Hormone Therapy for Endometriosis and Surgical Menopause - Research Paper Example

Hormone therapy for endometriosis and surgical menopause INTROUCTION Purpose of the research paper: The purpose of this study is to methodically review the literature in order to critically evaluate the paper describing the risk of pain and disease recurrence among woman with endometriosis who had undergone bilateral sapingoophorectomy (BSO), with and without hysterectomy and subsequently received hormone therapy. Significance of this research paper Endometriosis is one of the most severe gynecological diseases of women. At least 5.5 million women in North America alone have endometriosis. About 30 to 40 percent of women with endometriosis are infertile, making it one of the top three causes for female infertility ("Fast facts about," 2007). Relevance to college age students Endometriosis is a women sex related disorder in which the tissue that behaves like the cells lining the uterus (endometrium) grows in other areas of the body, causing pain, irregular bleeding and infertility. The disease is very much related to the menstrual cycle that starts in every woman who reaches puberty. Therefore, it is important for everyone including college students to know about the disease, its causes, and the treatment measures. There are five main points related to the disease, which are of prime concern in order to fully analyze the paper. These points are mentioned below: The biology of menstrual cycle What causes endometriosis? Controversy over treatment The role of Gn-RH and Gn-RH agonists Treatment strategies and outcomes The biology of menstrual cycle The female reproductive organs are situated in the pelvis, between the urinary bladder and the rectum. The ovaries have got two important functions -- they produce two hormones: estrogen and progesterone. The hormones produced by the ovaries are very important for ovulation to be (it is a process in the female menstrual cycle in which a mature ovarian follicle ruptures and discharges the ovum that participate in reproduction and fertilization) regular. These hormones are also responsible for preparing the inner lining of the uterus to conceive. When an egg is released from the ovarian follicle, it goes down to the uterus through the narrow fallopian tube, where it may be fertilized if it comes in contact with the sperm. If the egg is not fertilized with the sperm, the egg and the inner lining of the uterus i.e., endometrium are discharged to the outside of the body during the menstrual cycle. Once a month, if a woman does not become pregnant and the ovaries are functioning correctly, the endometrium is shed off to the outside of the body during (through vagina) the menstrual period. With age, the menstrual cycle becomes irregular and as menopause approaches, periods become more irregular and eventually stop. This occurs because the sex hormone i.e., estrogen and progesterone stop releasing. Many behavioral and physiological changes occur inside the body of women. Many women go for pre and postmenstrual counseling to prepare themselves for the changes that are to occur in process. What causes Endometriosis? Endometriosis occurs when endometrial tissue covers parts of the serosa (the outer layer of the uterus), the outside of the colon, the bladder, and the lining of the abdomen ("Endometriosis," 2009). This endometrial tissue shows the same features as the tissue that lines the inside of the uterus. During the normal menstrual cycle, these misplaced endometrial tissues go through the same changes as the endometrium in the uterus. This leads to several symptoms including pain in the abdomen, pain during urination and pain during sexual intercourse, etc. These symptoms may occur during the menstrual period or at any other time during the menstrual cycle. Infertility is another one of the problems caused by endometriosis. Scarring in and around the pelvis, ovaries and fallopian tubes cause infertility. About 30-40 percent of women with endometriosis have fertility problems ("X-plain endometriosis," 2008). Controversy over treatment: The choice of therapy depends upon the severity of symptoms, extent and location of the disease, desire for pregnancy and a woman’s age. Both surgical and medical methods are used for the treatment of endometriosis. Surgical treatment involves either the removal of uterus or the removal of ovary and the fallopian tube. However, hormone replacement therapy (HRT) involves the intervention of hormones to suppress the secretion of estrogen, which is believed to be the main cause of endometriosis. Endometriosis is believed to be an estrogen-dependent disorder. This statement is correctly supported by the overproduction of pre existing endometriosis after surgical menopause/natural menopause and the growth of endometrial tissue in animal on estrogen therapy. As a result, this has led to the use of gonadotropin-releasing hormone agonists (GnRHa) to induce ovarian suppression, which is widely accepted as a treatment for endometriosis. The fall of estrogen levels following treatment with GnRHa leads to significant improvement in the stage and symptoms of endometriosis. This may be used as a short-term strategy due to the risk of developing osteoporosis. The role of GnRH and Gn-RH agonists The pituitary gland located at the base of the brain controls the ovaries. In order to activate the ovaries, pituitary gland secretes two hormones called LH and FSH. These two hormones are responsible for the ovaries to secrete their own hormones: estrogen and progesterone. However, the pituitary gland is controlled by the hypothalamus, a small region in the brain, which is located just above the pituitary gland secretes a hormone called Gn-RH, which causes the pituitary gland to secrete hormones. In case of hormone replacement therapy, the aim of the therapy is to suppress the release of the hormone estrogen, which is responsible for menstrual cycle. So, in order to check the secretion of estrogen, Gn-RH agonist is used, which suppresses the secretion of Gn-RH from the hypothalamus. As a result, no pituitary hormone is secreted and ovaries are not activated. Treatment Strategies and outcomes: Inducing menopause either medically or surgically has become one of the strategies for the management of endometriosis. Removal of both ovaries is usually considered appropriate when the women is approaching menopause or in the presence of extensive disease. Hysterectomy: It is commonly performed for endometriosis. It is a surgical removal of the uterus. It is the second most frequently performed surgery in premenopausal women. Endometriosis accounts for a significant percentage of these procedures. However, hysterectomy does not always cure endometriosis. A woman cannot become pregnant after having a hysterectomy. There are two types of hysterectomies: Total Hysterectomy: It is the removal of uterus and the cervix. Bilateral Oophorectomy or Bilateral Salpingo-Oophorectomy (BSO): It is a procedure in which both fallopian tubes and ovaries are removed. For endometriosis treatment, ovaries are often removed in combination with hysterectomy. Hormone Replacement Therapy (HRT): This medical treatment is used to suppress the production of estrogen. Tibolone, a synthetic steroid hormone drug is being used for the treatment of women with endometriosis. It suppresses the secretion of estrogen, which researchers think is responsible for endometriosis. Women who had undergone surgical treatment of endometriosis were included in the inclusion criteria to test whether the hormone replacement therapy followed by surgical treatment show any disease or pain recurrence. Types of interventions used include Estrogen, Progesterone, Tibolone and other hormones. The data collected after certain period of time were analyzed properly. When compared with the control group for pain and disease recurrence, no significant difference was found. Conclusion: Endometriosis is a disorder and millions of women from all across the world are suffering from the same. Women with endometriosis suffer from abdominal pain and dysparenuia (painful intercourse). The most effective medical and surgical treatments for the disease are hormone therapy and removal of ovaries or uterus through surgical procedures. In surgical methods, ovaries are either conserved or removed depending upon the severity of the disease. Hormone replacement therapy on the other hand is also very effective. However, HRT and post-surgical menopause could result in pain and disease recurrence. From the literature, it has been observed that medical and surgical treatment methods could result in disease recurrence. Both controlled and test groups of women with endometriosis were observed after the intervention of hormones at different doses and periods. But no significant observation was seen that could differentiate the effects of tibolone from other hormone combinations. However, there is some evidence from the non-blinded randomized controlled trials that hormone replacement therapy for women with endometriosis and post-surgical menopause may lead to pain ad disease recurrence (H, 2009). But the overall result is not significant at all. Further study and research: Though HRT and post-surgical menopause could result in pain recurrence, the evidence in the given literature is not enough to suggest depriving severely symptomatic patients from this treatment in order to reduce the menopausal symptoms: Further studies are inevitable in order to compare the use of different types of hormone replacement therapy in women with endometriosis and surgical menopause. These studies need to address: Recurrence pattern of the disease: A through study of the recurrence pattern needs to be done in order to understand the problem in a better way. It will also depend on the severity of the disease, age of women and the treatment she has undergone. Recurrence of pain: From the above study, it is clear that both controlled and test groups experienced pain. And the end result is not significant. It is now important for the researchers to use more drug combinations, use of non-steroidal anti-inflammatory drugs to relieve pain and expand the parameter in order to come to a meaningful conclusion (C, 2005). Data gathered in the experiment should also need to be fully analyzed without any error. Women’s quality of life: This is one of the most important points that need to be considered for women suffering from the disorder. References H, Al Kadri. (2009). Hormone therapy for endometriosis and surgical menopause. PubMed, (CD005997), Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/19160262 X-plain endometriosis. (2008, 6 12). NCBI, Retrieved from http://www.nlm.nih.gov/medlineplus/tutorials/endometriosis/og109103.pdf Fast facts about endometriosis:. (2007, 10 1). Retrieved from http://www.nichd.nih.gov/publications/pubs/endometriosis/ C, Allen. (2005). Nonsteroidal anti-inflammatory drugs for pain in women with endometriosis. PubMed, Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/16235379 Endometriosis. (2009, 11 16). The National Womens Health Information Center, Retrieved from http://womenshealth.gov/faq/endometriosis.cfm#a Read More