing metabolic changes, but on the other hand, there are so many such entries, so it may still be better to find one or a few secondary sources that describe all of them. Mikael Häggström (talk) 15:21, 24 May 2012 (UTC)
- Indeed, they are probably all included in "Brosens I, Benagiano G (2011). "Endometriosis, a modern syndrome". Indian J. Med. Res. 133: 581–93. PMC . PMID 21727656. Unknown parameter
|month=ignored (help)" that you suggested below, and probably in a preferable prose format rather than what was more like a "list of substances that are lower or higher in people with endometriosis" without any knowledge about the actual direction of causation. Mikael Häggström (talk) 15:29, 24 May 2012 (UTC)
- Environmental Exposure to TCDD and PCBs: Previous work in nonhuman primates has shown that exposure to the dioxin 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) is associated with an increased prevalence and severity of endometriosis. Further animal experiments have implicated dioxin and dioxin-like compounds in this disease. Rodent studies support the plausibility of a role of environmental contaminants in the pathophysiology of endometriosis, although a convincing mechanistic hypothesis has yet to be advanced. 
- Tobacco smoking: The risk of endometriosis has been reported to be reduced in smokers. Smoking causes decreased estrogens with increased breakthrough bleeding and shortened luteal phases. Smokers have an earlier than normal (by about 1.5–3 years) menopause which suggests that there is some toxic effect of smoking on the follicles directly. Chemically, nicotine has been shown to concentrate in cervical mucous and metabolites have been found in follicular fluid and been associated with delayed follicular growth and maturation. Finally, there is some effect on tubal motility because smoking is associated with an increased incidence of ectopic pregnancy as well as an increased spontaneous abortion rate.
Endometriosis correlates with abnormal amounts of multiple substances, possibly indicating a causative link in its pathogenesis, although correlation does not imply causation:
- Endometrial cells in women with endometriosis demonstrate increased adherence to peritoneal cells and increased expression of splice variants of CD44, a cell-surface protein involved in cell adhesions.
- The matrix metalloproteinases MMP-1 and MMP-2 are also increased, and appear to be major factors involved in the invasion of endometrium into the peritoneum and in vascularization of endometriosis.
- Endometriosis patients also have elevated levels of vascular endothelial growth factor A (VEGF-A), soluble vascular endothelial growth factor receptors-1 and -2 (sVEGFR-1 and -2) and angiopoietin-2 (Ang-2). IL-4 may induce angiogenesis in endometriosis by inducing expression of eotaxin.
- Increased oxidative stress is also implicated in the pathophysiology of endometriosis, as well as 8-iso-PGF2α and oxysterols, being potential causative links in this oxidative stress.
Endometriosis is a condition that is estrogen-dependent and thus seen primarily during the reproductive years. In experimental models, estrogen is necessary to induce or maintain endometriosis. Medical therapy is often aimed at lowering estrogen levels to control the disease. Additionally, the current research into aromatase, an estrogen-synthesizing enzyme, has provided evidence as to why and how the disease persists after menopause and hysterectomy.
- One theory above suggests that endometriosis is an auto-immune condition and if the immune system is compromised with a food intolerance, then removing that food from the diet can, in some people, have an effect. Various dietary recommendations are made in popular media. For example, common intolerances in people with endometriosis are claimed to be wheat, sugar, meat and dairy. Avoiding foods high in hormones and inflammatory fats also appears to be important in endometriosis pain management. Eating foods high in indole-3-carbinol, such as cruciferous vegetables appears to be helpful in balancing hormones and managing pain. However, these popular claims are typically not supported by scientific studies. According to one scientific study, diets high in fat and low in fruit and β-carotene were associated with a lower risk of endometriosis, contradicting the typical idea of a healthy diet. Consumption of omega 3 fatty acids, particularly EPA, as a food supplement has been suggested as a therapy for endometriosis.
- Physical therapy for pain management in endometriosis has been investigated in a pilot study suggesting possible benefit. Physical exertion such as lifting, prolonged standing or running does exacerbate pelvic pain. Use of heating pads on the lower back area, may provide some temporary relief.
Moved from article. Please review Wikipedia:MEDMOS#Diseases or disorders or syndromes (if this text is warranted and cited correctly, the correct section is "Society and culture") and Wikipedia:MEDMOS#Notable cases. This is nothing but a list, poorly sourced, bare URLs, and nothing in it to establish anything about these people having made a lasting impression upon public perception of the condition. Think Ronald Reagan with Alzheimer's disease, Michael J. Fox with Parkinson's disease, Magic Johnson for HIV, or the significant amount of published journal articles about Samuel Johnson and Tourette syndrome. Wikipedia is not a collection of trivia or an indiscriminate list. I have never heard of Marilyn Monroe having any impact on perceptions of endometriosis: if there are sources that cover the importance of these people to endometriosis, please bring them forward, but we don't need a poorly sourced list of trivia. SandyGeorgia (Talk) 15:18, 21 April 2012 (UTC)
- Karen Duffy model, television personality and actress 
- Whoopi Goldberg actress 
- Julianne Hough professional ballroom dancer, country music singer and actress 
- Padma Lakshmi cookbook author, actress, model and television host 
- Marilyn Monroe actress 
- Lacey Schwimmer ballroom dancer and singer 
Full text recent secondary reviews, compliant with WP:MEDRS, that might be useful (for gosh sakes, this article is citing a 1999 AAFP article!):
- Bellelis P, Podgaec S, Abrão MS (2011). "Environmental factors and endometriosis" (PDF). Rev Assoc Med Bras. 57 (4): 448–52. PMID 21876930.
- Brosens I, Benagiano G (2011). "Endometriosis, a modern syndrome". Indian J. Med. Res. 133: 581–93. PMC . PMID 21727656. Unknown parameter
- Polyzos NP, Fatemi HM, Zavos A; et al. (2011). "Aromatase inhibitors in post-menopausal endometriosis". Reprod. Biol. Endocrinol. 9: 90. PMC . PMID 21693039. doi:10.1186/1477-7827-9-90.
- Ferrero S, Gillott DJ, Venturini PL, Remorgida V (2011). "Use of aromatase inhibitors to treat endometriosis-related pain symptoms: a systematic review". Reprod. Biol. Endocrinol. 9: 89. PMC . PMID 21693038. doi:10.1186/1477-7827-9-89.
- Nothnick WB (2011). "The emerging use of aromatase inhibitors for endometriosis treatment". Reprod. Biol. Endocrinol. 9: 87. PMC . PMID 21693036. doi:10.1186/1477-7827-9-87.
Epidemiology case reports
Of the 2 references given for cases affecting men and both marked unreliable, the first was a dead link, so I removed it altogether. The second mentions in the abstract that the patient died and no biopsy or autopsy samples were available to confirm the diagnosis. I'm not sure whether that's why it was considered unreliable for this purpose, so I substituted one that does include confirmation from biopsy samples, and therefore should at least be less unreliable. Pubmed only shows the abstract for that one, but the abstract says "Two previous reports of endometriosis in male subjects, who were also on estrogen therapy, are reviewed briefly.", so it may qualify as a review as well as a case report? In case it does, I removed the MEDRS marker - feel free to put it back if it doesn't. The Crab Who Played With The Sea (talk) 14:40, 11 May 2013 (UTC)
- Based on your research summarized here, and absent prominent coverage in a first-rate secondary source, coverage here of this incredibly rare circumstance seems WP:UNDUE. So, I've removed the sentence in question. -- Scray (talk) 15:27, 11 May 2013 (UTC)
- Daniel W. Cramer, Emery Wilson, Robert J. Stillman, Merle J. Berger, Serge Belisle, Isaac Schiff, Bruce Albrecht, Mark Gibson, Bruce V. Stadel, Stephen C. Schoenbaum (1986). "The Relation of Endometriosis to Menstrual Characteristics, Smoking, and Exercise". JAMA. 255 (14): 1904–8. PMID 3951117. doi:10.1001/jama.1986.03370140102032.
- Griffith JS, Liu YG, Tekmal RR, Binkley PA, Holden AE, Schenken RS (2010). "Menstrual endometrial cells from women with endometriosis demonstrate increased adherence to peritoneal cells and increased expression of CD44 splice variants". Fertil. Steril. 93 (6): 1745–9. PMC . PMID 19200980. doi:10.1016/j.fertnstert.2008.12.012. Unknown parameter
- Juhasz-Böss, I.; Hofele, A.; Lattrich, C.; Buchholz, S.; Ortmann, O.; Malik, E. (2010). "Matrix metalloproteinase messenger RNA expression in human endometriosis grafts cultured on a chicken chorioallantoic membrane". Fertility and Sterility. 94 (1): 40–45. PMID 19345347. doi:10.1016/j.fertnstert.2009.02.052.
- Bourlev, V.; Iljasova, N.; Adamyan, L.; Larsson, A.; Olovsson, M. (2010). "Signs of reduced angiogenic activity after surgical removal of deeply infiltrating endometriosis". Fertility and Sterility. 94 (1): 52–57. PMID 19324337. doi:10.1016/j.fertnstert.2009.02.019.
- Ouyang, Z.; Osuga, Y.; Hirota, Y.; Hirata, T.; Yoshino, O.; Koga, K.; Yano, T.; Taketani, Y. (2010). "Interleukin-4 induces expression of eotaxin in endometriotic stromal cells". Fertility and Sterility. 94 (1): 58–62. PMID 19338989. doi:10.1016/j.fertnstert.2009.01.129.
- Sharma, I.; Dhaliwal, L.; Saha, S.; Sangwan, S.; Dhawan, V. (2010). "Role of 8-iso-prostaglandin F2alpha and 25-hydroxycholesterol in the pathophysiology of endometriosis". Fertility and Sterility. 94 (1): 63–70. PMID 19324352. doi:10.1016/j.fertnstert.2009.01.141.
- Dian Shepperson Mills and Michael Vernon. "Endometriosis a key to healing and fertility through nutrition". endometriosis.co.uk.
- "Pain, Infertility, Hormone Problems? :: Health and Disease :: Women's Health Issues :: endometriosis". Alive.com. Retrieved 2009-08-19.
- Trabert B, Peters U, De Roos AJ, Scholes D, Holt VL (2011). "Diet and risk of endometriosis in a population-based case-control study". Br. J. Nutr. 105 (3): 459–67. PMID 20875189. doi:10.1017/S0007114510003661. Unknown parameter
- Netsu S, Konno R, Odagiri K, Soma M, Fujiwara H, Suzuki M (2008). "Oral eicosapentaenoic acid supplementation as possible therapy for endometriosis". Fertility and Sterility. 90 (4 Suppl): 1496–502. PMID 18054352. doi:10.1016/j.fertnstert.2007.08.014. Unknown parameter
- Wurn, L; Wurn, B; Kingiii, C; Roscow, A; Scharf, E; Shuster, J (2006). "P-343Treating endometriosis pain with a manual pelvic physical therapy". Fertility and Sterility. 86 (3): S262. doi:10.1016/j.fertnstert.2006.07.699.
If anyone is interested, I ran upon this source which links Endometriosis and female attractiveness. http://www.foxnews.com/health/2012/09/21/women-with-severe-endometriosis-may-be-more-attractive/?intcmp=obinsite.--v/r - TP 17:57, 24 September 2012 (UTC)
Risk among relatives
Coming over here in response to a query at WPMED. Under Endometriosis#Genetics we state "There is an about 10-fold increased incidence in women with an affected first-degree relative.", with ref 15 linking to an article at eMedicine (not exactly our best sourcing); even worse, following that link takes you to the statement (under Genetics on the Etiology page) "Studies have shown that first-degree relatives of women with this disease are more likely to develop it as well." Searching PubMed led me to a 2012 primary study PMID 23167810 that states, ""Endometriosis has long been recognized as showing heritable tendencies, with a 5- to 7-fold greater incidence risk for first-degree relatives." That seems promising, until you follow ref 4 (PMID 10711828, a 2000 review article), in which Table 1 has numbers that the citing study presumably summarized as "5- to 7-fold", but the words "relative risk" don't appear in that review (that said, the citing article is peer-reviewed and I think we could use that estimate). In agreement, a 2004 review article PMID 15541453 in The Lancet stated "The heritable features of endometriosis were first recognised more than 20 years ago when the risk for first-degree relatives of women with severe endometriosis was reported to be six times higher than that for relatives of unaffected women." I plan to add the latter estimate and citation to the article. -- Scray (talk) 18:10, 25 November 2012 (UTC)
"Conservative treatment consists of the excision (called cystectomy) of the endometrium, adhesions,"
This is clearly surgical treatment which is not conservative. Conservative treatment is noninvasive treatment usually with medication. Am I not right?
JAMA evidence synopsis
Problems with recent edits
I reverted these edits.
- The lead is meant to summarize the body, per WP:LEAD. New information should not be added only to the lead.
- You changed "6–10% of women" to "10% of young girls and women, many of whom begin experiencing symptoms at menarche", replacing a higher quality review with a primary source. We strongly prefer reviews for medical articles under WP:MEDRS. Furthermore, the new source does not use the term "young girls" or support the bit about menarche. Some sources argue that 10% may be an overestimate, so we should include the full range.
- You removed the accurate statement that endometriosis is most common in older women.
- You changed a line about differential diagnosis of chronic pelvic pain to be about co-morbid conditions, which is not what the source says.
- Agreed. I saw EmmaFlock (talk · contribs)'s edits soon after they were made, but I didn't revert because there was off-Wikipedia stuff I wanted to do, and I figured that Doc James would see the material and revert. I'd overlooked that you were watching this article. Flyer22 Reborn (talk) 01:51, 7 November 2015 (UTC)
"Types of endometriosis : Endometriosis is not 1 disease
Clinically 4 types of endometriosis exist : subtle lesions, typical lesions, cystic ovarian endometriosis and deep lesions (for images of the different types .) Subtle lesions or non coloured lesions are small vesicles or flame like lesions. Typical lesions or powder burn or gunshot lesions are dark lesions in a white sclerotic area. Cystic ovarian endometriosis or chocolate cysts are almost exclusively found in the ovary. Deep endometriosis are nodular lesions similar to benign tumours.
The prevalence in women with pain and or infertility of subtle, typical, cystic and deep endometriosis is highly variable and estimated at some 80%, 50% , 20% and 3-4% respectively. The pain symptoms are highly variable being no pain, mild pain in 50%, severe pain in 70% and very severe pain in 95% respectively. Also the relationship with infertility is varies from no cause of infertility, a slight decrease in half of the women, a strong decrease of fertility also because of adhesions, to a questionable cause of infertility respectively.
It is traditionally believed, according to the Sampson theory that following retrograde menstruation endometrial cells implant and that these cells will subsequently develop into more severe lesions. Endometriosis therefore is considered a progressive and recurrent disease. In order to understand endometriosis, its symptoms and management, this however has to be changed. the endometriotic disease theory considers subtle lesions as a natural physiologic phenomenon occurring at least intermittently in all women. Following a genomic incident, and determined by the type of genomic alteration, the lesion will develop into typical, cystic or deep lesions, which are 3 different diseases Clinically typical, cystic or deep lesions therefore should no longer be considered neither as progressive nor as recurrent. This is fundamental for understanding surgery. Anyway, it is clear that
- There is no evidence that subtle or typical lesions progress to more severe lesions .
- Although these endometriosis lesions must have grown at some moment in the past, at the moment of diagnosis none of the lesions are progressive (except rarely a deep lesion- some 10 in 3000 ).
- Cystic and deep endometriosis are clonal in origin.
- For simplicity adenomyosis, peritoneal pockets, stromatosis and Müllerianosis, although forms of endometriosis are not discussed.
Improvement to introductory paragraph
Hi Doc James. I presume, from your username, that you are a medical doctor. I am not, so, if so, I bow to your superior knowledge about endometriosis. In fact, until yesterday, although I had heard of endometriosis, I did not know what it meant! Because of an article I was reading in a newspaper, I just wanted a quick but accurate picture of what endometriosis means. So I turned to Wikipedia. I had no intention of reading the entire article - and I still haven't.
This is one mode in which I and, I guess, a lot of other Wikipedia users also, often use Wikipedia.
The main reason for my edit, yesterday, was that in order to understand the term "endometriosis", I really needed to know something else that I did not know - specifically, what the endometrium is, a word that was previously not mentioned until more than 1,000 words into the Wikipedia article, and, to build a little more detail into my picture of endometriosis, it was helpful to have some idea where the abnormal tissue is commonly sited.
By "other bit" I presume you refer to my second sentence, "In endometriosis, endometrial material grows ectopically outside the womb - commonly on the outer surfaces of the ovaries, the fallopian tubes, the uterus, the bowel, and on the peritoneum - the membrane lining the pelvic cavity." And, if so, you are right that the article "already said that other bit below". But it was more than 2,000 words below! True, I could have gone searching thought the contents list and found "localisation" then jumped to that text to read it.
However, the point is that with my edit in place as originally made, any reader could get a quick but accurate picture of the meaning of "endometriosis" simply by reading the introductory paragraph. I agree that my second inserted sentence repeats some information already in the first sentence (and I did for that reason consider rewriting and incorporating the first sentence into my slightly extended introduction) but it also introduces other material and an important related concept - ectopia, which I ensured was also linked to the relevant article, but which, now, after your edit, is not linked to from anywhere in the article and not mentioned until more than 1,000 words into the this article.
It is quite common for Wikipedia introductory paragraphs (and, in fact, for encyclopedia introductory paragraphs, in general) to contain material that is repeated and expanded upon later in the article.
I decided not replace the first sentence because it does provide a very short accurate and overt definition of endometriosis: i.e. it begins with the subject word, "Endometriosis is . . ." - something important which would have been lost if I had introduced the material in the 'logical' order of first defining "endometrium".
For all the above reasons, I believe that removing my second inserted sentence was a retrograde edit, rendering the article of less utility than with the sentence.
As to replacing my reference www.webmd.boots.com with one to the NIH website, I don't have a big problem with it. I agree, the NIH website is preferable because it contains less (looks like, no) advertising. But, this source is already linked to in the first footnote (and several others), whereas my reference provided another source not otherwise referenced in the article. However, the purpose of my link was to provide a source for the common sites of endometriosis, which I agree your link to the NIH site does, but it is now a superfluous reference because you have removed the information it was providing a source for!
There was, however, an error in the way my link was rendered, so that it linked to the main web site (www.webmd.boots.com) and not to the specific page on endometriosis (http://www.webmd.boots.com/women/endometriosis).
I don't know why the cite web tag works in this way, but it seems that it links to the url in its "website" attribute and not to the url in its "url" attribute, which would seem to be where one was intended to put the url of the link. The tag also reports as an error: "External link in |website", which seems to be the whole purpose of a web citation, so I think that the design of this part of Wikipedia markup needs looking at, to make it clearer what the tag is for and how it ought to be used. I note that the first footnote in the article (to http://www.nichd.nih.gov) also reports the same error. If you understand these issues, perhaps you would like to explain.