New Understanding of Diagnosis, Treatment and Prevention of Endometriosis

Bedayah Amro, Maria Eugenia Ramirez Aristondo, Shaima Alsuwaidi, Basma Almaamari, Zeinab Hakim, Muna Tahlak, Arnaud Wattiez and Philippe R. Koninckx
Additional contact information
Bedayah Amro: Latifa Hospital, Dubai 9115, United Arab Emirates
Maria Eugenia Ramirez Aristondo: Latifa Hospital, Dubai 9115, United Arab Emirates
Shaima Alsuwaidi: Latifa Hospital, Dubai 9115, United Arab Emirates
Basma Almaamari: Latifa Hospital, Dubai 9115, United Arab Emirates
Zeinab Hakim: Latifa Hospital, Dubai 9115, United Arab Emirates
Muna Tahlak: Latifa Hospital, Dubai 9115, United Arab Emirates
Arnaud Wattiez: Latifa Hospital, Dubai 9115, United Arab Emirates
Philippe R. Koninckx: Latifa Hospital, Dubai 9115, United Arab Emirates

IJERPH, 2022, vol. 19, issue 11, 1-14

Abstract: For 100 years, pelvic endometriosis has been considered to originate from the implantation of endometrial cells following retrograde menstruation or metaplasia. Since some observations, such as the clonal aspect, the biochemical variability of lesions and endometriosis in women without endometrium, the genetic-epigenetic (G-E) theory describes that endometriosis only begins after a series of cumulative G-E cellular changes. This explains that the endometriotic may originate from any pluripotent cell apart from the endometrium, that ‘endometrium-like cells’ can harbour important G-E differences, and that the risk is higher in predisposed women with more inherited incidents. A consequence is a high risk after puberty which decreases progressively thereafter. Considering a 10-year delay between initiation and performing a laparoscopy, this was observed in the United Arab Emirates, Belgium, France and USA. The subsequent growth varies with the G-E changes and the environment but is self-limiting probably because of the immunologic reaction and fibrosis. That each lesion has a different set of G-E incidents explains the variability of pain and the response to hormonal treatment. New lesions may develop, but recurrences after surgical excision are rare. The fibrosis around endometriosis belongs to the body and does not need to be removed. This suggests conservative excision or minimal bowel without safety margins and superficial treatment of ovarian endometriosis. This G-E concept also suggests prevention by decreasing oxidative stress from retrograde menstruation or the peritoneal microbiome. This suggests the prevention of vaginal infections and changes in the gastrointestinal microbiota through food intake and exercise. In conclusion, a higher risk of initiating endometriosis during adolescence was observed in UAE, France, Belgium and USA. This new understanding and the limited growth opens perspectives for earlier diagnosis and better treatment.

Keywords: endeometriosis; adenomyoisis; genetic and epgigenetic; surgery; medical therapy (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
References: View complete reference list from CitEc
Citations: View citations in EconPapers (1)

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