Podcast
Questions and Answers
What is the primary function of combined hormonal contraceptives (CHCs) in the context of endometriosis?
What is the primary function of combined hormonal contraceptives (CHCs) in the context of endometriosis?
- Promote ovulation
- Enhance blood flow to endometrial tissues
- Induce a state of hypoestrogenism (correct)
- Increase estrogen production
What is suggested about the relationship between CHC use and the development of endometriosis?
What is suggested about the relationship between CHC use and the development of endometriosis?
- Endometriosis is only treatable with CHCs
- CHC use does not increase the likelihood of developing endometriosis (correct)
- CHC use increases the severity of dysmenorrhea
- CHC use directly causes endometriosis
Which effect is observed from the use of CHCs on the symptoms of endometriosis?
Which effect is observed from the use of CHCs on the symptoms of endometriosis?
- Increased inflammation
- Strengthened retrograde menstruation
- Decreased prostaglandin production (correct)
- Elevated dysmenorrhea
What was the conclusion of the non-randomized cohort study regarding women using CHCs?
What was the conclusion of the non-randomized cohort study regarding women using CHCs?
What impact do CHCs have on backflow menstruation?
What impact do CHCs have on backflow menstruation?
What type of feedback loop do CHCs create to suppress ovarian hormone secretion?
What type of feedback loop do CHCs create to suppress ovarian hormone secretion?
How does the use of CHCs affect pelvic oxidative stress?
How does the use of CHCs affect pelvic oxidative stress?
What demographic was analyzed in the cohort study related to CHC use?
What demographic was analyzed in the cohort study related to CHC use?
What was the significant outcome observed with metformin in the treatment of endometriotic implants in rats?
What was the significant outcome observed with metformin in the treatment of endometriotic implants in rats?
Which treatment's effectiveness and tolerability are currently under investigation in a randomized, double-blind phase IIb clinical trial?
Which treatment's effectiveness and tolerability are currently under investigation in a randomized, double-blind phase IIb clinical trial?
What effect did retinoic acid and Elocalcitol have on endometriotic lesions in a mouse model?
What effect did retinoic acid and Elocalcitol have on endometriotic lesions in a mouse model?
What requirement was noted when using certain treatments for endometriosis?
What requirement was noted when using certain treatments for endometriosis?
What did the administration of resveratrol accomplish in animals prone to endometriosis?
What did the administration of resveratrol accomplish in animals prone to endometriosis?
What is a notable benefit of LNG-IUS compared to other treatments according to the findings?
What is a notable benefit of LNG-IUS compared to other treatments according to the findings?
Which treatment was found to be less effective than GnRH agonists for alleviating endometriosis pain?
Which treatment was found to be less effective than GnRH agonists for alleviating endometriosis pain?
Which of the following outcomes improved significantly with LNG-IUS insertion?
Which of the following outcomes improved significantly with LNG-IUS insertion?
What percentage of users experienced amenorrhea within 12 months when using GnRH agonists?
What percentage of users experienced amenorrhea within 12 months when using GnRH agonists?
How do GnRH agonists compare to elagolix in terms of effectiveness at three months?
How do GnRH agonists compare to elagolix in terms of effectiveness at three months?
What was one significant benefit noted for the use of LNG-IUS?
What was one significant benefit noted for the use of LNG-IUS?
Which treatment is stated to be as effective as LNG-IUS in pelvic pain alleviation after 6 months?
Which treatment is stated to be as effective as LNG-IUS in pelvic pain alleviation after 6 months?
What issue does the requirement of daily intake in some treatments lead to?
What issue does the requirement of daily intake in some treatments lead to?
What is one potential risk associated with continuous use of certain hormonal therapies?
What is one potential risk associated with continuous use of certain hormonal therapies?
Which option may help increase compliance in patients regarding hormonal treatment?
Which option may help increase compliance in patients regarding hormonal treatment?
Which method of hormonal delivery was found to be superior in terms of efficiency and satisfaction?
Which method of hormonal delivery was found to be superior in terms of efficiency and satisfaction?
What physiological effect do progestins have in endometrial tissues?
What physiological effect do progestins have in endometrial tissues?
Why might individual patient preferences be important in hormonal treatment plans?
Why might individual patient preferences be important in hormonal treatment plans?
What is a significant downside of using progestins in endometriosis?
What is a significant downside of using progestins in endometriosis?
Which of the following hormonal methods is NOT mentioned as a form of delivery?
Which of the following hormonal methods is NOT mentioned as a form of delivery?
What effect do progestins have on estrogen-induced mitosis?
What effect do progestins have on estrogen-induced mitosis?
What is one of the potential side effects of prolonged therapy with elagolix?
What is one of the potential side effects of prolonged therapy with elagolix?
Why is the clinical use of elagolix limited to 6 months?
Why is the clinical use of elagolix limited to 6 months?
Which side effect is associated with both elagolix treatment and hormonal therapies?
Which side effect is associated with both elagolix treatment and hormonal therapies?
What was the objective of the Elaris EM-I and Elaris EM-II studies?
What was the objective of the Elaris EM-I and Elaris EM-II studies?
What significant physical change could occur with prolonged elagolix therapy?
What significant physical change could occur with prolonged elagolix therapy?
What dosage of elagolix was found to be effective in the studies mentioned?
What dosage of elagolix was found to be effective in the studies mentioned?
Which of the following side effects is NOT commonly associated with elagolix treatment?
Which of the following side effects is NOT commonly associated with elagolix treatment?
Which study was conducted in the United States?
Which study was conducted in the United States?
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Study Notes
Combined hormonal contraceptives (CHCs)
- CHCs are often used off-label for endometriosis-associated pain
- CHCs suppress ovarian hormone secretion, leading to a decrease in estrogen-induced prostaglandin production and inflammation
- They promote decidualization of eutopic and ectopic endometrial tissues, reducing retrograde menses and pelvic oxidative stress
- Cyclic use may increase compliance, while continuous may increase unpredictable bleeding and amenorrhea
- Individual patient preferences should be determined
- Vaginal rings (VRs) and transdermal patches are alternative methods of hormonal delivery
- VRs were more efficient, satisfying, and had better compliance than patches, especially with rectovaginal lesions
Progestins
- Progestins include DNG, DSG, MPA, LNG, etonogestrel, and CPA but insufficient data exists to determine superiority
- Progestins induce decidualization and atrophy of eutopic and ectopic endometria
- They decrease estrogen-induced mitosis, suppress cell proliferation, inhibit inflammatory pathways, and inhibit angiogenesis and neurogenesis
- Progesterone receptor expression is reduced in endometriotic lesions
Gonadotropin-releasing hormone (GnRH) agonists
- They establish amenorrhea in ~20% of users within 12 months
- Most effective in improving dysmenorrhea, dyspareunia, and CPP scores at 3 months of treatment
- Superior to placebo and no-treatment in terms of total pelvic pain alleviation at 6 months
- Comparable to LNG and danazol in treatment
- Prolonged therapy can induce BMD decrease exceeding 1% per month in early months
- Clinical use is limited to 6 months due to long-term impacts on BMD
- Side effects include depression, lipid profile changes, hot flushes, headaches, urogenital atrophy, and loss of libido
Levonorgestrel-releasing intrauterine system (LNG-IUS)
- Has benefits such as lack of negative effects on lipid metabolism and BMD loss due to local progesterone delivery
- Does not require daily intake, thus decreasing fluctuating serum levels and improving patient compliance
- Alleviates dyspareunia and dysmenorrhea, enhancing quality of life
- Reduces serum CA-125 levels and DIE nodule size
Elagollix
- Two doses (150 mg once daily and 200 mg twice daily) were effective in alleviating dysmenorrhea and non-menstrual pelvic pain
- Higher dose significantly improved dyspareunia
- Side effects recorded include hot flushes and changes in BMD and lipid levels
- No effect on the volume of endometriomas was observed
- Concomitant contraception required as it did not inhibit ovulation
Other treatments
- Metformin reduces the size and number of endometriotic implants in rats through regulation of ovarian steroidogenesis and anti-inflammatory properties
- Retinoic acid and Elocalcitol reduced the size and weight of endometriotic lesions in mice
- Resveratrol reduced the size and number of endometrial lesions in endometriosis-prone animals and in vitro models
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