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Endometriosis: Reason for its prolonged diagnosis.

Endometriosis: Reason for its prolonged diagnosis.

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Endometriosis is a chronic disorder that can produce excruciating pain under various conditions, including menstruation and sexual activity. For some patients, getting an accurate endometriosis diagnosis might be difficult.

According to recent study, a number of factors, including societal and personal barriers, the behaviour and education of healthcare personnel, and other factors, can delay an endometriosis diagnosis by as much as 11 years.

The reasons why getting an accurate endometriosis diagnosis is challenging were recently investigated in a systematic review and qualitative synthesis.

The researchers pinpointed a number of causes, such as the normalisation of menstruation discomfort, the variety of symptoms, and the lack of training and fast referrals among medical personnel.

The analysis highlights opportunities for development in the early diagnosis and subsequent endometriosis treatment.

What is Endometriosis?

According to the Endometriosis Foundation of America, endometriosis is a painful disorder that affects an estimated 200 million people worldwide.

When endometrial-like tissue begins to proliferate outside the uterus, the disorder begins to manifest. Similar tissue normally only develops within the uterus. While it typically affects the rectum and reproductive organs, it can occasionally spread to other sites such as the bowel or pelvic cavity.

Endometrial-like tissue thickens and eventually disintegrates over the course of your menstrual cycle so that it can pass from your body when you menstruate. Similar tissue that develops outside of your uterus and cannot leave your body if you have endometriosis.

It consequently gets caught, irritating the tissues in the area and resulting in scar formation and adhesions. This may lead to chronic pain that gets worse during your period.

Other endometriosis signs and symptoms include:

  • uncomfortable urine or bowel movements, especially during your period
  • unpleasant interactions
  • infertility
  • heavy menstrual bleeding
  • between periods bleeding
  • abdomen and lower back pain right before, during, or right after your period

The following information will help you understand how to diagnose and treat endometriosis.

Consequences of endometriosis

In endometriosis, uterine-like tissue develops outside of the uterus. These lesions may be found in the bladder, fallopian tubes, or ovaries, among other places.

Chronic endometriosis is treated mostly by controlling symptoms. Pain, frequently in the pelvic region, is the primary complaint. At some periods, such as during menstruation, the pain could come on. There could be more signs as well, such as exhaustion and trouble getting pregnant. After menopause, endometriosis symptoms may occasionally get better.

Additional information about endometriosis was provided to us by Dr. Ann Peters, an expert in obstetrics and gynaecology at Mercy Medical Centre who was not engaged in the study:

The most common symptom of endometriosis is painful periods, but it can also cause other unpleasant symptoms like heavy bleeding, chest pains, chronic fatigue, diarrhea, and constipation. Other symptoms of endometriosis include pain during sexual activity and during bowel movements.

Endometriosis is thought to affect one in ten women, but there are currently no noninvasive diagnostic methods, such as ultrasound or blood work tests, that would accurately detect endometriosis, according to Dr. Ann Peters.

The authors of the current review observe that a lot of women wait a long time for a proper medical diagnosis. They wished to learn more about the causes of this delay.

Obstacles to diagnosing endometriosis

The 13 articles in this evaluation all complied with the tight eligibility requirements. All of the studies either enrolled endometriosis-affected women or medical professionals with endometriosis diagnosis expertise.

The evaluation concentrated primarily on qualitative research in which individuals talked about their experiences getting an endometriosis diagnosis. The authors’ study of these publications yielded four types of themes that contributed to delayed diagnosis:

  • individual elements
  • Individual differences
  • health system variables
  • endometriosis-specific F actors

They discovered that ladies have trouble comprehending the typical menstrual pain on an individual basis. For instance, participants frequently believed that their discomfort was normal and that they should learn to live with it.

The timing of the endometriosis diagnosis was probably impacted by these concepts and the usage of self-care techniques to control symptoms.

Researchers discovered that social stigma against addressing menstrual issues and society’s acceptance of monthly pain as normal may have further delayed diagnosis.

Finally, endometriosis and healthcare circumstances affected when a diagnosis was made. Participants cited instances where general practitioners dismissed concerns or gave the impression that they lacked endometriosis understanding. Similarly, individuals who worked in healthcare said they had received insufficient endometriosis training, and many said they lacked clear clinical guidelines for diagnosis.

There were additional communication issues. Oral contraceptives are occasionally used by medical experts to help diagnose and treat endometriosis. Participants weren’t always given clear explanations of how to rule out other diagnoses or how to utilize oral contraceptives.

Lack of endometriosis testing

Medical specialists also pointed out that endometriosis symptoms often resemble those of other diseases, which can cause delays in diagnosis. Because there are no noninvasive tests that can provide a reliable diagnosis for endometriosis, it might be difficult to make a diagnosis. Referrals were made slowly.

The idea that laparoscopic surgery is the only method of diagnosis was one factor in this. Even medical specialists questioned the value of an endometriosis diagnosis.

Dr. Sophie Davenport, an English physician who wrote the study as part of her Master of Public Health (MPH) dissertation, outlined the multifaceted strategy that will be required to remove these obstacles:

The data’s main takeaways are that there are delays in diagnosis at every stage of the trip. We need to address these on a variety of fronts, from society understanding what “normal” menstruation is and being open to discussing menstrual problems to clinicians being knowledgeable about presentation and diagnosis and paying attention to patients who claim their periods aren’t normal, according to study author Dr. Sophie Davenport.

Diagnosed with endometriosis in the past

There were some issues with this study that point to the need for more investigation.

All of the research in the study were carried out in high-income nations, the majority of which provided universal healthcare. As a result, it might not be able to generalize the findings, and this research doesn’t address any potential financial obstacles to diagnosis.

The majority of participants in studies that provided demographic data were white women, highlighting the need for increased diversity in future research.

The samples among participants with endometriosis may be biassed towards those with more severe cases.

Participants in the research that examined the opinions of healthcare professionals were mostly general practitioners and doctors. Other service providers and experts in the field could be studied in future studies. The review was undertaken by just one reviewer, which increased the chance of bias or methodological flaws.

Dr. Davenport identified the following areas of future study:

Investigating how a patient’s perceptions of receiving an endometriosis diagnosis vary now that the clinical guidelines advise treating empirically based on signs and symptoms rather than doing a laparoscopic surgery first will be an important topic of research. According to the papers, this discouraged physicians from sending women to specialty services and caused a delay in the diagnosis and subsequent treatment of those women, according to Dr Sophie Davenport.

Can I speed up the diagnosing process?

It is becoming simpler to receive a correct diagnosis as more individuals become aware of endometriosis and its symptoms. However, there are a few things you can do ahead of time to make sure you receive a prompt, correct diagnosis:

Try a self-test for endometriosis. Here is a quiz you can give yourself. on show your doctor during your appointment, print out your results, or save them on your phone.

Maintain a symptom log. Keeping thorough records of your symptoms may seem boring, but they will help your doctor make a proper diagnosis. Record your symptoms’ severity on a scale of 1 to 10, as well as any details about when in your cycle they often appear.

Use a period-tracking app or a notebook to record this information.

Find a specialist in endometriosis. Request a recommendation from your doctor for a gynecologist who specializes in endometriosis. For doctor recommendations and other advice, you can also look through internet support communities.

REFERENCES:

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Can antibiotics help in reducing endometriosis symptoms?

Can antibiotics help in reducing endometriosis symptoms?

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Researchers discovered that compared to less than 10% of individuals without the ailment, approximately two-thirds of patients with endometriosis have higher levels of a particular bacterium around their uterus.

The researchers observed that the levels of the bacteria and the development of endometriosis-related lesions were decreased after administering antibiotics to endometriosis-affected mice.

To determine whether the results apply to people, however, more research is required.

In the disorder known as endometriosis, uterine lining-like cells proliferate outside of the uterus. Along with symptoms like discomfort and nausea, this can result in the production of scar tissue and inflammation in the pelvic area as well as different organs.

In the entire world, endometriosis affects about 10% of people of reproductive age who were born female. There is presently no cure for the illness, though various therapies can assist control it. Additionally, there is no method to avoid the illness.

Millions of people worldwide could have their health and quality of life improved as a result of further endometriosis research.

Recently, scientists discovered that treating mice with a particular bacterium may lessen lesions related to endometriosis. Science Translational Medicine included the findings in one of its issues.

Not a part of the study, Dr. Marc Winter, medical director of Hoag’s minimally invasive surgical gynaecology, told us:

Fusobacterium, a type of bacteria, is implicated in this study from Japan as a potential agent encouraging the development of inflammatory cells that cause inflammation, scar tissue, and pain related to endometriosis. This finding may prompt the addition of particular antibiotics as an essential component of endometriosis therapy.

Fusobacterium in endometriosis

Starting with fibroblasts from four patients with endometriosis and four individuals without, the researchers performed a genomic study. Cells known as fibroblasts help repair wounds and create connective tissues.

They discovered that individuals with endometriosis had much higher levels of the transgelin (TAGLN) gene. It also codes for a protein known as transgelin, which is involved in cell reproduction and is crucial for the growth of the illness.

The expression of TAGLN, which may result from a bacterial infection, can be upregulated by inflammation. According to prior studies, patients with endometriosis have much higher levels of some bacterial genera than healthy people.

The researchers next evaluated the frequency of a bacterium known as Fusobacterium within and outside of the uteruses of 79 people with and 76 people without endometriosis to examine how the presence of these bacteria in the uterine effects endometriosis.

Fusobacterium was found in higher concentrations in the uterine endometrial tissue of 64.3% and the endometrial tissue that had grown outside the uterus of 52.4% of patients with endometriosis. Only 7.1% of those without the disease had higher concentrations of the bacteria in their uteri.

The scientists then looked into whether Fusobacterium encouraged endometriosis in nine mice models of the disease. They discovered that Fusobacterim-exposed animals had higher uterine lesions than control mice.

In contrast, animals without Fusobacterium did not produce as many uterine lesions. This discrepancy persisted even after oestrogen stimulation, which medical professionals believe may induce tissue resembling uterine lining to develop outside of the uterus.

Treatment with antibiotics lessened symptoms

The final goal of the study was to see whether antibiotics could eliminate Fusobacterium in mice and lessen endometriosis symptoms.

To do this, scientists treated endometriosis-affected mice models with metronidazole and chloramphenicol for a total of five days. After a week, they discovered that the mice no longer had Fusobacterium and that transgelin expression had decreased close to the uterus.

They added that animals given antibiotics had less and smaller endometrial lesions than mice not given antibiotics.

According to the researchers’ findings, both antibiotics might be effective in treating endometriosis. However, they pointed out that it is uncertain why Fusobacterium infects some people.

Endometriosis bacteria are unknown.

We discussed the limits of the study with Dr. Karnika Kapoor, a family doctor from Medical Offices of Manhattan who was not engaged in it.

Since mice don’t have a menstrual cycle and don’t naturally develop endometriosis, the mouse model employed in this study has some inherent limitations, according to the researcher.

She said that there is insufficient evidence in the study to support the theory that endometriosis is promoted by Fusobacterium near the uterus after retrograde menstruation, which occurs when the period flows upward via the fallopian tubes and is thought by some researchers to be a possible cause of the disorder.

The authors were careful to make it clear that their analysis could not establish causation, Dr. Stringfellow did observe. This is an important distinction.

“More research is required to prove that Fusobacterium is a causal agent. To ascertain whether other microbial species might have a harmful function, more investigation is also required, he added.

Treatment with antibiotics can slow the spread of endometriosis.

These two studies provide evidence that antibiotic therapy can slow the spread of endometriosis and stop the early development of endometriotic lesions.

The bacterial ecosystem in the mice given antibiotic treatment was also examined by the researchers. Mice with endometriosis who were not given antibiotics had a greater variety of bacteria in their guts.

The mice that received antibiotic treatment had the least bacterial variety.

For endometriosis, metronidazole might be more efficient.

The effectiveness of metronidazole and neomycin as a stand-alone endometriosis treatment was also investigated by the researchers. Lesions on the mice receiving metronidazole were less severe than those on the mice receiving neomycin.

Additionally, the lesions in the mice receiving metronidazole exhibited fewer inflammatory components.

Finally, mice with endometriosis treated with metronidazole were fed endometriotic mouse faeces. Endometriotic lesions developed and resembled those from endometriosis animals given aspartame in their drinking water in terms of mass and volume.

This shows that the bacterial population in the gut can affect how endometriosis develops and spreads.

Future treatments for endometriosis

Dr. Kapoor discussed the limitations of the available endometriosis treatments today.

The current endometriosis treatment options rely on hormone medication, which prevents women from becoming pregnant while receiving care. The removal of endometrial lesions raises concerns since there is a high recurrence rate, which is an option for people with recurring pelvic pain, she said.

“This research appears to point to a possible Fusobacterium-related mechanism of endometriosis, and that antibiotic elimination is a treatment possibility. If antibiotic therapies for endometriosis are found to be beneficial in subsequent research, we could be able to use them in our clinical practise. Karnika Kapoor, M.D.

Dr. Winter concurred that the discoveries might result in fresh therapeutic approaches. “The function of Fusobacterium in promoting endometriosis may result in a completely new strategy for treating it. Further research is required to understand the contribution of Fusobacterium to the development of endometriosis, according to him.

He said, “The use of a widely prescribed antibiotic metronidazole may be a key in improving the efficacy of endometriosis treatment.”

Further research is required.

If similar effects also occur in humans, more research is needed to confirm this. There may be new endometriosis treatments developed if gut bacteria can affect the onset and course of endometriosis in humans.

REFERENCES:

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Genetic Overlap of Endometriosis & Chronic pain conditions

Genetic Overlap of Endometriosis & Chronic pain conditions

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There is presently no cure for the disease endometriosis, which can lead to discomfort and infertility. In order to determine whether endometriosis has a hereditary component, researchers at the University of Oxford in the United Kingdom examined DNA samples from hundreds of female participants.

25 teams from around the world worked together with the researchers to collect and analyse a sizable amount of data from female participants with and without endometriosis.

Their results demonstrated a link between endometriosis and other inflammatory disorders in addition to demonstrating the genetic component of this condition. For those who have it, endometriosis can be a crippling ailment, and identifying it can be expensive and challenging.

Scientists from the University of Oxford collaborated with experts from other countries to study the DNA from tens of thousands of female volunteers. In order to understand more about the genetic variables influencing the illness. They found that endometriosis might be related to other inflammatory diseases.

Endometriosis overview

The endometrial lining, the tissue that lines the inside of the uterus, thickens during the menstrual cycle as part of the process. This lining usually sheds throughout the menstrual cycle if a person does not become pregnant.

A tissue that resembles this lining can occasionally proliferate where it shouldn’t, which is what happens with endometriosis. This lining may develop in the pelvic region, around the ovaries, or around the fallopian tubes. It can occasionally even grow around other organs like the intestines or the bladder.

Endometriosis symptoms and indicators might include:

The World Health Organization (WHO) estimates that 10% of menstrual women worldwide who are in their reproductive stage are affected by endometriosis.

The study methods

In order to ascertain whether there is probably a genetic component to endometriosis, the research team from the University of Oxford planned to undertake a genome-wide association study (GWAS). They did a meta-analysis of the data gathered.

The researchers gathered data from more than 60,000 people. People had been diagnosed with endometriosis in collaboration with 25 other teams. They compared it to DNA samples from slightly more than 700,000 people who had been diagnosed with endometriosis.However they not have the disease.

Participants with either European or East Asian heritage provided the samples.

The genetic differences between those who have endometriosis and those who do not were taken into consideration by the researchers when they examined the data. The implications of these variations on “endometrium, blood, and other important tissues” were also taken into account.

In order to determine whether there was a connection between endometriosis and nine other immunological or inflammatory illnesses, researchers also looked at those conditions.

Genetic map of endometriosis

The scientists discovered 42 genetic loci sites of genes or genetic sequences in the genome. They regarded important for developing endometriosis after reviewing the data provided.

This research supports the hypothesis that endometriosis may have a hereditary component, which may be important for the advancement of diagnostic procedures and therapeutic approaches.

The researchers were able to pinpoint a number of genes and hormone regulators that were linked to both endometriosis and other pain problems after further investigating these locations.

The scientists discovered links between a number of medical illnesses and symptoms, including asthma, osteoarthritis, chronic back pain, and migraines.

Senior research scientist at the Wellcome Centre for Human Genetics at the University of Oxford and the study’s first author, Dr. Nilufer Rahmioglu, spoke about the study.

“We were able to generate a treasure trove of new information about genetically driven endometriosis subtypes. Also, pain experience using different datasets of women with and without endometriosis. Some of which had unprecedented detailed data on surgical findings and pain experience collected using standardised criteria,” said Dr. Rahmioglu.

Links to IBS, migraine, asthma

MNT spoke with Dr. G. Thomas Ruiz, the head of OB/GYN at Memorial Care Orange Coast Medical Center in Fountain Valley, California, who was not associated with this study.

This study confirms the significance of a family history of endometriosis. Gynecologists have long known this, and this study confirms their theory, according to Dr. Ruiz.

Dr. Ruiz stated that the study’s huge sample size is a strength and that a lot of useful information can be extrapolated from it. He advises concentrating on the overall concept that “endometriosis and advanced stage endometriosis” have a genetic basis.

Dr. Ruiz continued, “There seems to be a connection between the body’s response to endometriosis and other inflammatory diseases like osteoarthritis and asthma.

The results of the study were also discussed by Dr. Steve Vasilev, an integrative gynecologic oncologist who is board-certified, the medical director of integrative gynecologic oncology at Providence Saint John’s Health Center, and a professor at Saint John’s Cancer Institute in Santa Monica, California. Dr. Vasilev was not involved in the study.

Diagnosis and management

Endometriosis may be the cause of persistent pelvic discomfort, painfully heavy periods, and other menstrual symptoms. Women who are concerned about these symptoms should speak with their gynaecologists.

There is currently no blood test that can validate a doctor’s diagnosis of endometriosis, according to recommendations published in the Canadian Medical Association Journal earlier this month.

Endometriosis is generally diagnosed by laparoscopic surgery. But like all operations, this one is a little intrusive and comes with certain dangers.

As a result, these new diagnostic guidelines advise doctors to detect endometriosis by combining patient history with imaging. Diagnostic techniques covered by the recommendations include magnetic resonance imaging (MRI) and transvaginal ultrasound.

Hormone therapy, such as birth control tablets can have efficacy rates of 60-80%, people with endometriosis can manage their symptoms. Nonetheless, surgery may be required to eliminate lesions in those who are attempting to get pregnant.

REFERENCES:

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Is Norethisterone good to treat gynecological disorders?

Is Norethisterone good to treat gynecological disorders?

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Gynecological Disorders

A woman’s reproductive organs undergo continuous change from puberty to menopause due to sexual activity, pregnancy, age, natural processes, etc. Gynecology is the branch of medicine that deals with the condition female reproductive systems (vagina, uterus, and ovaries).

A gynaecological disorder is a condition that affects the female reproductive organs. It including the breasts, the uterus, the ovaries, the fallopian tubes, the vagina, and the vulva. Almost every woman will experience a gynaecological problem at some point in her life. It may be disastrous or insignificant.

Types of Gynecological Disorders

There are many different tpes of Gynecological Disorders found in wome. Some of the most common types of disorder include,

  • PCOS(Polycystic ovary syndrome) – The most frequent reason for anovulatory infertility is PCOS. Women who have PCOS are more likely to develop a number od medical conditions. It includes endometrial cancer, endometrial hyperplasia, metabolic syndrome, type 2 diabetes, cardiovascular disease, obesity, obstructive sleep apnea, and mood problems.
  • Endometriosis – About 10% of women of reproductive age are affected by endometriosis, which significantly contributes to the formation of pelvic adhesions, infertility, ectopic pregnancy, and persistent pelvic pain.
  • Uterine Fibroids (leiomyomata) -The most frequent benign gynecologic tumour in women, uterine fibroids (leiomyomata) are linked to a number of harmful health outcomes, such as irregular uterine bleeding, pelvic pain, infertility, miscarriage, and preterm childbirth.
  • Vaginitis – Any condition that results in swelling or inflammation of the vulva and the vagina is referred to as vaginitis. Yeast infections, bacterial vaginosis, non-infectious vaginitis, and vaginitis that is transmitted through sexual contact are common types of vaginitis.
  • Menstrual Disorders – Irregular or heavy menstrual bleeding affects quality of life and can be a sign of underlying gynecologic diseases including endometrial polyps, uterine fibroids, or anovulatory disorders.

Norethisterone

Norethisterone is a medical drug available to us under the name Noriday which belongs to a class of medication called Progestins. This medicine is used for several women reproduction related disorders such as painful periods, premenstrual tension, breast cancer, endometriosis and also for the treatment of gynecological disorders.

How to use?

Norethisterone is available to us in a form of pill that must be taken by mouth with or without food as per your doctor’s prescription. It is usually taken once a day daily. The dosage and length of the treatment is based on your medical condition, response to the treatment and other medicine that you may be taking for the same or different reason. Swallow the tablet whole rather than chewing or crushing it in your mouth as it may release all the drug in your mouth which increases the risk of side effects.

Your doctor may start you with a low dose which will increase gradually. Take the medicine at the same time daily to get the most benefits from it. Do not increase your dose or take it more often than prescribed as this may also increase the risk of side effects without any improvement in your condition. Discuss all the other medicines that you might be taking along with  Norethisterone for the same or different reasons. Follow the medical prescription carefully and inform your doctor in case of any exception or confusion.

Side Effects of Norethisterone

Common side effects observed while medicating with Ibandronate are nausea, vomiting, headache, weight gain, bloating or breast tenderness, may occur. Inform your doctor if these conditions persist or get worse.

There are some serious side effects which must be informed to the doctor right away if observed such as lumps in the breast, mental/mood changes, severe stomach/abdominal pain, unusual changes in vaginal bleeding, dark urine, yellowing eyes/skin, etc. 

There are also some severe allergic reactions involved with these medications which require immediate medical attention if observed such as rash, itching/swelling (especially of the face/tongue/throat), trouble breathing, severe dizziness, chest/jaw/left arm pain, confusion, sudden dizziness/fainting, pain/swelling/warmth in the groin/calf, trouble speaking, sudden shortness of breath/rapid breathing, unusual headache, unusual sweating, weakness on one side of the body, vision problems/changes, etc.

Precaution before using Norethisterone

  • If you have any allergies, including those to other progestins or norethindrone, let your doctor or pharmacist know before using this drug. Inactive chemicals in this product have the potential to trigger allergic reactions or other issues. To learn more, speak with your pharmacist.
  • Inform your doctor or pharmacist of your medical history before taking this medication, especially of any of the following conditions such as blood clots (for example, in the legs, eyes, or lungs), blood clotting disorders (such as protein C or protein S deficiency), high blood pressure, abnormal breast exam, cancer (especially endometrial or breast cancer), low levels of “good” cholesterol (HDL), depression, diabetes, severe headaches/migraines, heart problems (such as heart valve disease, irregular heartbeat, Jaundice, liver disease (including tumours), unexplained vaginal bleeding, history of yellowing of the eyes or skin (jaundice) during pregnancy or while using hormonal birth control (such as pills or a patch).
  • Inform your surgeon or dentist of all the products you use prior to surgery (including prescription drugs, nonprescription drugs, and herbal products).
  • Your face and skin may develop blotchy, dark spots as a result of this drug (melasma). This effect could get worse in the sun. Keep sun exposure to a minimum. Avoid using sunlamps and tanning booths. When outdoors, wear protective gear and sunscreen.
  • Pregnancy should not be the time to use this drug. Inform your doctor as soon as possible if you become pregnant or suspect that you may be pregnant.
  • Small doses of this medicine may enter breast milk and cause unfavourable effects on a nursing newborn. Before breastfeeding, speak with your doctor.

Norethisterone effects on Gynecological Disorders

  • With regard to treating dysmenorrhea, causing amenorrhea for at least six months, and reducing the size of ovarian endometriomas, the current data showed that NET was effective.
  • Progestins have anti-inflammatory and anti-angiogenic effect in endometriotic tissues and do not raise the risk of thrombosis. In endometriosis, NET and DNG both seem to be equally effective at reducing pain and the size of lesions. DNG is anti-androgenic, but NET also exhibits this property. These two progestins lack the strong glucocorticoid or anti-mineralcorticoid effects that many other hormonal medications have. Even progestins by themselves may help in bone development. Because NET is partially converted to estrogens, this may be an advantage over DNG.

In conclusion, the available evidence points to NET as a viable treatment for endometriosis-related dysmenorrhea and for shrinking ovarian endometriomas. Oral progestins alone can be used at any age, have very few adverse effects, do not increase the risk of thrombosis, and are capable of suppressing ovulation and causing amenorrhea.

REFERENCES:

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