Endometriosis: Conventional Treatment Approaches

Medical treatment of endometriosis includes both pharmaceutical and surgical approaches. Pharmaceutical treatments provide only suppression of the disease; they do not exact a cure. Decisions regarding treatment are based on endometriosis severity and staging, symptom picture, and ultimately, the woman’s needs and goals, for example, desire for children in the future. For women experiencing mild symptoms (or none) and for women who are close to menopause, the appropriate treatment may be to do nothing. For women with mild to moderate symptoms, and those who desire pregnancy, the appropriate pharmacologic therapy should be considered, and if necessary, can be combined with conservative surgery. It should be noted that, in spite of medical treatment, endometriosis has a high recurrence rate of 5% to 20% unless total hysterectomy and bilateral oophorectomy are performed. With pharmacologic interventions, pain typically resumes upon cessation of medications, although initially with pain that is less intense than prior to treatment. Pain relief, pregnancy rates, and recurrence rates are similar with all treatment methods. The goal of pharmaceutical treatment is to interrupt patterns of endometrial stimulation and bleeding. Read more […]

Endometriosis: Anti-Inflammatories and Antioxidants

Inflammation is a hallmark of endometriosis, and as discussed, free radical damage may be part of the etiology of this disorder. It has been suggested that growth factors and inflammatory mediators produced by activated peritoneal leukocytes participate in the pathogenesis of endometriosis by facilitating endometrial cells growth at ectopic sites. Elevated levels of inflammatory cells and mediators such as peritoneal macrophages, prostaglandins, proteolytic enzymes, complement fragments, IL-1, and tumor necrosis factor (TNF) have been identified in the peritoneal fluid of patients with endometriosis. Numerous herbs that have been used traditionally for inflammatory types of conditions demonstrate significant anti-inflammatory and antioxidant effects and should be considered for use in formulations for treatment and symptomatic relief, along with herbs whose use for inflammation is only recently being discovered. These are discussed in the following. Dong Quai Dong quai has antispasmodic, analgesic, and tonic effects, and has demonstrated significant antioxidant and free radical scavenging actions, partially through inhibition of anion radical formation. Limited animal and in vitro studies have reported Read more […]

Herb-Drug Interactions: Cannabis

Cannabis sativa L. (Cannabaceae) Synonym(s) and related species Bhang, Dagga, Ganja, Hashish, Indian hemp, Marihuana, Marijuana. Cannabis indica Lam. Constituents Cannabis herb contains a wide range of cannabinoids, which are the major active compounds. The main psychoactive constituent is delta9-tetrahydrocannabinol (THC; dronabinol), and it is the cause of many of the pharmacological effects elicited by the consumption of cannabis. However, other cannabinoids, which do not possess psychoactive properties, such as cannabidiol, cannabinol (a decomposition product of delta9-tetrahydrocannabinol), cannabigerol and cannabichromene, are increasingly being investigated for their pharmacological and therapeutic properties. Cannabinoids are often found in the plant as their acid metabolites, e.g. ll-nor-9-carboxy-delta9-tetrahydrocannabinol, cannabidiol acid and others, especially if the plant has been grown in a cooler climate. These decarboxylate to the parent cannabinoid at high temperatures, such as during smoking. Most medicinal cannabis products have been heat treated to ensure that the cannabinoids are present only in the non-acid form. Use and indications Cannabis has no current established use in herbal Read more […]

CYCLOOXYGENASE INHIBITORS

CYCLOOXYGENASE INHIBITORS bind reversibly or irreversibly to the enzyme cyclooxygenase (originally referred to as the prostaglandin synthase system or ‘prostaglandin H2 synthase'; (PGHS)-l and (PGHS)-2). Members of the prostaglandin family have a number of proinflammatory or hyperalgesic actions, and consequently many cyclooxygenase inhibitors are used as anthnflammatories and ANALGESICS. Prostanoids are members of the eicosanoid family of phospholipid mediators, and are comprised of the thromboxanes and the prostaglandins, both of which are formed by the complex cyclooxygenase system. They share common precursors in the form of a series of unstable cyclic endoperoxides. The first stage of the transformation of arachidonic acid has the enzyme endoperoxide synthase oxygenate arachidonate, followed by cyclization to give a cyclic endoperoxide called PGG2. These reactions are inhibited by cyclooxygenase inhibitors. Subsequently, PGG2 is converted by a peroxidase action to PGH2. This is a common precursor for a number of different pathways, forming prostacyclin (by prostacyclin synthase), the various prostaglandins or thromboxanes (by thromboxane synthase). See THROMBOXANE SYNTHASE INHIBITORS. The conversion depends Read more […]

ANTIINFLAMMATORY AGENTS

ANTIINFLAMMATORY AGENTS are drugs that are used to reduce inflammatory responses in the body. Although inflammation is essentially a normal defensive mechanism (a reaction to tissue injury, infection, inhalation of foreign proteins), the manifestations may be so serious and inappropriate or involve such discomfort, that treatment with antiinflammatory agents is required. Inflammatory conditions can be acute (as in insect stings) or chronic (chronic asthma, dermatitis and other skin conditions, rheumatoid conditions). A wide range of drugs may be used to treat one or other inflammatory condition, and potential toxicity in relation to the medical condition is an important determinant of choice. The NSAID ANALGESIC group has the widest antiinflammatory use, and their inhibitory antiinflammatory property is due to their cyclooxygenase activity (see CYCLOOXYGENASE INHIBITORS). Here the associated relief of pain is largely attributable to some degree of correction of the underlying inflammatory condition. Some of this group are relatively non-toxic and are available without prescription for use for relatively trivial complaints, e.g. aspirin and ibuprofen. (Paracetamol has insufficient antiinflammatory action to be useful Read more […]