POPULARITY
4 episodes with Endometrium
4 episodes with Endometrium
2 episodes with Endometrium
2 episodes with Endometrium
2 episodes with Endometrium
2 episodes with Endometrium
2 episodes with Endometrium
3 episodes with Endometrium
3 episodes with Endometrium
The rate of cancer and cancer malignancy differ greatly among mammalian species. The placental – maternal interface is also highly variable between placental mammals. This lecture will discuss recent advances that suggest that there is a causal connection between the evolution of placental biology and the biology and rate of cancer malignancy. Series: "CARTA - Center for Academic Research and Training in Anthropogeny" [Humanities] [Science] [Show ID: 40694]
The rate of cancer and cancer malignancy differ greatly among mammalian species. The placental – maternal interface is also highly variable between placental mammals. This lecture will discuss recent advances that suggest that there is a causal connection between the evolution of placental biology and the biology and rate of cancer malignancy. Series: "CARTA - Center for Academic Research and Training in Anthropogeny" [Humanities] [Science] [Show ID: 40694]
CARTA - Center for Academic Research and Training in Anthropogeny (Video)
The rate of cancer and cancer malignancy differ greatly among mammalian species. The placental – maternal interface is also highly variable between placental mammals. This lecture will discuss recent advances that suggest that there is a causal connection between the evolution of placental biology and the biology and rate of cancer malignancy. Series: "CARTA - Center for Academic Research and Training in Anthropogeny" [Humanities] [Science] [Show ID: 40694]
The rate of cancer and cancer malignancy differ greatly among mammalian species. The placental – maternal interface is also highly variable between placental mammals. This lecture will discuss recent advances that suggest that there is a causal connection between the evolution of placental biology and the biology and rate of cancer malignancy. Series: "CARTA - Center for Academic Research and Training in Anthropogeny" [Humanities] [Science] [Show ID: 40694]
The rate of cancer and cancer malignancy differ greatly among mammalian species. The placental – maternal interface is also highly variable between placental mammals. This lecture will discuss recent advances that suggest that there is a causal connection between the evolution of placental biology and the biology and rate of cancer malignancy. Series: "CARTA - Center for Academic Research and Training in Anthropogeny" [Humanities] [Science] [Show ID: 40694]
The rate of cancer and cancer malignancy differ greatly among mammalian species. The placental – maternal interface is also highly variable between placental mammals. This lecture will discuss recent advances that suggest that there is a causal connection between the evolution of placental biology and the biology and rate of cancer malignancy. Series: "CARTA - Center for Academic Research and Training in Anthropogeny" [Humanities] [Science] [Show ID: 40694]
Dr. Ebony Hoskins and Dr. Andreas Obermair discuss the surgical management of gynecologic cancers, including the role of minimally invasive surgery, approaches in fertility preservation, and the nuances of surgical debulking. TRANSCRIPT Dr. Ebony Hoskins: Hello and welcome to the ASCO Daily News Podcast, I'm Dr. Ebony Hoskins. I'm a gynecologic oncologist at MedStar Washington Hospital Center in Washington, DC, and your guest host of the ASCO Daily News Podcast. Today we'll be discussing the surgical management of gynecologic cancer, including the role of minimally invasive surgery (MIS), approaches in fertility preservation, and the nuances of surgical debulking, timing, and its impact on outcomes. I am delighted to welcome Dr. Andreas Obermair for today's discussion. Dr. Obermair is an internationally renowned gynecologic oncologist, a professor of gynecologic oncology at the University of Queensland, and the head of the Queensland Center for Gynecologic Cancer Research. Our full disclosures are available in the transcript of this episode. Dr. Obermair, it's great speaking with you today. Dr. Andreas Obermair: Thank you so much for inviting me to this podcast. Dr. Ebony Hoskins: I am very excited. I looked at your paper and I thought, gosh, is everything surgical? This is everything that I deal with daily in terms of cancer in counseling patients. What prompted this review regarding GYN cancer management? Dr. Andreas Obermair: Yes, our article was published in the ASCO Educational Book; it is volume 44 in 2024. And this article covers some key aspects of targeted precision surgical management principles in endometrial cancer, cervical cancer, and ovarian cancer. While surgery is considered the cornerstone of gynecologic cancer treatment, sometimes research doesn't necessarily reflect that. And so I think ASCO asked us to; so it was not just me, there was a team of colleagues from different parts of the United States and Australia to reflect on surgical aspects of gynecologic cancer care and I feel super passionate about that because I do believe that surgery has a lot to offer. Surgical interventions need to be defined and overall, I see the research that I'm doing as part of my daily job to go towards precision surgery. And I think that is, well, that is something that I'm increasingly passionate for. Dr. Ebony Hoskins: Well, I think we should get into it. One thing that comes to mind is the innovation of minimally invasive surgery in endometrial cancer. I always reflect on when I started my fellowship, I guess it's been about 15 years ago, all of our endometrial cancer patients had a midline vertical incision, increased risk of abscess, infections and a long hospital stay. Do you mind commenting on how you see management of endometrial cancer today? Dr. Andreas Obermair: Thank you very much for giving the historical perspective because the generation of gynecologic oncologists today, they may not even know what we dealt with, what problems we had to solve. So like you, when I was a fellow in gynecologic oncology, we did midline or lower crosswise incisions, the length of stay was, five days, seven days, but we had patients in hospital because of complications for 28 days. We took them back to the operating theaters because those are patients with a BMI of 40 plus, 45, 50 and so forth. So we really needed to solve problems. And then I was exposed to a mentor who taught minimal invasive surgery. And in Australia he was one of the first ones who embarked on that. And I can remember, I was mesmerized by this operation, like not only how logical this procedure was, but also we did rounds afterwards. And I saw these women after surgery and I saw them sitting upright, lipstick on, having had a full meal at the end of the day. And I thought, wow, this is the most rewarding experience that I have to round these patients after surgery. And so I was thinking, how could I help to establish this operation as standard? Like a standard that other people would accept this is better. And so I thought we needed to do a trial on this. And then it took a long time. It took a long time to get the support for the [LACE - Laparoscopic Approach to Cancer of the Endometrium] trial. And in this context, I just also wanted to remind us all that there were concerns about minimal invasive surgery in endometrial cancer at the time. So for example, one of the concerns was when I submitted my grant funding applications, people said, “Well, even if we fund you, wouldn't be able to do this trial because there are actually no surgeons who actually do minimally invasive surgery.” And at the time, for example, in Australia, there were maybe five people, a handful of people who were able to do this operation, right? This was about 20 years ago. The other concern people had was they were saying, could minimally invasive surgery for endometrial cancer, could that cause port side metastasis because there were case reports. So there were a lot of things that we didn't know anyway. We did this trial and I'm super happy we did this trial. We started in 2005, and it took five years to enroll. At the same time, GOG LAP2 was ramping up and the LACE trial and GOG LAP2 then got published and provided the foundations for minimally invasive surgery in endometrial cancer. I'm super happy that we have randomized data about that because now when we go back and now when people have concerns about this, should we do minimally invasive surgery in P53 mutant tumors, I'm saying, well, we actually have data on that. We could go back, we could actually do more research on that if we wanted to, but our treatment recommendations are standing on solid feet. Dr. Ebony Hoskins: Well, my patients are thankful. I see patients all the time and they have high risk and morbidly obese, lots of medical issues and actually I send them home most the same day. And I think, you know, I'm very appreciative of that research, because we obviously practice evidence-based and it's certainly a game changer. Let's go along the lines of MIS and cervical cancer. And this is going back to the LACC [Laparoscopic Approach to Cervical Cancer] trial. I remember, again, one of these early adopters of use of robotic surgery and laparoscopic surgery for radical hysterectomy and thought it was so cool. You know, we can see all the anatomy well and then have the data to show that we actually had a decreased survival. And I even see that most recent updated data just showing it still continued. Can you talk a little bit about why you think there is a difference? I know there's ongoing trials, but still interested in kind of why do you think there's a survival difference? Dr. Andreas Obermair: So Ebony, I hope you don't mind me going back a step. So the LACC study was developed from the LACE trial. So we thought we wanted to reproduce the LACE data/LAP2 data. We wanted to reproduce that in cervix cancer. And people were saying, why do you do that? Like, why would that be different in any way? We recognize that minimally invasive radical hysterectomy is not a standard. We're not going to enroll patients in a randomized trial where we open and do a laparotomy on half the patients. So I think the lesson that really needs to be learned here is that any surgical intervention that we do, we should put on good evidence footing because otherwise we're really running the risk of jeopardizing patients' outcomes. So, that was number one and LACC started two years after LACE started. So LACC started in 2007, and I just wanted to acknowledge the LACC principal investigator, Dr. Pedro Ramirez, who at the time worked at MD Anderson. And we incidentally realized that we had a common interest. The findings came totally unexpected and came as an utter shock to both of us. We did not expect this. We expected to see very similar disease-free and overall survival data as we saw in the endometrial cancer cohort. Now LACC was not designed to check why there was a difference in disease-free survival. So this is very important to understand. We did not expect it. Like, so there was no point checking why that is the case. My personal idea, and I think it is fair enough if we share personal ideas, and this is not even a hypothesis I want to say, this is just a personal idea is that in endometrial cancer, we're dealing with a tumor where most of the time the cancer is surrounded by a myometrial shell. And most of the time the cancer would not get into outside contact with the peritoneal cavity. Whereas in cervix cancer, this is very different because in cervix cancer, we need to manipulate the cervix and the tumor is right at the outside there. So I personally don't use a uterine manipulator. I believe in the United States, uterine manipulators are used all the time. My experience is not in this area, so I can't comment on that. But I would think that the manipulation of the cervix and the contact of the cervix to the free peritoneal cavity could be one of the reasons. But again, this is simply a personal opinion. Dr. Ebony Hoskins: Well, I appreciate it. Dr. Andreas Obermair: Ebony at the end of the day, right, medicine is empirical science, and empirical science means that we just make observations, we make observations, we measure them, and we pass them on. And we made an observation. And, and while we're saying that, and yes, you're absolutely right, the final [LACC] reports were published in JCO recently. And I'm very grateful to the JCO editorial team that they accepted the paper, and they communicated the results because this is obviously very important. At the same time, I would like to say that there are now three or four RCTs that challenge the LACC data. These RCTs are ongoing, and a lot of people will be looking forward to having these results available. Dr. Ebony Hoskins: Very good. In early-stage cervical cancer, the SHAPE trial looked at simple versus radical hysterectomy in low-risk cervical cancer patients. And as well all know, simple hysterectomy was not inferior to radical hysterectomy with respect to the pelvic recurrence rate and any complications related to surgery such as urinary incontinence and retention. My question for you is have you changed your practice in early-stage cervical cancer, say a patient with stage 1B1 adenocarcinoma with a positive margin on conization, would you still offer this patient a radical hysterectomy or would you consider a simple hysterectomy? Dr. Andreas Obermair: I think this is a very important topic, right? Because I think the challenge of SHAPE is to understand the inclusion criteria. That's the main challenge. And most people simplify it to 2 cm, which is one of the inclusion criteria but there are two others and that includes the depth of invasion. Dr. Marie Plante has been very clear. Marie Plante is the first author of the SHAPE trial that's been published in the New England Journal of Medicine only recently and Marie has been very clear upfront that we need to consider all three inclusion criteria and only then the inclusion criteria of SHAPE apply. So at the end of the day, I think what the SHAPE trial is telling us that small tumors that would strictly fulfill the criteria of a 1B or 1B1 cancer of the cervix can be considered for a standard type 1 or PIVA type 1 or whatever classification we're trying to use will be eligible. And that makes a lot of sense. I personally not only look at the size, I also look at the location of the tumor. I would be very keen that I avoid going through tumor tissue because for example, if you have a tumor that is, you know, located very much in one corner of the cervix and then you do a standard hysterectomy and then you have a positive tumor margin that would be obviously, most people would agree it would be an unwanted outcome. So I'd be very keen checking the location, the size of the tumor, the depths of invasion and maybe then if the tumor for example is on one side of the cervix you can do a standard approach on the contralateral side but maybe do a little bit more of a margin, a parametrial margin on the other side. Or if a tumor is maybe on the posterior cervical lip, then you don't need to worry so much about the anterior cervical margin, maybe take the rectum down and maybe try to get a little bit of a vaginal margin and the margin on the uterus saccals. Just really to make sure that you do have margins because typically if we get it right, survival outcomes of clinical stage 1 early cervix cancer 1B1 1B 2 are actually really good. It is a very important thing that we get the treatment right. In my practice, I use a software to record my treatment outcomes and my margins. And I would encourage all colleagues to be cognizant and to be responsible and accountable to introduce accountable clinical practice, to check on the margins and check on the number on the percentage of patients who require postoperative radiation treatment or chemo radiation. Dr. Ebony Hoskins: Very good. I have so many questions for you. I don't know the statistics in Australia, but here, there's increased rising of endometrial cancer and certainly we're seeing it in younger women. And fertility always comes up in terms of kind of what to do. And I look at the guidelines and, see if I can help some of the women if they have early-stage endometrial cancer. Your thoughts on what your practice is on use of someone who may meet criteria, if you will. The criteria I use is grade 1 endometrioid adenocarcinoma. No myometria invasion. I try to get MRI'd and make sure that there's no disease outside the endometrium. And then if they make criteria, I typically would do an IUD. Can you tell me what your practice is and where you've had success? Dr. Andreas Obermair: So, we initiated the feMMe clinical trial that was published in 2021 and it was presented in a Plenary at one of the SGO meetings. I think it was in 2021, and we've shown complete pathological response rates after levonorgestrel intrauterine device treatment. And so in brief, we enrolled patients with endometrial hyperplasia with atypia, but also patients with grade 1 endometrial adenocarcinoma. Patients with endometrial hyperplasia with atypia had, in our series, had an 85 % chance of developing a complete pathological response. And that was defined as the complete absence of any atypia or cancer. So endometrial hyperplasia with atypia responded in about 85%. In endometrial cancer, it was about half, it was about 45, 50%. In my clinical practice, like as you, I see patients, you know, five days a week. So I'm looking after many patients who are now five years down from conservative treatment of endometrial cancer. There are a lot of young women who want to get pregnant, and we had babies, and we celebrate the babies obviously because as gynecologist obstetricians it couldn't get better than that, right, if our cancer patients have babies afterwards. But we're also treating women who are really unfit for surgery and who are frail and where a laparoscopic hysterectomy would be unsafe. So this phase is concluded, and I think that was very successful. At least we're looking to validate our data. So we're having collaborations, we're having collaborations in the United States and outside the United States to validate these data. And the next phase is obviously to identify predictive factors, to identify predictors of response. Because as you can imagine, there is no point treating patients with a levonorgestrel intrauterine joint device where we know in advance that she's not going to respond. So this is a very, very fascinating story and we got our first set of data already, but now we just really need to validate this data. And then once the validation is done, my unit is keen to do a prospective validation trial. And that also needs to involve international collaborators. Dr. Ebony Hoskins: Very good. Moving on to ovarian cancer, we see patients with ovarian cancer with, say, at least stage 3C or higher who started neoadjuvant chemotherapy. Now, some of these patients are hearing different things from their medical oncologist versus their gynecologic oncologist regarding the number of cycles of neoadjuvant chemotherapy after getting diagnosed with ovarian cancer. I know that this can be confusing for our patients coming from a medical oncologist versus a gynecologic oncologist. What do you say to a patient who is asking about the ideal number of chemotherapy cycles prior to surgery? Dr. Andreas Obermair: So this is obviously a very, very important topic to talk about. We won't be able to provide a simple off the shelf answer for that, but I think data are emerging. The ASCO guidelines should also be worthwhile considering because there are actually new ASCO Guidelines [on neoadjuvant chemotherapy for newly diagnosed, advanced ovarian cancer] that just came out a few weeks ago and they would suggest that we should be aiming for R0 in surgery. If we can maybe take that as the pivot point and then go back and say, okay, so what do need to do to get the patient to zero? I'm not an ovarian cancer researcher; I'm obviously a practicing gynecologic oncologist. I think about things a lot and things like that. In my practice, I would want a patient to develop a response after neoadjuvant chemotherapy. So, if a patient doesn't have a response after two or three cycles, then I don't see the point for me to offer her an operation. In my circle with the medical oncologists that I work with, I have a very, very good understanding. So, they send the patient to me, I take them to the theater. I take a good chunk of tissue from the peritoneum. We have a histopathologic diagnosis, we have a genomic diagnosis, they go home the same day. So obviously there is no hospital stay involved with that. They can start the chemotherapy after a few days. There is no hold up because the chances of surgical complication in a setting like this is very, very low. So I use laparoscopy to determine whether the patient responds or not. And for many of my patients, it seems to work. It's obviously a bit of an effort and it takes operating time. But I think I'm increasing my chances to make the right decision. So, coming back to your question about whether we should give three or six cycles, I think the current recommendations are three cycles pending the patient's response to neoadjuvant chemotherapy because my aim is to get a patient to R0 or at least minimal residual disease. Surgery is really, in this case, I think surgery is the adjunct to systemic treatment. Dr. Ebony Hoskins: Definitely. I think you make a great point, and I think the guideline just came out, like you mentioned, regarding neoadjuvant. And I think the biggest thing that we need to come across is the involvement of a gynecologic oncologist in patients with ovarian cancer. And we know that that survival increases with that involvement. And I think the involvement is the surgery, right? So, maybe we've gotten away from the primary tumor debulking and now using more neoadjuvant, but surgery is still needed. And so, I definitely want to have a take home that GYN oncology is involved in the care of these patients upfront. Dr. Andreas Obermair: I totally support that. This is a very important statement. So when I'm saying surgery is the adjunct to medical treatment, I don't mean that surgery is not important. Surgery is very important. And the timing is important. And that means that the surgeons and the med oncs need to be pulling on the same string. The med oncs just want to get the cytotoxic into the patients, but that's not the point, right? We want to get the cytotoxic into the patients at the right time because if we are working under this precision surgery, precision treatment mantra, it's not only important what we do, but also doing it at the right time. And ideally, I I would like to give surgery after three cycles of neoadjuvant chemotherapy, if that makes sense. But sometimes for me as a surgeon, I talk to my med onc colleagues and I say, “Look, she doesn't have a good enough response to her treatment and I want her to receive six cycles and then we re-evaluate or change medical treatment,” because that's an alternative that we can swap out drugs and treat upfront with a different drug and then sometimes they do respond. Dr. Ebony Hoskins: I have maybe one more topic. In the area I'm in, in the Washington D.C. area, we see lots of endometrial cancer and they're not grade 1, right? They're high-risk endometrial cancer and advanced. So a number of patients with stage 3 disease, some just kind of based off staging and then some who come in with disease based off of the CT scan, sometimes omental caking, ascites. And the real question is we have extrapolated the use of neoadjuvant chemotherapy to endometrial cancer. It's similar, but not the same. So my question is in an advanced endometrial cancer, do you think there's still a role, when I say advanced, I mean, maybe stage 4, a role for surgery? Dr. Andreas Obermair: Most definitely. But the question is when do you want to give this surgery? Similar to ovarian cancer, in my experience, I want to get to R0. What am I trying to achieve here? So, I reckon we should do a trial on this. And I reckon we have, as you say, the number of patients in this setting is increasing, we could do a trial. I think if we collaborate, we would have enough patients to do a proper trial. Obviously, we would start maybe with a feasibility trial and things like that. But I reckon a trial would be needed in this setting because I find that the incidence that you described, that other people would come across, they're becoming more and more common. I totally agree with you, and we have very little data on that. Dr. Ebony Hoskins: Very little and we're doing what we can. Dr. Obermair, thank you for sharing your fantastic insights with us today on the ASCO Daily News Podcast and for all the work you do to advance care for patients with gynecologic cancer. Dr. Andreas Obermair: Thank you, Dr. Hoskins, for hosting this and it's been an absolute pleasure speaking with you today. Dr. Ebony Hoskins: Definitely a pleasure and thank you to our listeners for your time today. Again, Dr. Obermair's article is titled, “Controversies in the Surgical Management of Gynecologic Cancer: Balancing the Decision to Operate or Hesitate,” and was published in the 2024 ASCO Educational Book. And you'll find a link to the article in the transcript of this episode. Finally, if you value the insights that you hear on the ASCO Daily News Podcast, please take a moment to rate, review and subscribe wherever you get your podcasts. Disclaimer: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity or therapy should not be construed as an ASCO endorsement. Find out more about today's speakers: Dr. Ebony Hoskins @drebonyhoskins Dr. Andreas Obermair @andreasobermair Follow ASCO on social media: @ASCO on Twitter ASCO on Bluesky ASCO on Facebook ASCO on LinkedIn Disclosures: Dr. Ebony Hoskins: No relationships to disclose. Dr. Andreas Obermair: Leadership: SurgicalPerformance Pty Ltd. Stock and Ownership Interests: SurgicalPerformance Pty Ltd. Honoraria: Baxter Healthcare Consulting or Advisory Role: Stryker/Novadaq Patents, Royalties, and Other Intellectual Property: Shares in SurgicalPerformance Pty Ltd. Travel, Accommodation, Expenses: Stryker
Vincent travels to the Karolinska Institute in Stockholm to meet up with Niklas Björkström and Joakim Dillner to review their research on the endometrial immune system, and the plan to eliminate cervical cancer in Sweden. Host: Vincent Racaniello Guests: Niklas Björkström and Joakim Dillner Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Become a patron of TWiV! Links for this episode MicrobeTV Discord Server Endometrial immune system variation (Sci Immunol) Immune defense in the womb (News from Karolinska) HPV vaccination and screening for elimination (Nat Comm) Cervical cancer elimination strategies (Int J Cancer) Timestamps by Jolene. Thanks! Intro music is by Ronald Jenkees Send your virology questions and comments to twiv@microbe.tv Content in this podcast should not be construed as medical advice.
In this episode, we discuss the evidence behind one layer and two layer Cesarean closures with an emphasis on inclusion of the endometrium and the risk of cesarean scar ectopics and placenta accreta spectrum disorders. Plus, we define minimally invasive surgery and trace the origin of the term and it's introduce a new concept: less invasive vs minimally invasive surgery. 00:00:02 Hysterotomy Closure Techniques in Cesarean Deliveries00:14:46 Debunking Claims About Cesarean Techniques00:27:20 Uterine Closure Techniques in Cesarean Deliveries00:36:44 Defining Minimally Invasive Surgery00:48:18 Advanced Techniques in Minimally Invasive SurgeryFollow us on Instagram @thinkingaboutobgyn.
Do you want to know ways to make your ornery endometrium behave? Join Dr. Carrie Bedient from The Fertility Center of Las Vegas, Dr. Abby Eblen from Nashville Fertility Center and Dr. Susan Hudson from Texas Fertility Center for an episode discussing listener questions about ways to make your endometrium grow thicker and look prettier. We discuss supplements and medications that may help the endometrium. Other treatments such as estradiol valerate, vaginal estrogen, and vaginal estrace are mentioned. We also talk about the impact of uterine adhesions, fibroids and polyps. Finally, we talk about the timing of surgery for those conditions in relation to the timing of egg retrieval and embryo transfer. Don't miss this episode if you have an ornery endometrium. Have questions about infertility? Visit FertilityDocsUncensored.com to ask our docs. Selected questions will be answered anonymously in future episodes.
W tym odcinku podcastu poznasz fascynującą i poruszającą historię dr Marleny Kaźmierskiej, której życie zostało przewrócone do góry nogami przez endometriozę – chorobę, która dotyka miliony kobiet na całym świecie.Dr Kaźmierska dzieli się swoją trudną drogą do diagnozy, która trwała aż 9 lat, oraz opowiada, jak choroba wpłynęła na jej życie osobiste, zawodowe i naukowe. Dowiesz się, jakie wyzwania stoją przed kobietami cierpiącymi na endometriozę i jak medyczna marihuana stała się kluczowym elementem jej leczenia, przynosząc ulgę tam, gdzie inne metody zawiodły. Poznasz również jej pracę naukową, która rzuca nowe światło na wpływ endometriozy na życie kobiet, oraz usłyszysz o jej rekomendacjach dotyczących poprawy systemu opieki zdrowotnej.Z odcinka dowiesz się:Jak wyglądało życie dr Marleny przed i po diagnozie endometriozy.Jak choroba wpłynęła na jej decyzje dotyczące kariery zawodowej i edukacji.Jakie metody leczenia stosowała, w tym medyczną marihuanę, oraz jakie były ich efekty.Jakie wnioski płyną z jej pracy naukowej na temat endometriozy.Jakie zmiany systemowe sugeruje dr Kaźmierska w kontekście leczenia i diagnozowania endometriozy.Ten odcinek jest obowiązkowy dla każdego, kto chce zrozumieć, jak endometrioza zmienia życie i jak ważne jest wsparcie oraz edukacja w walce z tą chorobą. Dołącz do nas i odkryj, jak siła i determinacja dr Kaźmierskiej mogą inspirować innych do działania.Zasubskrybuj nasz podcast, udostępnij odcinek znajomym i zostaw komentarz. Wszystkie linki i dodatkowe informacje znajdziesz w opisie odcinka.Ciesz się słuchaniem i niech kanabinoidy będą z nami!Rozmowy Konopne w aplikacji na telefonie:Spotify: https://spoti.fi/3XlQXgCYouTube: https://youtu.be/u-NGHkHPdnkApple Podcasts: https://apple.co/3Dh9GQ1Google podcast: http://bit.ly/3wwpuuxDezer: http://bit.ly/3XDm05jSpreaker: https://bit.ly/4dWIEhvTomasz Ołubczyńskiwww.RozmowyKonopne.plMarlena Kaźmierskahttps://www.facebook.com/endodoktorantkahttps://pokonacendometrioze.pl/Rozdziały:00:00:00 - Intro00:02:00 - Pierwsze objawy endometriozy i trudna droga do diagnozy00:03:23 - Wpływ endometriozy na życie zawodowe i osobiste00:07:11 - Najtrudniejszy okres choroby00:10:04 - Leczenie przed wprowadzeniem medycznej marihuany00:11:39 - Pierwsze kroki w leczeniu konopiami00:19:29 - Długotrwały proces diagnozowania00:21:45 - Praca naukowa dr Kaźmierskiej nad endometriozą00:38:51 - Świadomość endometriozy w środowisku akademickim00:39:49 - Rekomendacje dla systemu opieki zdrowotnej00:47:03 - Podsumowanie i refleksje na temat świadomości społecznej
In this month's Fertility and Sterility: Unplugged, we take a look at articles from F&S's sister journals! Topics this month include a review of studies of menstrual fluid (2:18), changing our language regarding progestin protocols (18:35), and nanoscale motion tracing of spermatozoa (26:46). F&S Reviews: https://www.fertstertreviews.org/article/S2666-5719(24)00032-X/fulltext Consider This: https://www.fertstert.org/news-do/language-matters-rename-progestin-priming-progestin-protocols-vitro-fertilization-ivf F&S Science: https://www.fertstertscience.org/article/S2666-335X(24)00037-5/fulltext View the sister journals at: https://www.fertstertreviews.org https://www.fertstertreports.org https://www.fertstertscience.org
Asavari and Rachel discuss endometrial cancer risk factors, diagnosis, workup, and management with Dr. Katelyn Tondo-Steele. 00:30: Dr. Tondo-Steele Bio 01:32: Endometrial Cancer Overview 05:00 Case 1: 28yo G0 woman with EIN 14:00 Case 2: 59yo G3P2 postmenopausal woman with AUB 22:23 Case 3: 73yo G2P2 with postmenopausal bleeding, dyspnea, pelvic pain, and other systemic symptoms Transcript: https://bit.ly/Ultrasounds_endocancer Resources: ACOG Practice Bulletin 149: Endometrial Cancer ACOG Clinical Consensus Number 5: Management of Endometrial Intraepithelial Neoplasia or Atypical Endometrial Hyperplasia NEJM Endometrial Cancer Review Article NCCN Endometrial Cancer Guidelines ACOG Committee Opinion Number 734: The Role of Transvaginal Ultrasonography in Evaluating the Endometrium of Women with Postmenopausal Bleeding American Cancer Society: Ket Statistics for Endometrial Cancer AAFP Endometrial Biopsy
FertiliPod: Reproductive Medicine and Fertility podcast for professionals
Live IVIRMA Journal Club from January 18th. Dr. Haley Genovese presents an article by Baris Ata et al. recently published in Fertility & Sterility. Drs. Jason Franasiak and Emre Seli comment on the effect of the endometrial thickness on the live birth rate after a euploid frozen embryo transfer, followed by Q&A from the audience including Antonio Pellicer, Thomas Molinaro, Kassie Bollig, and Filippo Ubaldi. Podcast website: https://www.ivi-rmainnovation.com/fertilipod/
The questions for the podcast have come pouring in, and it has been an important confirmation of what we already know: there are many knowledge gaps to fill for women when it comes to their hormone health. Hormones can be very complicated on an individual level, and more often than not, women are not getting the help that they need to navigate this important health concern. The most important thing is to remember that help is available. You don't have to do this alone. Your hormone health is a legitimate and valid priority. For today's episode, we are sharing answers to some of your most important questions so you can find some answers and gain some traction toward embarking on your own hormone health journey. In this episode: ● Why personalized professional help is so important. ● What hormone factors can cause heart palpitations. ● The best way to wean off of hormone medications. ● What basal body temperature can tell you about your thyroid. ● What to do if your hypothyroid symptoms return. ● Why you shouldn't take HRT compounds. ● Which hormones can potentially lead to fluid retention. ● What width your endometrial lining should be. ● Why you should do a Dutch test to figure out your estrogen metabolism. ● What a healthy range of estradiol looks like. ● Why oral progesterone might make you too tired. ● How to take progesterone if you need an alternative method. ● Why testosterone pellets raise women's testosterone levels sky high. ● Why it's crucial for accuracy to test free testosterone levels. ● What symptoms you may have if you have too much progesterone. ● How long to wait for hormone testing after IUD removal. ● Symptoms you may experience with loss of estrogen. 20 Pounds Down No more Pain and Energy is Back! Plus, what to look for and what to avoid in a hormone replacement prescriber The Progesterone Puzzle Unraveled: Understanding the Differences Between Natural, and Synthetic Progesterone and the Surprising Benefits of this Hormone in the Body, Recognizing Symptoms of Progesterone Loss and Excess [00:02:08] Importance of hormone health. [00:06:23] Heart palpitations and thyroid medication. [00:10:52] Ideal thyroid hormone levels. [00:14:14] Finding a hormone therapy doctor. [00:19:19] Treatment options for uterine lining overgrowth. [00:23:30] Hormone treatment for menopause. [00:27:02] Oral vs. transdermal progesterone. [00:31:39] Testosterone treatment complications. [00:36:00] Hormone imbalance and weight gain. [00:42:45] Estrogen dominance and birth control. [00:45:26] Gut health and food sensitivities. [00:49:10] Hormone fluctuations and tongue issues. [00:53:23] Hormone conversion and supplements. [00:58:01] Cutting progesterone dosage in half. [01:02:38] Retracted guidelines for HRT. Interested in joining our NEW Peptide Weight Loss Program? Join today and get the details here. Join our Women's Group Coaching Program OnTrack TODAY! Karen Martel, Certified Hormone Specialist & Transformational Nutrition Coach and weight loss expert. Visit https://karenmartel.com/ Karen's Facebook Karen's Instagram
Dr Jarrod McKenna is a reproductive biologist & science communicator and his research focused on female reproductive health; however, Dr McKenna loves making the difficult, inaccessible science concepts fun and interesting regardless of what field it is!Watch the video version of this podcast episode here: https://youtu.be/DvDj4wkC3NcDuring our conversation, Jarrod explains how the menstrual cycle works and compares it to the far more common estrous cycle. We also discuss topics like hormones, birth control, and pregnancy as our reproductive biologist encourages us to learn more about our bodies. You can follow Dr McKenna on Twitter: https://www.twitter.com/its_drmac& check out Dr McKenna's website: https://www.thesimplescience.comGet guest updates and submit your listener questions via Instagram: https://instagram.com/travellingscience/During this episode, a donation was made to the Endo Australia charity.Endo Australia: https://endoaustralia.org.au/If you'd like to support this podcast and the charities we donate to each week, you can make a contribution here: https://www.patreon.com/thetravellingscientistThank you for making a positive change in the world!
Dzisiejszy odcinek poświęcony będzie chorobie na którą cierpi ogromna ilość kobiet w PolsceChoroba rozwija się po cichu w większości przypadków nie jest wcześnie diagnozowana. Doprowadza do sytuacji w którejPojawiają się silne bóleStany depresyjne,Obniżenie płodności bądź niepłodność,jak również NowotworySkala problemu jest znaczna żeby nie pokusić się o stwierdzenie ogromna zważywszy iż cierpienia, braku możliwości normalnego funkcjonowania w społeczeństwie i rodzinie nie sposób wycenić.Dzisiaj porozmawiamy o Endometriozie.Moim dzisiejszym gościem jest ginekolog Jacek Orłowski .To właśnie jego przychodnia Cannabis Clinic była pierwszą w Łodzi placówką specjalizującą się w leczeniu medyczną marihuaną. W terapiach pacjentów wykorzystuje medyczną marihuanę, umiejętnie dołączając ją do obecnego leczenia pacjenta.Porozmawiamy o możliwościach i benefitach wynikających ze stosowania marihuany medycznej w leczeniu endometriozy.https://cannabis-clinic.pl/https://www.facebook.com/centrummedycynykonopneje-mail: kontakt@cannabis-clinic.pl; rejestracja@cannabis-clinic.pl tel.: +48 574 252 505 (Łódź); +48 604 098 115 (Katowice)Zapraszam do podcastu RozmowyKonopne w aplikacji na telefonie:Spotify: https://spoti.fi/3RaOgdbApple Podcasts: https://apple.co/3Dh9GQ1Google podcast: http://bit.ly/3wwpuuxDezer: http://bit.ly/3XDm05jSpreaker: http://bit.ly/3WGIaCCTomasz Ołubczyńskiterapeuta konopny+48 605 694 260www.RozmowyKonopne.plrozmowykonopne@gmail.com
As part of our medical training and education, we often learn diagnoses in isolation. For example, we have learned that Proliferative Endometrium on EMB is a non-pathological finding. That result can be left alone without therapy, correct? But what if that is found in the context of a postmenopausal patient. Is it still considered a nonpathological finding? In this episode, we will summarize the current nomenclature for endometrial pathology and why one classification scheme is favored over the other (EIN over WHO). We will also summarize key points form a February 2023 publication (Obstetrics and Gynecology) released under the section, “Clinical Conundrums: Proliferative Endometrium in Menopause, to Treat or Not to Treat?”.
I talk with Dr Harvey Kliman about his research and medical opinion when it comes to the placenta, pregnancy loss/stillbirth, & reoccurring pregnancies. He is a research Scientist in the Department of Obstetrics, Gynecology, and Reproductive Sciences at the Yale University of Medicine and the Director of the Reproductive and Placental Research Unit with the following Research Interests: Pregnancy Complications and losses, Autistic Disorder, Endometrium, and Infertility. Dr Kliman is the one who gave me some answers around Brody's death. He shed some light on what could have happened & how we prevent it from happening again. Without his placenta pathology report, I would still be going off of what my OB said, "he was perfect, this was freak, & it won't happen again." False.Here's what we discuss:His background and how he got hereDeveloping the Estimated Placenta Volume measurementsPushback from doctorsCauses of stillbirthCauses of a small placentaHow to monitor if your placenta is smallHow do approach doctors about EPVC***d & the placentaAnd so much more... Important info from Dr Harvey Kliman:EPV: Estimated Placental VolumePregnancy loss: Pregnancy LossesHome page: Reproductive and Placental Research UnitOrganization: Measure the PlacentaEmail: harvey.kliman@yale.eduThis is an episode for those who are curious about the placenta, who want to find answers, who also want to learn about other things outside of a small placenta, & to hear how we can prevent this from happening again in subsequent pregnancies. ***NOTE: this is always an open platform from the viewpoint of the guest and does not always reflect my beliefs. As always do your own research & use your own judgement on what's best for you. I am not a doctor or a therapist. I am just a real life loss mom describing her experiences with life after loss. This is my real life, and I'm putting it out there so you feel less alone. ***For more REAL TALK about pregnancy loss, stillbirth and grief, hit follow!Instagram https: @thekatherinelazarFacebook: @thekatherinelazarWATCH IT HERE: Youtube: @thekatherinelazarEmail: thekatherinelazar@gmail.comWebsite: www.katherinelazar.com Some helpful resources:https://countthekicks.org/https://www.measuretheplacenta.org/https://www.pushpregnancy.org/https://www.tommys.org/ Follow me on Social Media:Instagram and Facebook: @thekatherinelazar
Lexman is interviewed by Natalya Bailey, an artist and theorist who has written extensively on Derek, endometrium, and Chuckhole. They discuss Gwendolen, Rothko, and the potential for artificial intelligence to instill human-like thought in machines.
Timestamps & Summary 2:48Let's remind the audience where you see the current status of reproductive efficiency in the North American dairy herd.Dr. Eduardo RibeiroIf we look at every metric, in large datasets from both the US as well as Canada, they tell the same story. And I think the first message that they tell us is that we are making progress. So dairy producers, they are improving reproductive efficiency in their herds, at least for the last 15 to 20 years. Another thing that we can take out of this large data set is that we still have huge variability. So, we still have herds that do very poorly in reproductive management, and herds that are excellent in reproductive management. […]5:30So, let's talk about embryonic loss.How best to measure reproductive losses after the establishment of very early conception?What are some of the biological minimums or key performance indicators we should be shooting for?How do we minimize this embryonic loss?Dr. Eduardo RibeiroExcellent questions. To facilitate our discussion, I like to divide pregnancy losses in two types:One is the early pregnancy losses that happen before early diagnosis of pregnancy. So, we're talking about the losses that occur in the first 30 to 40 days.And then we have late pregnancy losses, occurring after the first pregnancy diagnosis, that can be measured on the farm. It is basically the proportion of cows that were pregnant in the first pregnancy diagnosis that do not deliver a calf at the end. […]People might have an idea of the percentage that they are losing in the interval from the 30 to 40 to the 60 to 90 days but the losses after that are normally called abortion by producers. So, you have to put those out together. And sometimes the information is not entered correctly in the software that the producers use for management. So, if you put out together, it's not uncommon to see farms with 20–25% losses. So, we don't have large statistics on that number, which is a problem. So, we don't actually know what the average in North America will be. But based on our experience, there's a lot of herds on their range of 20–25% losses. And what producers should aim is to reduce that number the most they can. And if you're close to 10%, I would say that that's good. […]On average, when we do studies, fertilization is around 80–85% for cows that have a successful ovulation around the time of breeding. So then, based on that, you could estimate how much you're losing based on the percentage of cows that are pregnant after the first diagnosis. But why you should work on is just to try to improve your pregnancy for AI. Basically, if you're doing that, you're reducing failures with time of insemination, fertilization of the egg, and also early embryonic losses or early pregnancy losses.11:48What are some of the things that a producer can do to minimize these losses, enhance the pregnancies through the early term, and in the end, minimize the losses in short and medium long term?Dr. Eduardo RibeiroThere are a few things that can be done. One is related to the genetics of the herd. It's not something that will have a huge impact immediately, but in the long term, it becomes important. So, it's important for producers to include fertility, health and longevity of traits in their genetic selection program. In the long term that will help and as more research is done in this area, more markers are included in those genomic tests. […]25:08So, take home messages for our audience today. What would you remind them to emphasize if they really want to try and maximize reproductive performance?Dr. Eduardo RibeiroI think the first thing is to realize that excellent reproductive efficient is possible. So, we've made a lot of progress in the last 15 years. That improvement that we observe in reproduction was done in parallel with improvements in milk production, as well. […]The second thing is, before you focus on pregnancy losses, make sure you fix everything that is easier to fix. So, then you can focus on pregnancy losses. […]
Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2022.11.17.516854v1?rss=1 Authors: Hosoya, S., Yokomizo, R., Kishigami, H., Fujiki, Y., Kaneko, E., Amita, M., Saito, T., Kishi, H., Sago, H., Okamoto, A., UMEZAWA, A. Abstract: Background: Menstrual blood-derived cells show regenerative potential as a mesenchymal stem cell and may therefore be a novel stem cell source of treatment for refractory infertility with injured endometrium. However, there have been few pre-clinical studies using cells from infertile patients, which needs to be addressed before establishing an autologous transplantation. Herein, we aimed to investigate the therapeutic capacity of menstrual blood-derived cells from infertile patients on endometrial infertility. Methods: We collected menstrual blood-derived cells from volunteers and infertile patients, and confirmed their mesenchymal stem cell phenotype by flowcytometry and induction of tri-lineage differentiation. We compared the proliferative and paracrine capacities of these cells. Furthermore, we also investigated the regenerative potential and safety concerns of the intrauterine transplantation of infertile patient-derived cells using a mouse model with mechanically injured endometrium. Results: Menstrual blood-derived cells from both infertile patients and volunteers showed phenotypic characteristics of mesenchymal stem cells. In vitro proliferative and paracrine capacities for wound healing and angiogenesis were equal for both samples. Furthermore, the transplantation of infertile patient-derived cells into uterine horns of the mouse model ameliorated endometrial thickness, prevented fibrosis and improved fertility outcomes without any apparent complications. Conclusions: In our preclinical study, intrauterine transplantation of menstrual blood-derived cells may be a novel and attractive stem cell source for the curative and prophylactic therapy for injured endometrium. Further studies will be warranted for future clinical application. Copy rights belong to original authors. Visit the link for more info Podcast created by Paper Player, LLC
Warum ist eine Endometriose eigentlich so schmerzhaft, woher kommt sie und was hat sie mit ungewollter Kinderlosigkeit zu tun? Unsere Expertin Dr. Claudia Sondermann erklärt uns in dieser Podcastfolge, was eine Endometriose im Körper bewirkt, wie sie diagnostiziert werden kann und ob sie immer behandelt werden muss.
Dr. Natalie Crawford explains the endometrium—what it is, what it is hormonally responsive to, things that change it, and possible abnormalities. She dives into all things related to the endometrium, including, what can cause a thin endometrium lining, uterine septum, endometrial polyps, and more. She also discusses an NBC essay about how Texas' abortion trigger ban has stopped a woman from pursuing further IVF treatment. Finally, Natalie answers your social media questions during her segment FFS—For Fertility's Sake. How far in advance do I start a prenatal before trying to conceive? What are the percental risks of multiples during IUI? Does a short follicular phase equal worse egg quality? Don't forget to ask your questions on Instagram for next week's For Fertility's Sake segment when you see the question box on Natalie's page @nataliecrawfordmd. You can also ask a question by calling in and leaving a voicemail! Call 657–229–3672 and ask your fertility question today. Thanks to our amazing sponsor! Check out this deal just for you: Figs — wearFIGS.com and use code ASAWOMAN to get 15% off your first order. If you haven't already, please rate, review, and follow the podcast to be notified of new episodes every Sunday. Plus, be sure to follow along on Instagram @nataliecrawfordmd, check out Natalie's YouTube channel Natalie Crawford MD, and if you're interested in becoming a patient, check out Fora Fertility.
Gebärmutterkörperkrebs ist nach dem Brustkrebs die zweithäufigste Krebsart, die vorwiegend Frauen im reproduktiven Alter betrifft. Durch die Tatsache, dass wir Menschen immer älter werden und letztlich auch immer weniger bewegen, nimmt auch die Zahl der Frauen mit Gebärmutterkörperkrebs deutlich zu. Die Inzidenz ist steigend auf 11.000 Neuerkrankungen pro Jahr. Die Diagnose, Therapie und Nachsorge des Gebärmutterkörperkrebses sind komplex und bedürfen einer sorgfältigen Planung. In diesem Podcast geben Dr. med. Robert Armbrust (Link) und Prof. Dr. med. Dr. h.c. Jalid Sehouli (Link) einen Überblick über die entscheidenden Fragen in der Diagnostik, Therapie und Nachsorge des Endometriumkarzinom. Wir erleben durch die neuen Immuntherapien eine ganz neue Dynamik in der Behandlungsstrategie beim Gebärmutterkörperkrebs. Wo der Gebärmutterhalskrebs ist in Deutschland durch eine Vorsorgeuntersuchung Screening Untersuchung gut abgedeckt ist, erkennt man den Gebärmutterkörperkrebs an bestimmten Leitsymptomen. Gerade in der Therapie ist eine Abwägung von Strahlen, Chemo oder Immuntherapie je nach Risikogruppe unerlässlich. Unter anderem legen wir auch ein Hauptaugenmerk auf die Nachsorge, die gerade bei Gebärmutterkörperkrebs Patientinnen mit einem Nachsorge Konzept durchdacht sein sollte. Webseite: www.krebs-podcast.de Referenten: Prof. Dr. med. Dr. h.c. Jalid Sehouli (Direktor der Klinik für Gynäkologie mit Zentrum für onkologische Chirurgie (CVK) und Klinik für Gynäkologie (CBF), Charité Berlin) Dr. med. Robert Armbrust (Oberarzt, Klinik für Gynäkologie mit Zentrum für onkologische Chirurgie, Charité Berlin) Erfahren Sie in dieser von vier Folgen alles über die neuesten Entwicklungen in der Diagnostik und Therapie des Gebärmutterkörperkrebses. Diese Folge des Krebspodcast wird unterstützt durch GlaxoSmithKline (GSK). GSK ist jedoch nicht für den Inhalt des Vortrags verantwortlich. Thema und Inhalt obliegen der wissenschaftlichen Freiheit der Referenten. Hosted on Acast. See acast.com/privacy for more information.
Gebärmutterkörperkrebs ist nach dem Brustkrebs die zweithäufigste Krebsart, die vorwiegend Frauen im reproduktiven Alter betrifft. Durch die Tatsache, dass wir Menschen immer älter werden und letztlich auch immer weniger bewegen, nimmt auch die Zahl der Frauen mit Gebärmutterkörperkrebs deutlich zu. Die Inzidenz ist steigend auf 11.000 Neuerkrankungen pro Jahr. Die Diagnose, Therapie und Nachsorge des Gebärmutterkörperkrebses sind komplex und bedürfen einer sorgfältigen Planung. In diesem Podcast geben Dr. med. Robert Armbrust (Link) und Prof. Dr. med. Dr. h.c. Jalid Sehouli (Link) einen Überblick über die entscheidenden Fragen in der Diagnostik, Therapie und Nachsorge des Endometriumkarzinom. Wir erleben durch die neuen Immuntherapien eine ganz neue Dynamik in der Behandlungsstrategie beim Gebärmutterkörperkrebs. Wo der Gebärmutterhalskrebs ist in Deutschland durch eine Vorsorgeuntersuchung Screening Untersuchung gut abgedeckt ist, erkennt man den Gebärmutterkörperkrebs an bestimmten Leitsymptomen. Gerade in der Therapie ist eine Abwägung von Strahlen, Chemo oder Immuntherapie je nach Risikogruppe unerlässlich. Unter anderem legen wir auch ein Hauptaugenmerk auf die Nachsorge, die gerade bei Gebärmutterkörperkrebs Patientinnen mit einem Nachsorge Konzept durchdacht sein sollte.Webseite: www.krebs-podcast.deReferenten:Prof. Dr. med. Dr. h.c. Jalid Sehouli (Direktor der Klinik für Gynäkologie mit Zentrum für onkologische Chirurgie (CVK) und Klinik für Gynäkologie (CBF), Charité Berlin)Dr. med. Robert Armbrust (Oberarzt, Klinik für Gynäkologie mit Zentrum für onkologische Chirurgie, Charité Berlin)Erfahren Sie in dieser von vier Folgen alles über die neuesten Entwicklungen in der Diagnostik und Therapie des Gebärmutterkörperkrebses. Diese Folge des Krebspodcast wird unterstützt durch GlaxoSmithKline (GSK). GSK ist jedoch nicht für den Inhalt des Vortrags verantwortlich. Thema und Inhalt obliegen der wissenschaftlichen Freiheit der Referenten. Our GDPR privacy policy was updated on August 8, 2022. Visit acast.com/privacy for more information.
Take a sneak peak at this month's Fertility & Sterility! Topics this month include a Fertile Battle on optimal endometrial lining in ART (2:00), an RCT using FSH with a trigger (8:40), the relationship between paternal factors and embryonic aneuploidy of paternal origin (20:00), an RCT looking at live birth using the endometrial receptivity analysis (27:35), risk of miscarriage after treatment for chronic endometritis and IVF/ICSI (41:25), Cardiometabolic risks in middle childhood (47:00) and evaluating the efficacy of different treatments for c-section scar ectopics (51:40). View the August 2022 issue of Fertility and Sterility, Volume 118, No. 2 at https://www.fertstert.org/issue/S0015-0282(21)X0022-2 View Fertility and Sterility at https://www.fertstert.org/
In this episode I share my personal experience with a HSG, sonohysterogram, Endometrium biopsy, and pelvic MRI. Please note this is just my experience and some women have different experiences.
You might not give much thought to your uterine lining (endometrium), but having a healthy lining is necessary to have a healthy pregnancy and baby. Join Dr. Carrie Bedient from The Fertility Center of Las Vegas, Dr. Abby Eblen from Nashville Fertility Center and Dr. Susan Hudson from Texas Fertility Center as they discuss why a thin endometrium is a problem. The Fertility Docs will also talk about what can cause this issue and how to treat it. Have questions about infertility? Visit FertilityDocsUncensored.com to ask our docs. Selected questions will be answered anonymously in future episodes.
Kanser endometrium biasanya berlaku secara purata pada umur 60 tahun dan 80 peratus tergolong kepada wanita yang telah putus haid atau menopaus. Apa itu kanser endometrium?
In the second of a two-part series from ASRM 2021 Scientific Congress and Expo, we bring you interviews and discussion about the groundbreaking science being presented at the conference. Interviews in Part 2 include: Dr. Samantha Pfeifer (1:12), Dr. Nicole Doyle (12:53), Dr. Jerrine Morris (20:43), Dr. Yigit Cakiroglu (30:30), Dr. Jonah Bardos (38:42), Dr. Jen Bakkensen (47:48), Dr. Alexandra G. Huttler (56:16), Dr. Lauren Butler (1:00:40) and Dr. Kara Goldman (1:05:33). View Fertility and Sterility at https://www.fertstert.org/ More information about ASRM 2021 can be found at https://asrmcongress.org
We go deeper than your Sex Ed class ever did on this episode about Ovulation. Ovulation is just one of four steps in the menstrual cycle. We discover that the egg is the unsung hero and that sperm are just riding on its coat tails. DISCLAIMER Our Audio Fucked Up in a Major Way. We Apologize for the fuzziness and the level of Charlotte's voice. Resources https://www.youtube.com/watch?v=nLmg4wSHdxQ&t=2s https://helloclue.com/articles/cycle-a-z/basal-body-temperature-bbt-what-is-it-how-is-it-used-to-estimate-ovulation https://www.verywellhealth.com/does-birth-control-stop-ovulation-906740 https://medlineplus.gov/lab-tests/luteinizing-hormone-lh-levels-test/ https://www.avawomen.com/avaworld/ovulated-egg/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1126506/ https://www.healthline.com/health/pregnancy/ovulation-pain#treatement https://www.mayoclinic.org/healthy-lifestyle/womens-health/multimedia/ovulation/vid-20084729
Take a sneak peak at this month's Fertility & Sterility! Topics this month include biomarkers for ectopic pregnancies, perinatal outcomes in singleton IVF pregnancies over 24 years, new data on endometrial thickness, and new documents from the Practice & Ethics Committee! View Fertility and Sterility July 2021 Volume 116 Issue 1 View Fertility and Sterility at https://www.fertstert.org/
Town Square with Ernie Manouse airs at 3 p.m. CT. Tune in on 88.7FM, listen online or subscribe to the podcast. Join the discussion at 888-486-9677, questions@townsquaretalk.org or @townsquaretalk. Michelle Iracheta experience pain in her side since she was 13-years-old. She repeatedly told doctors the pain was debilitating and left her unable to move. Yet, it's dismissed as cramps or untreable- if addressed at all. Only later after extensive self-research did she find the answer to her ailment- endometriosis. Endometrium tissue, the lining of the uterus, grows outside the uterus which can lead to pain, breaks down the surrounding tissue, and forms webs of scar tissue in the abdomen. Iracheta lived with the condition for more than a decade and a half before she found the cause and cure for her condition. According to the World Health Organization, women experience a lower quality of life and health. Women make up more than half the US population. But are their health concerns – and their voices – aren't given enough attention. Our experts walk us through the contributing factors of unequal access to information and healthcare and what women can you do to overcome them. Dr. Kjersti Aagaard Professor of obstetrics and gynecology at Baylor College of Medicine and Texas Children's Hospital Felicia Latson Senior Director Social Determinants of Health at Legacy Community Health Michelle Iracheta Communications Officer Endometriosis Foundation of Houston Town Square with Ernie Manouse is a gathering space for the community to come together and discuss the day's most important and pressing issues. Audio from today's show will be available after 5 p.m. CT. We also offer a free podcast here, on iTunes, and other apps.
1 in 10 people have it, but we still have more questions than answers - and no cure. In this episode, we're deep diving into the world of Endometriosis, a painful chronic illness that for some can take a decade to diagnose.
1 in 10 people have it, but we still have more questions than answers - and no cure. In this episode, we're deep diving into the world of Endometriosis, a painful chronic illness that for some can take a decade to diagnose.
1 in 10 people have it, but we still have more questions than answers - and no cure. In this episode, we're deep diving into the world of Endometriosis, a painful chronic illness that for some can take a decade to diagnose.
1 in 10 people have it, but we still have more questions than answers - and no cure. In this episode, we're deep diving into the world of Endometriosis, a painful chronic illness that for some can take a decade to diagnose.
FertiliPod: Reproductive Medicine and Fertility podcast for professionals
Live Online Journal Club from March 24th. Dr. Mauro Cozzolino and Dr. Paul Pirtea discuss two very interesting scientific papers on recurrent implantation failure and the use of preimplantation genetic testing for aneuploidy (PGT-A) and endometrial receptivity array (ERA) with guest speakers: Dr. Dominique DeZiegler, Dr. Nicolás Garrido, Dr. Richard Scott, and Dr. Steve Young. Moderators: Dr. Juan García Velasco and Dr. Andrés Reig. Podcast website: https://www.ivi-rmainnovation.com/?utm_source=podcast&utm_medium=episode&utm_campaign=ep25
In part 2, we talk about how endometriosis is different from the endometrium in terms of its estrogen and progesterone receptors. These directly affect the biological processes of the endometriotic tissue, causing it to act differently than the endometrium does in response to estrogen and progesterone, ultimately leading to… you guessed it! Pain and inflammation! LIKE OUR SHOW? Please rate it or leave a review! CONNECT WITH US! INSTAGRAM: @in16yearsofendo WEBSITE AND RESOURCES: insixteenyears.com
We bespreken zaken van levensbelang die missen in het huis van Gaia
Endometriosis is tissue that is SIMILAR to the endometrium (uterine lining) but it is NOT the endometrium. Yet many websites, medical bodies, well-meaning advocates, and even misinformed doctors continue to get the definition of endo incorrect. Is it really such a big deal to know that endo is NOT the endometrium? Yes, because the two tissues act differently in the body! We talk about some ways that endo and the endometrium differ, and why this is so important to know in terms of treatment options. This episode is part 1 of 2! LIKE OUR SHOW? Please rate it or leave a review! CONNECT WITH US! INSTAGRAM: @in16yearsofendo WEBSITE AND RESOURCES: insixteenyears.com
Tahnee's back on the Women's Series today, with returning guest Dr. Amanda Waaldyk talking female reproductive health, with a spotlight on endometriosis (endo). Recent figures on the Endometriosis Australia page show approximately 1 in 9 women worldwide suffer from this at times debilitating disease, that's around 200 million. These are pretty alarming statistics, considering it takes (on average) 7-10 years for endo diagnosis. Amanda has so much knowledge in this space; she is the founder/director of Angea Women's Health Clinic (Melbourne), doctor of Chinese Medicine, acupuncturist, yoga teacher, and energy healer. Being diagnosed and living with endo herself, Dr. Amanda's personal experience has deepened her holistic approach to treating this disease and is helping so many women on their journey of healing. This episode is a must for all women; the ladies get into pertinent aspects of the menstrual cycle, pregnancy, the contraceptive pill, and how they're affected by endometriosis. Tahnee and Dr. Amanda discuss: What is endometriosis, why is it so painful? Endometriosis and the vital role of the liver. Chinese herbs for treating gynecological issues. Treating endometriosis holistically. Adenomyosis vs endometriosis, what's the difference? Dyspareunia (painful intercourse) and dysmenorrhea (painful menstruation), as common symptoms of endometriosis. Why painful menstruation is not normal. The genetic link with endometriosis; looking at paternal and maternal family history. Why is endometriosis often misdiagnosed as IBS? The DUTCH test (advanced hormone testing) and why it's essential when diagnosing endometriosis. The benefits of abdominal, Mayan, and womb massage for the female reproductive system. Understanding endometriosis as an inflammatory condition and foods to avoid. Yoni steaming. Who is Dr. Amanda Waaldyk? Amanda is the founder and director of Angea Women’s Health Clinic, an integrative Chinese medicine practice that focuses on fertility, female endocrinology, and supporting women through every phase of life. With extensive experience in reproductive/hormonal conditions, menopausal concerns, endometriosis, and PCOS, Angea clinic is truly a haven for women. Amanda’s practice is soul meets science, guiding her patients to ultimate health by providing a whole-body approach. Amanda is a Doctor of Chinese medicine, yoga and meditation teacher, acupuncturist, hormone expert, and energy healer. Amanda empowers and educates her clients to reconnect with their inherent body wisdom, navigate their way back to balance (naturally), and live the happiest and most thriving version of their lives. Resources: Angea Clinic Angea Instagram Angea Facebook Women's Yoga Training Holistic Fertility with Dr. Amanda Waaldyk (EP#35) I Am Gaia (the SuperFeast Nourishing Women's Blend) read about it here Q: How Can I Support The SuperFeast Podcast? A: Tell all your friends and family and share online! We’d also love it if you could subscribe and review this podcast on iTunes. Or check us out on Stitcher, CastBox, iHeart RADIO:)! Plus we're on Spotify! Check Out The Transcript Here: Tahnee: (00:00) Okay. Hi everyone, and welcome to the SuperFeast podcast. Today I am here with Dr. Amanda Waaldyk from Angea, which is this incredible space down in Melbourne, and I can't wait to go there as soon as I'm allowed. She's the founder and director of Angea Women's Health Clinic and she has an integrative Chinese medicine practise that also weaves in traditions like yoga and abdominal massage, which I hope we get to touch on a little bit today. And she works a lot with fertility and female reproductive health. Tahnee: (00:34) So, we're here to talk about endometriosis today, which I'm really excited about, but I wanted to welcome Amanda back, because we have had her on the podcast before and she was very, very popular amongst our community. So thank you for coming back again, Amanda. Dr. Amanda: (00:48) Oh, thank you for having me. I've been so excited to chat about this today. Tahnee: (00:52) Yeah. Such a great topic, and I mean, such a relevant one right now. Something we're hearing a lot through our communication channels at SuperFeast. It's one that women are really enduring. So I wonder, could you tell us a little bit about how you got to be working in women's fertility, and your journey toward becoming this expert on endometriosis? Dr. Amanda: (01:14) Well interestingly, I am an adenomyosis and endo as well myself. So it's something that I've been really interested in back in my university days. I did an assignment on liver function and looking at endometriosis and the role of the liver and endo together. So that sparked a little bit of an interest. And then also, to just with the magnificence of Chinese herbs, how well herbs can actually treat gynaecological issues for women. And I did study four years of Chinese medicine, specifically herbs, and then did two years after with an acupuncture degree. Dr. Amanda: (01:55) So, I was always into sports, I think, and when I finished university I went over to China and lived in China and studied in China for a year. Did a lot of gynaecological training over there. And was going to come back and set up a sports clinic, but of course, the universe had other things in store. And women just kept appearing at my door. So from there it's just organically grown, and I think because I've had so much trauma in my life, how much that actually I can support on a holistic perspective, not only physically, but also through the use of acupuncture, but also emotionally as well. Tahnee: (02:38) Yeah, because we were first connected by Farley who's one of our staff, and that was her experience, being treated by you was not just about receiving Chinese medicine treatment, it was on this multi-dimensional level that you were really supporting her. And she still raves about that experience, and I think she's still looking for someone like you up here. Tahnee: (02:59) But yeah, I think it's like you were saying before we jumped on, a huge amount of women coming through your clinic are suffering from endometriosis. So do you know anything around the statistics of how many people are suffering from the condition in general? Or is that hard to gauge? Dr. Amanda: (03:17) Yeah, it's an epidemic. Statistically worldwide there's 176 million women been diagnosed with endometriosis. So if we think about those numbers, there's probably a higher amount as well, considering the ones that go undiagnosed. Because unfortunately it takes around seven to 10 years for women to be diagnosed. A lot of women often go misdiagnosed as irritable bowel or just heavy periods. Dr. Amanda: (03:43) It's just part of the female normal existence, and that's part of, I think, where this podcast is so important, because it's creating an education piece for women to really understand their bodies more, but also their menstrual cycles. I think in Australia it's about 600,000 women have been diagnosed with endometriosis, and one in 10 women have endo. Tahnee: (04:08) Wow. Dr. Amanda: (04:10) And also too, the statistics now are that 42% of women that have been diagnosed with adenomyosis are also diagnosed with endometriosis. So it's huge, and for some women it can be a very debilitating condition that they're living with, not only daily but monthly. And having those constant reminders of being in excruciating pain and then being told that, sorry, there's nothing that we can do for your pain, I think is extremely frustrating. Because women are so intuitive, and we know when there's something wrong in our bodies, don't we? Dr. Amanda: (04:45) So when we notice that something's wrong, we seek out answers. And then we'll go and see our GP or our healthcare provider. And if those symptoms are dismissed, then the dialogue starts to create of, "What's actually wrong with me? What's wrong with myself and my body?" Dr. Amanda: (05:06) A lot of common symptoms that we see with women with endometriosis is dyspareunia. Dyspareunia is painful intercourse. Dysmenorrhea which is painful periods. And we have a rating at work, we often have a scale of one to ten. So if any women are experiencing pain up around the eight, nine, ten mark, that requires an investigative process. Because if you're having to take days off school or having to take time off work when you're having your period, we just want to assure you that that's actually not normal, and painful periods are not normal. Dr. Amanda: (05:42) Then also, too, menorrhagia which is heavy bleeding. And also too pelvic pain is part of that presentation. Abdominal bloating. Nausea, vomiting, clotting. So you can see it's quite an extensive list, and if I've missed something all, I think I've managed to catch it all. Tahnee: (06:04) Well, it's something that when you say that, that sounds like what a lot of people endure just with periods. And one of your big topics is always around painful periods aren't normal. I appreciate your social media so much for flying that flag all the time. It's your right to have a healthy menstrual cycle. Tahnee: (06:22) So if you're saying it takes seven to ten years to be diagnosed, are you saying that women are suffering for seven to ten years waiting to find someone who can diagnose them? Is that basically the problem? It's common? Dr. Amanda: (06:34) Yeah, yeah. Tahnee: (06:34) Yeah. Okay. Dr. Amanda: (06:37) I guess what happens is, I mean, it is an invisible condition in the sense that if you were to go and see your GP, you were complaining of painful periods, and they sent you off for a pelvic ultrasound, and that pelvic ultrasound showed that there was no endometriomas or no endometriotic tissue then that would come back and they'd say, "Well, you're fine. There's nothing there." Dr. Amanda: (07:02) Also, too, it's genetically linked, so it's really important, and I think this is what's great about the Chinese medicine, is that when we go back to the history of what was your mother's menstrual cycle like? What was your grandmother's menstrual cycle like? Because it can come from both the genetic link of paternal and maternal sides. Dr. Amanda: (07:20) For young women that are going through puberty, it's that if their mothers had a hysterectomy or if they had endo, because a lot of it went misdiagnosed back in our parents' generation, because they were all having children younger, and that's why it's called the career women's disease because now we're forging on our careers and having children later, is that painful periods will often start for those pubescent girls when they have their first menstrual cycle. Dr. Amanda: (07:47) So, for all our young listeners out there, if you're having painful periods and heavy periods and you're needing to take time off school, and your mother's had a history of heavy periods, then please find someone that you can actually work with. A GP or a healthcare provider, that can offer you some support. Because sometimes women have to have laparoscopic surgery in their teenage years because their periods are so debilitating. Tahnee: (08:15) Yep. Just if people don't know exactly what we're talking about, one of the main things that occurs with endometriosis is that the lining of the uterus, the endometrium, actually exists outside of its normal habitat, right? Is that the diagnosis? Dr. Amanda: (08:34) Yeah. You're exactly right, but it's so interesting, because there's a lot of women out there now, I guess, that are celebrities, that are actually creating a greater awareness for endometriosis. But the actual definition is, it's not actually the endometrium that lines our uterus that we shed each month. It's a different type of tissue. It's called epithelial glands, and the endometrial stroma, that basically it migrates to areas within our uterus, to essentially the pelvic organs, the pelvic reproductive organs. Dr. Amanda: (09:16) So the tissue will migrate, it'll implant around the ovaries, it could implant into the fallopian tubes. It can also go into the muscle layer of the bowels. It can be found in our pouch of Douglas, our uterine ligaments, and then also, too, in extreme cases, lungs and liver, and it can also migrate to our bladder. So you can just get that constant irritation when you're having your period of feeling like your bladder's full all the time and that you need to go. Dr. Amanda: (09:48) The issue is, is that the tissue still responds to the same hormonal fluctuations that our menstrual cycle relates to, so your oestrogen and progesterone. So the tissue still responds in that way, so every time you're about to get your bleed, is that tissue will start to respond because it's got prostaglandins. Prostaglandins line endometrium, and so if we've got endometriosis, we know that it's an inflammatory condition, and the research also shows that prostaglandins are actually elevated for endometriosis. Dr. Amanda: (10:26) I've done so much study into the endometrium. I love it, because it's its own endocrine gland, and it forms in spirals. I always like to say you imagine a DNA helix. Endometrium forms in spirals. It has prostaglandins. The prostaglandins' role is to essentially create a gentle uterine cramp, so as the oestrogen and the progesterone drop, it signals the endometrium to start to shed, to start to bleed. So it creates this gentle, mild cramping so the lining can start to shed. Dr. Amanda: (10:57) Can you imagine, if we've got endometriosis, we've got high amounts of inflammation, is that that tissue has a wringing. Imagine a towel wringing out, right? And that's going to cause extreme amounts of pain, because I'll go on a divergent here. In Chinese medicine we know that the liver meridian comes up through the medial aspect, it circulates around our reproductive organs, finishes at our breast tissue. You know the liver, the liver's role is to ensure the smooth flow of chi and blood. Dr. Amanda: (11:25) So the heart being the empress at the time of the period says to the liver, "Okay, General," which it should be a woman, "It's time to release the blood. So let that blood flow." And so when the liver is impacted, which we know that it is, because endometriosis is an oestrogen-dominant condition, and the liver's role within Western medicine is to be able to metabolise our estrogens through the right pathways. So that chi and blood then becomes impeded, and starts to form pockets of blood stagnation, because the blood can't empty properly. Dr. Amanda: (12:17) Because the first thing that we're taught in Chinese medicine in our gynaecological classes is that the period has to empty completely so you can start afresh with a new cycle, new, fresh blood flows, and endometriosis is called [foreign language 00:12:33] in Chinese medicine which essentially means big stagnation. Tahnee: (12:36) So there's pain as well, when you have stagnation. Dr. Amanda: (12:43) Yeah. All that pathology. Tahnee: (12:46) Yep. Because one of the things blood stagnation causes is pain, because it's a bruise or something, right? You touch it and it hurts. Is it throughout the cycle that there's that stagnation feeling as well? Dr. Amanda: (13:00) Yeah, absolutely. Tahnee: (13:01) Yeah. Dr. Amanda: (13:02) Yeah. Because the liver attacks the spleen, so you've got an inflammatory response condition happening the whole time. And some women experience, throughout their entire cycle, that pain and stagnation. Because also, too, if their bowels involved, most of the time it gets diagnosed as irritable bowel, is that when they're trying to have a bowel movement is that they're getting a lot of constipation. So that whole peristalsis action becomes impeded as well, so you get blocked bowels. You're alternating from constipation sometimes to diarrhoea. Dr. Amanda: (13:42) So when you've got that pressure... Because if we think anatomically, girls, if you imagine that you've got your bladder and then you have your vagina next to your bladder, and then at the back you've got your rectum. And then in between the rectum and your vagina you have the pouch of Douglas. And the pouch of Douglas is where a lot of endo tends to hide, goes into this... It's like a deep, dark crevice, right? And so that then pushes onto the bowel. So that's where you get even more stagnation. So you just think, because [foreign language 00:14:20] as we know, what's the role of the [foreign language 00:14:23] 00:14:24] it's that water element. Tahnee: (14:25) Exactly. Dr. Amanda: (14:26) To keep everything in flow. So nothing's in flow. The liver's not in flow. Everything's becoming stagnant, tight, and so blocked, and then you just start to get all this pathology. Tahnee: (14:40) So I'm thinking immediately we've got spleen and liver involved and then kidney, because you're sounding like there's this genetic link as well. Is that where you're looking mostly when you're treating women? It's a combination of those organs that you tend to see dysfunctional? Or is there more going on? Because I've also heard it's positive as an autoimmune kind of thing, but is that more the inflammatory response, that the tissue's in the wrong place and the body's attacking it? Would that be more what that would be pointing to? Dr. Amanda: (15:13) No. You're absolutely right. There is an immune condition as well, from the research they've found that there is an immune response which is also linked to that inflammatory response. So you have multiple organs involved. But it's also too, so much of that is the liver. Dr. Amanda: (15:34) That's why I always recommend my endo patients to have the Dutch test, and the reason being, because if they have to go and have a surgery, because once they've had excision surgery, and we'll come back to that, is that you want to make sure that the endometriosis is being completely removed with the scissors and cut out. Because that way, it reduces the chances of that endometriotic tissue growing back. And so, by doing the Dutch test, we can see which pathway is our liver metabolising the estradiol properly. Because then we know we've got the 2-OH pathway, and that's the way that we can metabolise that oestrogen out properly, and then with endometriosis sometimes we can have high amounts of estrone, which is the 16-OH pathway, and then estriol, which does the 4-OH. Dr. Amanda: (16:23) They're the ones that are more prone to breast cancers, to ovarian cancers, so this is where it's really important to find out that whole history of your family. So when I did my Dutch test, I found out mum's got breast cancer, ovarian cancer, so I was very high on that estrone. So my liver wasn't metabolising my oestrogen properly. So by finding that out, then you can support it, supplement foods, to make sure that you're able to metabolise it. And of course your gut health as well, to metabolise your excess estrogens and make sure you're getting the conversion into estradiol that can then be metabolised out through your liver correctly. Dr. Amanda: (17:06) I think there's actually, if anyone's out there, just putting it out there if anyone's up for doing a study on that, I actually think it would be great research. Tahnee: (17:19) For sure. Well, because I think that's the thing, like we were talking before we turned on the recording, but about how people are prescribed the Pill. I'm thinking if you've already got a liver that's not functioning well and then you're putting a synthetic oestrogen or a progesterone or something in there, that's going to make the liver suffer more. It seems like you're just building up for more problems later on down the track, right? Is that what you see? Dr. Amanda: (17:47) Babe, yes, you're so right there. Because I would actually love the medical community to go, "Okay, we've got a young girl who's Stage Four endometriosis, and if she's had surgery I need to make sure this grows back quite quickly." There sometimes these women are candidates for the contraceptive pill in terms of just management, because sometimes these are the options that are available, particularly for those really difficult cases. Dr. Amanda: (18:22) But then, to see if they did go on the contraceptive pill, to perhaps go back and do a surgery in two years to actually see if the endometriosis had grown back. Or had the pill actually stopped the growth of endometriosis? Because we know that women that go on the Pill that come off the Pill then have to have laparoscopic surgery. The endo's still there. And then like you said, because if your whole liver pathway's this synthetic oestrogen, I see it as synthetic oestrogen liver can't metabolise, you're therefore then increasing that estradiol which is then going to amplify the endo anyway. Tahnee: (19:07) Which sounds like maybe a band-aid solution for short-term results. So, I mean, I've heard of people having improvements with pregnancy. Is that something you see clinically as well, or is that more of an anecdotal thing? Dr. Amanda: (19:22) What was that? Say that again. It cut out a bit. Tahnee: (19:24) I've heard of people having improvements with pregnancy. Is that something you see clinically? Dr. Amanda: (19:34) Doctors will be like... I had a patient the other did, she said, "The doctor said to me after my surgery that I should get pregnant, because pregnancy essentially cures endometriosis." Tahnee: (19:43) Yeah, but then you have a child. Dr. Amanda: (19:45) I thought that was... Tahnee: (19:49) Oh, my dear. Dr. Amanda: (19:52) No. So in terms of, absolutely, it's like a Band-Aid, isn't it? It solves a problem for a short period of time. But I think that's where we absolutely have control of being able to support our health by doing all the right things to minimise that endometriosis from growing back, which is diet, nutrition, all your lifestyle factors, and then your supplements, acupuncture, exercise, pelvic floor, physiotherapist. So having a real holistic approach to it. Tahnee: (20:33) Because you offer abdominal massage in the clinic, and is that something? Because I often think with these inflammatory things, is it beneficial to manipulate that tissue, or do you have any experience with that in terms of women doing self-massage and those kinds of things? Because I mean, I'm always an advocate for it just in terms of connecting to your body. It's such a great way, I think, to get in touch with learning where all the bits are and all that kind of thing. But yeah, I'm just wondering as a clinical treatment, I imagine it would help relieve some of the stagnation and pain. Dr. Amanda: (21:06) Yeah. Absolutely. Like you said, it's the best way to be able to reconnect into your body and develop a loving relationship. Because for a lot of women that have endo, you hate your body. You hate it, because you're experiencing so much pain. Because tissues have issues, as we know. Tissues have imprints of everything. They hold our whole life story. It's a web. So by doing abdominal massage, absolutely. Because then, you're starting to create healthy blood flow through your reproductive organs and through your abdomen. So then you start to break out some of that tissue as well. Dr. Amanda: (21:51) We know that for women that have had laparoscopic surgery, or haven't, is scar tissue. So what does scar tissue look like? When tissue meshes, it meshes in together like there's a synergy, where it just folds in together. But with scar tissue, it's all just hacky. Hacky tissue, that's formed together in these weird, web-like structures. So by doing gentle abdominal massage, we're starting to create a beautiful flow. And we know that when tissue's in flow that it brings in chi, it brings in energy, allows the blood to flow. Dr. Amanda: (22:26) So absolutely, abdominal massage, Mayan massage, womb massage. Because you're going deeply into the layers of that connected tissue and the reproductive organs are part of the fascial planes, as we know, embryonically that form when we're embryos. And there's a body of research that says that endometriosis is formed actually when we're in utero. Tahnee: (22:51) Wow. Okay. Is that pointing to then something genetic? Or is it pointing to something going on in an epigenetic sense? Do you have any sense of what that might be? Dr. Amanda: (23:04) I would say genetic, absolutely. And then also too epigenetic, isn't it? Because when we're an egg in our grandmother's womb, forming in our mothers, so you think about that. Tahnee: (23:16) Wow. Dr. Amanda: (23:19) And trauma. Trauma. So much trauma. I mean, I got only diagnosed with endo at 41. I'd never had painful periods. I've had multiple traumas. I was raped a couple of times, and I think that that definitely... It's our sacred chakra. It's our pleasure centre. So if someone has entered without permission, that causes a stagnation and a trauma, and that then develops into a pathology. So I think there's so much stuff around trauma, and I see a lot of women in clinic with a link between sexual abuse experiences. First-time sexual experience trauma, whether that's physical abuse, emotional abuse, even women working in male-dominated industries where they've not been able to be their expressive selves. Tahnee: (24:22) Well, that ties into what you're saying about that idea of being a career woman, too, and almost in a more masculine setting. It could be some suppression of that feminine, creative expression. Because you really think about that lower area as that Shakti, it's that feminine, creative space, and so if it's not fully expressed then yeah, you're going to see stagnation of that energy. And over time, that's one of the things Chinese medicine teaches us, is over time that energetic stagnation causes a physical transformation or changes a tissue in some way. That's how we end up with the disease process. Tahnee: (24:57) I mean, it's sounding like if someone's got endo, it's a bit more complicated, I guess, than just focus on one thing. So you're normally getting people to do Dutch tests and I guess, working with herbs, and acupuncture, and emotionally. Are there other areas people should look at if they've been diagnosed and they're not sure how to go forward? Is healing possible? Is it something you see where women can really transform this? Dr. Amanda: (25:23) Yeah, absolutely. And I think it's also, to put a point in there, is it's really important to know as a provider ourselves, is that we're limited to what we can do. I always say, if women come in and they have no relief from Chinese medicine, acupuncture, womb healing, Moksa, and being on the correct diet, Dutch test, is that that's when we know that they actually need to have surgery. Dr. Amanda: (25:51) Then it's being able to work with a surgeon, and I would say, ladies, do your research here. Really important to find an endometriosis specialist surgeon. Not just a gynaecologist, gynaecology, fertility specialist, an endo surgeon, because they've dedicated their life to mastering how to be able to excise the tissue. Because that will therefore then, it extends your anatomy, your fertility as well, and then you're not having to go back for repeated surgeries. And I think I'm a good test case. Tahnee: (26:33) Of course you are. Dr. Amanda: (26:33) Look, I'm hoping. I've got adenomyosis, which is even... You know, they're just as bad as each other. Adenomyosis is endo's mean stepsister. Mean sister, mean cousin. Tahnee: (26:49) She's a bitch, that's what she is. Dr. Amanda: (26:50) She is a bitch. Tahnee: (26:54) Would you want to touch a little bit on that? Because if you're saying 40% of people have both of these conditions, what's going on there? What's the causality, do you think? Or what's the relationship between them? Dr. Amanda: (27:08) They say it's retrograde menstruation where the blood goes outside the reproductive organs. So the tissue essentially migrates into your myometrium. So I always use the analogy in clinic is that our uterus is a beautiful garden. Underneath we have our irrigation, which is all the uterine arteries and veins. We need to have a beautiful, healthy vascular blood flow through there as well to help create a nice soil, a fertile soil, an endometrium. And then we have the myometrium, which is the muscle layer. That's the terrain that supports our garden. Dr. Amanda: (27:42) So when we've got endometriosis, it's a weed. The endometriosis grows in and around, so essentially it's disease tissue. If we've got fibroids, fibroids move into the myometrium. They're like a boulder. So endometriotic tissue migrates into the myometrium, which is the muscle layer of our uterus. So then you've got tissue migrating into this muscle layer, and you imagine that's a smooth muscle. Dr. Amanda: (28:09) So when we have our babies, that muscle grows and grows and grows, and we have an expansion of our uterus. It also releases oxytocin at the time of birth. So the myometrium, you've got this endometriotic tissue migrating, and it starts to change the shape of the uterus because you've got this heavy cramping into smooth muscle each month when you're bleeding. So over time, this starts to change the shape of your uterus. So when you go for a pelvic ultrasound, it can be seen on a pelvic ultrasound, and it's normally described as a bulky uterus. Dr. Amanda: (28:42) With that, you get lots of diaphragmatic pain up in your upper rib cage. Heavy bloating, feeling like you're distended, feeling like you're six months pregnant. Really heavy periods or just periods that just don't bleed properly, like really lots of stagnation, clots. And then issues with your bowels as well. So that one's hysterectomy. You need to have a hysterectomy. So there's no way I'm having a hysterectomy. I'm not on the Mirena. I'm just dealing by doing Chinese herbs and all the things that I know to best support the health of my liver, and my uterus, and my menstrual cycle. Tahnee: (29:25) Well, coming back to the Chinese medicine question, because if you think about the spleen too, it's keeping the blood in the right place, right? That's one of the functions of the spleen. And if you're thinking of soil as well, that soil function is what the spleen provides for the blood. That nutritive function. So I mean, there's got to be a spleen component too. So, diet you were saying before is super effective. What do you see as... Are there dietary themes? Or is it really individualised? Or is there anything you can speak to there? Dr. Amanda: (29:57) Absolutely. I think looking at the earth, what is the earth element? The earth is our centre. It's ability to be able to digest, transform and separate the turbid from the pure. So in order to make sure that the body and the spleen function and the stomach's able to separate the pure from the turbid, then you're actually able to absorb all your nutrients through your gut. And interestingly enough, there's been a link between estrobolome and estrobolome is... Okay, I'm just going to read. Dr. Amanda: (30:32) Basically, of course, gut health being the spleen is really important, so we know how much a healthy microbiome influences our digestive function. So with endometriosis, there's been research that shows we are lacking in lactobacillus. We're lactobacillus deficient. And also, our vagina has its own ecosystem as well. And women who have endo have lactobacillus deficiency. Particularly women over 40 as well. So really important that we have a healthy microbiome. Dr. Amanda: (31:04) So new research has emerged indicating that the gut microbiome, of course, plays an integral role in the regulation of our oestrogen levels. So metabolism is really important when it comes to endo so we can metabolise (as you were saying), those estrogens out. Dr. Amanda: (31:20) So essentially, when there's too much inflammation in our gut it causes a gut dyssymbiosis, and that starts to wreak havoc, creating more of an inflammatory response in through our gut. So when we have that, the body can't metabolise the oestrogen out properly. So we just have more oestrogen circulating through our bloodstream. So, what it does is the estrobolome comes in. Estrobolome is a term used to describe the collection of enteric gut bacterial microbes. Their job is to essentially metabolise the oestrogen. And these microbes, the estrobolome, produce beta-glucuronidase, sorry about the pronunciation there. This enzyme alters oestrogen into its active form which binds to oestrogen receptors and influences oestrogen-dependent physiological processes. Dr. Amanda: (32:12) Essentially, basically, the more your gut is out of balance, the more beta-glucanase is produced and the less oestrogen is excreted out of your body. So the research has shown that women that have high amounts of beta-glutinase bacteria leads to higher amounts of oestrogen circulating, in a roundabout way. Sorry about that. Tahnee: (32:32) No, yeah. So basically, gut dysbiosis is leading to higher circulating estrogens in the body, and that's effectively on account of, for whatever reason, from a TCM perspective, the spleen function isn't there. From a Western perspective, it's going to be maybe intolerances and things like that, or an inappropriate diet. Dr. Amanda: (32:54) Your sugars, blood sugar. And interestingly enough, what's the flavour of the spleen? The spleen loves sweet. Tahnee: (33:01) Yeah. Not too much. Dr. Amanda: (33:05) Yeah. Don't kill it with sweet. So you've got that whole gut thing going on. And some research that I found out was, the body's essentially designed to procreate, right? So when we don't conceive, is the endometrial changes into glucose secretions. So that's why we also, too, as we're losing our blood, the chi and blood come out, we're losing energy. You know when we get into that second half of our cycle and we're like, "Just give me the sugars, give me the carbs." That's because there's actually a physiological function that's taking place with the change in the spiral arteries of the endometrium. Dr. Amanda: (33:44) Then, that's the spleen, isn't it? The spleen function comes in. We just want those things that are nurturing, like the earth, to support us. Give us all those sweet foods. But it's a perpetuating washing machine, isn't it? Tahnee: (33:58) Yep. And I mean, I guess our culture's definition of sweet versus a traditional Chinese definition of sweet, which was more your grains and your root vegetables and starchy kind of things, whereas we're talking- Dr. Amanda: (34:11) Barleys. Tahnee: (34:12) Yeah. We're talking Mars bars, and that's not really going to be particularly helpful. Dr. Amanda: (34:19) Sure. And then you think about the liver. What's the emotion of the liver? The liver's anger, frustration, stress. So women that have endo and adeno, how stressed are we? How angry do we become because we're frustrated that no one's listening to us? Our symptoms are being dismissed? That then causes tightness through the actual liver meridian. And what's the pathology? The fascia becomes tight. The fascia becomes restricted. Dr. Amanda: (34:48) And then you've got the kidneys. If you're losing a lot of amount of blood as well, you become anaemic. So that then therefore affects the spleen, which is production of iron. The kidney function, as women, us being in that male dominant Yang type, living our life out in the Yang, the adrenals then become deficient, don't they? Which then affects the kidneys. And we know how much the kidneys support the reproductive function in Chinese medicine. So it's just this whole cycle. So it's really looking at so much of that holistic approach to supporting endo, through all the organ bodies, through your supplements, to make sure you're getting all your nutrients. Through your nutrition as well, because our nutrition doesn't deliver everything that we need, that our body needs. Dr. Amanda: (35:41) And then of course, wanting to teach our tissue to love our tissue again. And having a pelvic floor specialist physio to be able to teach you how to switch off your pelvic floor. Because of course, Yang women, hypertonic pelvic floor. Tahnee: (35:57) Yeah. That is a good visual for people. Dr. Amanda: (36:03) Sounds [crosstalk 00:36:04] Tahnee: (36:05) Well, people have been taught, again having done some Taoist study, we're taught to relax as much as we're taught to strengthen. But you go and talk to a Western-trained physio and it's Kegels and all these squeezy-squeezy-squeezies. And it's like, well, no, we need that to be like a diaphragm. It needs to be able to be soft, and it needs to be able to be supple, and it needs to be able to spread, and also to contract when required. So yeah, I think it's that tonus, that ability to be flexibility that we lose. Tahnee: (36:32) But again, you're looking at the liver, that makes so much sense if there's that rigidity in the tissue, there's going to be that rigidity and that stress in the mind as well. Right? Dr. Amanda: (36:41) You're so right. It is. It's teaching women how to come back into the essence of being women, isn't it? It's slowing down and really honouring that Yin aspect, which is nurturing and nourishing, because we're very good at having the opposite of that, of constantly doing or overachieving in our careers. Which is a great thing as well, but where's that other half? Where's the duality of bringing the Yin and Yang back in and finding that balance? Dr. Amanda: (37:10) So self-care, babe, like you were saying. Self-care is so important. Your little rituals, when you're bleeding you might want to bleed into a menstrual cup and then look at your blood when you bleed and honour her. Honour your bleed. And then maybe find a tree and put your blood into that tree, so you're nourishing back into Mother Earth as well with your bleed, rather than looking at your bleed like it's the worst thing possible, as starting to cultivate a really healthy relationship with parts of our body that we don't like. Because when we can start to disassociate from the pain, like in yoga. A witness. We can start to change the neuroplasticity of our brain to our pain. That's so important, too. Tahnee: (38:01) I can even imagine that fear of the cycle coming would impact the kidney as well, and then you get these perpetual cycles of fear of the pain, the pain itself, and then this... Yeah, must be an ordeal, I can imagine. Dr. Amanda: (38:16) Yes. Tahnee: (38:18) Yes, yes. She's like, "Yes, it is an ordeal." So yeah, I mean, if someone's wanting to avoid... Is it the worst-case scenario, hysterectomy is where it goes? Is that the last resort for these kinds of things? Dr. Amanda: (38:38) Yeah. It is, yes. For some women, one of our patients, she's had a hysterectomy and she said it was the most liberating thing that she ever did. She also had ovarian cancer as well. So for her she said, actually, having not to go through that every month, the pain, to have that liberation, and then to be able to feel like she can function as a woman every month. So she didn't have her ovaries removed, just her uterus removed. So she's still got her reproductive- Tahnee: (39:15) Cycle. Dr. Amanda: (39:15) Yeah. Tahnee: (39:15) Yeah, because that's something I'm curious about, even, because I know that the uterus itself is an endocrine organ and I think you just mentioned that before, with the endometrium having that function as well. And even, I was talking to another integrative doctor the other day and we were talking about how the menstrual blood is actually different to the blood in our veins. Do you know much about that? Dr. Amanda: (39:44) Yeah. I do. Tahnee: (39:46) It's cool. I was like, "This is cool. These are cool." Dr. Amanda: (39:53) Yes. It's so amazing. You're so right. It's just phenomenal how our bodies operate. That whole evolution, isn't it? I still think about when babies formed in utero, how incredibly, highly intelligent that is. There's no science- Tahnee: (40:10) It's wild. Yeah. It's just like, "Make a human, go." And you're just eating your, I was eating my tamari almonds like, "I'm making a baby right now." Dr. Amanda: (40:22) I know. Tahnee: (40:26) It's wacky. Dr. Amanda: (40:30) It's wild. "I'm growing a heart today. I'm growing the skeletal system." There's 386 different proteins. The endometrial lining is made up of vaginal secretions, the endometrial stroma, the epithelial cells, and then 356 different proteins that help to form that endometrial lining. So it's totally different to the blood that circulates through our veins. So essentially, when we are bleeding each month, and this is what I love, is that it's that whole thing of releasing. They say it's, when we're having a period, that we're releasing the debris. So medical, isn't it? Just releasing the debris. Dr. Amanda: (41:19) Well, we're releasing cytokines, so if we don't conceive it releases inflammation. We're releasing cytokines, the vaginal fluid. And so that's the process women, of honouring that letting go, we're releasing the old, essentially. The old blood, to make way for the new. So that is that process of releasing, letting go, and then bringing in the new. So when we go into our menstrual cycle, we're going into winter. We're going into that time to slow down, to honour ourselves as women, honour the letting go, looking at those psychological things of potentially what we wanted to let go of through that last cycle so then that way we can bring in the evolution of the new. Tahnee: (42:05) We were talking about trauma before, and about this stagnation that occurs. Is there a sense of holding on? Is that one of the themes that you see with people? I mean, I guess that's something you need to work through with a therapist, but is there a sense of resisting life in some way? Or I don't want to be rude or anything, but I'm just feeling into that, and it's like, yeah, I could feel like if there was a trauma or something you couldn't handle and you couldn't share, then you would store that in the body and that would manifest. Dr. Amanda: (42:43) Yes. So every month that's coming up, and it's a reminder as well. So even just deep, cleansing breaths. Using all your tonal sounds when you are bleeding, to soften through all that connective tissue. And then it's also an opportunity to practise the physicality of letting go. I always like to use... And go deep to then where you're softening through your diaphragm, that whole jellyfish analogy, soft through your diaphragm, and allow the blood to release and let it go. So when you're sitting on the toilet, if you're at home and you've got a really heavy cramp, instead of bending over and holding your stomach, you could take a nice deep breath in. And then as you feel the blood pass, and you go... It's no different to giving birth. Tahnee: (43:38) Like birth. Yeah. It makes a roar. Dr. Amanda: (43:46) Get your lion out. Women that have, we've got a lot of tight jaws, that connection of tight jaws. So you can soften through. And then when you do that, you can actually feel the blood passing, and the whole pelvis starts to soften, and the whole connected tissue starts to release. And you're like, "Ah." And you can feel the physical body releasing that stress in that moment. So breath, major part of treatments. Tahnee: (44:15) Yeah. Yeah. And I mean I am curious about things like steams and things. Do you have any experience with those? Because I personally haven't had endo but I've used them for things like, a little bit later than just having given birth, but in my postpartum stage I used them. And yeah, I'm just curious as to whether you've got any evidence of whether they're useful for helping... Because I imagine warmth would really help, something I can imagine. Dr. Amanda: (44:45) Yeah. Well, no, you know, because in that post-partum period, our uterus is vacious and in Chinese medicine, everything's prone to exogenous, external factors. So when we're losing our blood, the period, the whole menstrual bleed is emptying our uterus, and it's the same after we've given birth. So by doing steams, you've got medicinal herbs that are helping to promote healthy blood flow, warming the uterus, protecting the uterus as well from any external factors from coming in. Because if cold comes in, that's why you should never swim on your period, particularly in Melbourne, because it's so bloody freezing, the uterus contracts. Dr. Amanda: (45:25) You don't want anything to be causing a contraction, because more contraction leads to more blood stagnation, which leads to more pain, more inflammation. So yeah. And I think as women, we want to explore all the different options that we can. And yoni steaming is one of those. I actually haven't personally tried it myself. Can you share to me, how does it feel? Yeah. Tahnee: (45:48) I love it. I mean, I don't do it much at the moment really, but I used to do it a lot for self-care before my daughter. I just think it's this really... I usually do it when I'm not bleeding, so just the week before. For me, I guess I'm quite a livery type of person anyway, so it's that pause. It's an intentional pause. You're sitting there for a period of time with all the yummy herbs. I will often use rose and quite beautiful herbs, because I don't have any medicinal problems. Medical problems, I mean. But yeah, and for me that warmth in my lower abdomen is just a really nourishing feeling. It's something that I just find very comforting. Tahnee: (46:33) And my experience has been, post-partum, that it helps to clear blood. I had some dark, stringy blood at the first bleed, after I finished breastfeeding, so about 18 months. So did steams for the next two or three months after that, and it just seemed to clear it out. The blood became fresh and bright again. It just seemed to clear out any of that lingering stuff that maybe hadn't moved through well after birth, or was remaining from after birth. Tahnee: (46:59) And I mean, I've had my teacher, she said she passed a mass, a big... She said it was almost a placenta, a big alien clump. I've heard some wild stories. But I think yeah, just as a general thing to try, it's definitely worth it. You've got to be careful not to burn yourself. But it's beautiful. It's a really beautiful therapeutic practise. I love saunas, I love heat anyway. Dr. Amanda: (47:28) Me too. Tahnee: (47:29) Yes. It's so nourishing. Dr. Amanda: (47:31) It is so nourishing. Tahnee: (47:33) Yeah, yeah. So I just imagine that would be beneficial. And I mean, from an internal perspective, obviously great to see a clinician and work on that level, and I know you've got some things pending which is exciting. So yeah, in general, if people were looking for supplements or herbs or things, are there things that you see working, or again should they just seek individual care? Is there any general things we can talk about? I'm imagining DIM, an estro-block kind of a product? Do you know that product? Dr. Amanda: (48:03) Yes. I think that's where it's good to do the Dutch test, because sometimes DIM can actually have the opposing effect and it can cause more oestrogen dominance. So I guess, if you are experiencing all that breast tenderness, yeah, all your cruciferous vegetables as we know, because they help to block the oestrogen receptors and to be able to metabolise oestrogen through your stools. And psyllium husks also are a great one to use. Curcumin, there's been some great research there to help reduce inflammation. And also evening primrose oil, evening primrose helps with the elevation of prostaglandins. It also helps with reducing inflammation. So all our essential fatty acids. Basically, no sugar. Definitely no gluten and wheat, are huge proponents for increasing more inflammation, particularly noting if you've got any celiac in your family, because then you'll definitely have a gluten sensitivity. Dr. Amanda: (49:01) Dairy as well. If you think about what's happening when cows are constantly being milked, in terms of they have to be milked regularly otherwise they get mastitis, they've just given birth. They've got oestrogen circulating, producing hormones, that's going into the milk. So it's just no dairy. Also, too, because dairy creates an inflammatory response through your gut. So if you notice that you're sensitive to dairy, cut dairy out. Farm to plate. Your blend, I love your women's blend. The Gaia. Tahnee: (49:36) Yeah. Yes. Dr. Amanda: (49:38) She is beautiful because she's got the [foreign language 00:49:39] and the [foreign language 00:49:41] helps to warm. It also nourishes blood. So after you've had your bleed take your Mother Gaia, because that helps, then you've got your goji berries, so the goji berries are really good because we know that they go to the liver meridian. They also help to support the spleen function as well, and they're red in colour. And they're delicious. Tahnee: (50:03) Something that's tasty [crosstalk 00:50:06] thank you so much for your time, Amanda. I will create a list of show notes for everybody to access your site, your book, all of your resources, your training, opportunities to work with you, and yeah, I really appreciate everything you've shared. It's been really enlightening and nourishing conversation. So thank you. Dr. Amanda: (50:24) Thanks, beautiful. Thank you so much.
Endometrium lining of uterus symptoms and treatment for pregnancy thin endometriosis can cause issues with pregnancy. #Endometrium #Endometriosis Subscribe Our Channel https://www.youtube.com/channel/UC26D... Like Us On Facebook- https://www.facebook.com/DrPahlajaniIVF/ Follow us on Instagram - https://www.instagram.com/pahlajani_ivf/ Follow Us On Twitter- https://twitter.com/RaipurIVF?s=09 Website - https://www.raipurivf.com/ #pehlepahlajni #drpahljaniwomenshospital #PlanWithPahlajani #DrSameerPahlajani #ivfprocedure #DrNeerajPahlajani #ivfraipur #gynecologistandobstetrician #IVFCenter #pahlajaniivf
In this rebroadcasted episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez, is joined by Dr. Dimitrios Nasioudis a to discuss adjuvant treatment in UPSC limited to endometrium and his article, "Adjuvant treatment for patients with FIGO stage I uterine serous carcinoma confined to the endometrium," (ijgc.bmj.com/content/early/2020…4/ijgc-2020-001379) the Lead Article in the August 2020 issue of IJGC. Dr. Nasioudis is a resident at the Hospital of the University of Pennsylvania, Philadelphia. His current interests include population science and outcomes research with an emphasis on rare gynecologic tumors.
This week we are discussing endometriosis. Endometriosis is an often painful disorder in which tissue similar to the tissue that normally lines the inside of your uterus — the endometrium — grows outside your uterus. Endometriosis most commonly involves your ovaries, fallopian tubes and the tissue lining your pelvis. Rarely, endometrial tissue may spread beyond pelvic organs. Returning to our show to discuss endo is our guest Asiya Rafiq. She joined us last week to talk about adaptive clothing.
In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez, is joined by Dr. Dimitrios Nasioudis a to discuss adjuvant treatment in UPSC limited to endometrium and his article, "Adjuvant treatment for patients with FIGO stage I uterine serous carcinoma confined to the endometrium," (https://ijgc.bmj.com/content/early/2020/07/14/ijgc-2020-001379) which is the Lead Article in the August 2020 issue of IJGC. Dr. Nasioudis is a resident at the Hospital of the University of Pennsylvania, Philadelphia. His current interests include population science and outcomes research with an emphasis on rare gynecologic tumors.
Session about carcinoma of endometrium , important topic for medical students , aspirants , residents. By: Dr Syed Yasar , MD Oncology . For more visit- https://www.aim4pg.com/learn-pad To Join Medical Group- https://www.aim4pg.com/study-group ....................... WWW.AIM4PG.COM --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app --- Send in a voice message: https://anchor.fm/aim4pg/message
Endometriosis affects 1 in 10 women (it’s almost as common as breast cancer and 8 times more common than ovarian cancer), yet the general public still has very little awareness of the disease. In this episode, Elyse chats with Britt Thelemann Pangerl of the Minnesota Endo Warriors and the new podcast "The Endo Cast" about what endometriosis is, how to get a diagnosis, what treatment options are available and her favorite resources to check out.The Endo Cast: https://www.matriarchdm.com/endocastMinnesota Endo Warriors: https://www.mnendowarriors.org/Nancy's Endometriosis Nook: https://www.facebook.com/groups/NancysNookEndoEd/
Deep Pit Steep Cliff: Endometrium Cuntplow & Dendera Bloodbath! These are performances by Endometrium Cuntplow, Dendera Bloodbath & Deep Pit Steep Cliff, recorded in The Lava Lamp Lounge on 26 October 2019. We are also a part of the They Might Be Giants Dial-a-Song Network! This week’s TMBG DAS is, “I Left My Body.” https://ia601504.us.archive.org/2/items/wtbcdeeppitsteepcliff/WTBCDeepPitSteepCliff.mp3 […]
The Endometrium And It's Role In Producing A Successful IVF Pregnancy The endometrium needs to improve your chances of success with IVF. Multiple studies show that endometrial thickness has to be within a specific range to give you the maximum chances of success. Tune in to this podcast episode, to learn what that specific range is, and lots more! If you find this episode useful and know someone else who would benefit, please do share it with them. Your referral is the ultimate compliment!
080: Yoga and Endometriosis [Part 2] with Dustienne Miller In part 2 of our 2-part series on endometriosis, Shannon asked yoga teacher and physical therapist Dustienne Miller to share her knowledge and experience working with clients with this chronic illness. Dustienne feels strongly endometriosis is underdiagnosed and that there is much more to be understood in this area of women's health. It is now recognized that 1 in 10 women struggle with this chronic illness. Dustienne also wants all women to trust their intuition when determining the severity of their pain and to know that period pain should never be debilitating. Dustienne began studying to become a physiotherapist in 1994 and began practicing yoga while doing musical theater in New York City as a way to warm up. She continued practicing yoga at home and decided to pursue yoga teacher training at Kripalu. Dustienne came to realize as a yoga teacher and a physiotherapist specializing in pelvic health, that these disciplines complemented each other beautifully. She began to integrate yoga into physical therapy home programs and saw the difference yoga made to her clients suffering from endometriosis. Dustienne details for us how pranayama and asana can ease the symptoms of endometriosis. She describes the connection between pranayama and the pelvic floor and her way of leading clients through asana in a progressive fashion to minimize overextending themselves. 6:20 Dustienne's yoga and physical therapy journey 8:50 Dustienne describes endometriosis 10:40 Symptoms of endometriosis 12:20 What Dustienne has heard from her clients suffering from endometriosis 13:20 Are the endo flare-ups in sync with the menstrual cycle? 15:40 Pain management- the importance of teaching strategies in order to allow sufferers to have ownership over managing the flares How yoga can benefit those with endometriosis: 16:25 Pranayama- a daily practice can help with the prominence of the parasympathetic nervous system to be more dominant which can lessen the pain 17:30 Relationship between pranayama and the pelvic floor and the importance of lengthening the spine to optimize the pranayama-pelvic floor connection 20:55 Asana- a gentle yoga program can mobilize the tissues and the muscles that are attaching to both the pelvis and the thorax 22:15 Yoga poses to approach with caution extensions and cause rebound pain 24:40 Is there a pain level where one should avoid asana and Dustienne's hope that students will feel that for themselves 27:40 The benefit of child's pose, goddess pose, banana pose, standing half-moon, supine twist (to help with rotation through the spine) and their variations 32:55 Dustienne's love for restorative yoga, that it is “real” yoga 33:55 Additional advice from Dustienne and on reconditioning the body to have a different response to pain to help lessen it (softening the belly, table pose letting belly hang) 36:05 Other treatments Dustienne recommends for endometriosis 38:20 How endometriosis can be diagnosed and how treatment options are evolving as research into this illness expands 40:25 Misconceptions around endometriosis, how raising awareness is helping e.g. through social media campaign #1in10 42:10 Importance of listening to intuition- don't push yourself 42:55 Shannon's closing thoughts and wrap-up and on “curating your team” Links Dustienne's summary page of resources Dustienne's website: Your Pace Yoga Related TCYT Episodes: 079: Yoga and Endometriosis [Part 1] with Kimberly Castello 007: Breath and Pelvic Health with Trista Zinn 008: Core Breath and Pelvic Health with Kim Vopni 009: Kegels, Mula Bandha, and Pelvic Health with Shelly Prosko 033: A New Perspective on Diastasis Recti with Sinead Dufour 073: The 8 Limbs of Yoga [Part 1] with Shannon Crow 074: The 8 Limbs of Yoga [Part 2] with Jennie Lee Yoga for Pelvic Health Teacher Training September 22nd and 23rd, 2018 Gratitude to our Sponsor Schedulicity
Prolapse is not included in the glossy brochure of pregnancy but one in five mothers will need surgery to treat pelvic organ prolapse. Prolapse is a difficult topic because it involves talking about vaginas, bowels and bladders and painful damaging births. This week we're talking frankly about an incredibly uncomfortable topic and one that has been ignored for too long.
Tune in to today's episode as we discuss the effects of having a thin endometrium in your IVF Journey.
OM&K Is mobile this week, reporting from the road (just different roads). Some of us have been watching Corrie diligently, some hardly at all, and, remarkably, the outcomes are nearly indistinguishable. This week found Norris and Mary a long time ago in a galaxy far, far away, Toyah Battersby battered by baby imagery, and everyone's favorite new Dads in a little over their heads. Pour a bitter lemon (if you can?) and enjoy our most faff-free episode yet!
Endometriosis is considered as a benign aseptic inflammatory disease, characterised by the presence of ectopic endometrium-like tissue. Its symptoms (mostly pain and infertility) are reported as constant stressors. Corticotropin releasing hormone (CRH) and urocortin (UCN) are neuropeptides, strongly related to stress and inflammation. The effects of CRH and UCN are mediated through CRHR1 and CRHR2 receptors which are implicated in several reproductive functions acting as inflammatory components. However, the involvement of these molecules to endometriosis remains unknown. The aim of this study was to examine the expression of CRHR1 and CRHR2 in endometriotic sites and to compare the expression of CRHR1 and CRHR2 in eutopic endometrium of endometriotic women to that of healthy women. We further compared the expression of CRH, UCN, CRHR1 and CRHR2 in ectopic endometrium to that in eutopic endometrium of women with endometriosis. Endometrial biopsy specimens were taken from healthy women (10 patients) and endometrial and endometriotic biopsy specimens were taken from women with endometriosis (16 patients). Τhe expression of CRH, UCN, CRHR1, and CRHR2 was tested via RT-PCR, immunohistochemistry and Western blotting. This study shows for the first time that CRH and UCN receptor subtypes CRHR1β and CRHR2α are expressed in endometriotic sites and that they are more strongly expressed (p
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Tierärztliche Fakultät - Digitale Hochschulschriften der LMU - Teil 05/07
Sat, 12 Feb 2011 12:00:00 +0100 https://edoc.ub.uni-muenchen.de/12926/ https://edoc.ub.uni-muenchen.de/12926/1/Mayer_Verena.pdf Mayer, Verena ddc:590, ddc:500, Tie
Tierärztliche Fakultät - Digitale Hochschulschriften der LMU - Teil 05/07
Sat, 12 Feb 2011 12:00:00 +0100 https://edoc.ub.uni-muenchen.de/13214/ https://edoc.ub.uni-muenchen.de/13214/1/Merkl_Maximiliane.pdf Merkl, Maximiliane ddc:590, ddc:500, Tierärztliche Fa
Medizinische Fakultät - Digitale Hochschulschriften der LMU - Teil 11/19
Thu, 28 Jan 2010 12:00:00 +0100 https://edoc.ub.uni-muenchen.de/11407/ https://edoc.ub.uni-muenchen.de/11407/1/Stieger_Sabine_H.pdf Stieger, Sabine Hariett
Background: During surgery for endometrial cancer, a pelvic lymphadenectomy with or without para-aortic lymphadenectomy is performed at least in patients with risk factors (stage I, grading 2 and/or histological subtypes with higher risk of lymphatic spread), and is hence recommended by the International Federation of Obstetrics and Gynecology (FIGO). Although lymph node metastases are important prognostic parameters, it has been contentious whether a pelvic lymph node dissection itself has a prognostic impact in the treatment of endometrial cancer, especially in endometrioid adenocarcinoma. Therefore, this study evaluated whether lymphadenectomy has a prognostic impact in patients with endometrioid adenocarcinoma. Methods: The benefits of lymphadenectomy were examined in 214 patients with a histological diagnosis of endometrial adenocarcinoma. Tumour characteristics were analysed with respect to the surgical and pathological stage. Results: Of the 214 patients with endometrial adenocarcinoma, 171 (79.9%) were classified as FIGO stage I, 15 (7.0%) FIGO stage II, 21 (9.8%) FIGO stage III and 7 (3.3%) FIGO stage IV. One hundred and thirty four (62.6%) of the patients had a histological grade 1 tumour, while 56 (26.2%) and 24 (11.2%) had a histological grade 2 or grade 3 tumour, respectively. Lymphadenectomy was performed in 151 (70.6%) patients. Only 11 (5.1%) patients showed metastatic disease in the lymph nodes. The performance of a lymphadenectomy resulted in significantly increased cause-specific and overall survival, while progression-free survival was not affected by this operative procedure. Conclusions: The performance of an operative lymphadenectomy resulted in better survival of patients with endometrioid adenocarcinoma. This increase was significant for cause-specific and overall survival, while there was a tendency only towards increased progression-free survival. Therefore, even in endometrioid adenocarcinoma, a pelvic and/or para-aortic lymphadenectomy should be performed.
Tierärztliche Fakultät - Digitale Hochschulschriften der LMU - Teil 04/07
Fertility problems are the main reason for slaughter of high-performance milk cows, because prolonged calving intervals result in financial losses for the farmer and retard genetic progress. Genetic improvement of fertility would be of great benefit, but functional traits for effective selection are missing. Recent advances in functional genomics tools like DNA microarrays could be the key to identify gene expression patterns in the endometrium that correlate with maternal fertility. Therefore, a bovine oviduct and endometrium cDNA array was established that contains a set of 1,440 cDNA clones and long oligonucleotides representing 950 different genes. The major part of these genes results from a series of differential gene expression studies in endometrium (different stages of the oestrous cycle, day 18 and day 15 pregnant vs. nonpregnant) and oviduct epithelial cells (different stages of the oestrous cycle). Using this custom-made cDNA array the response of the endometrium was studied to the changing hormonal environment during the bovine oestrous cycle. Endometrium samples were recovered from Simmental heifers slaughtered on day 0 (oestrus), 3.5 (metoestrus), 12 (dioestrus) and 18. The latter group was divided into animals with high (late dioestrus) and low progesterone levels (preoestrus). Statistical analysis with the Significance Analysis of Microarrays (SAM) method revealed 269 genes exhibiting significant changes in their transcript levels during the oestrous cycle in distinct temporal patterns. Two major types of expression profiles were observed, which showed the highest mRNA levels during the oestrus phase or the highest levels during the luteal phase, respectively. A minor group of genes exhibited the highest mRNA levels on day 3.5. Gene ontology (GO) analyses revealed GO categories related to extracellular matrix remodelling, transport, and cell growth and morphogenesis enriched at oestrus, whereas immune response and particular metabolic pathways were overrepresented at dioestrus. Generation of gene interaction networks uncovered genes possibly involved in biological processes important for establishment of early pregnancy, such as endometrial remodelling (e.g. collagen genes, MMP2, TIMP1), regulation of angiogenesis (e.g. ANGPTL2, TEK), regulation of invasive growth (e.g. PCSK5, tight junction proteins, ITGB4), cell adhesion (e.g. MUC16, LGALS3BP) and embryo feeding (e.g. SLC1A1, ENPP1). Localisation of mRNA expression in the endometrium was analysed for CLDN4, CLDN10, TJP1, PCSK5, MAGED1, and LGALS1. Future application of the BOE array, based on the knowledge from the cycle study, could be the use in systematic studies of interactions between the metabolic status and functionality of the endometrium to identify genes that could be used for differential diagnosis of fertility problems.
Medizinische Fakultät - Digitale Hochschulschriften der LMU - Teil 08/19
In dieser Arbeit wurden 838 Hysteroskopieberichte der Universitäts-Frauenklinik der Ludwig-Maximilians-Universität München aus den Jahren 1995 bis 1998 ausgewertet. Das Durchschnittsalter der Patientinnen lag bei 53 bis 55 Jahren. Die hysteroskopischen Befunde wurden mit den histologischen Ergebnissen der Abrasio fracta verglichen. Häufigste Indikation zur Untersuchung war die postmenopausale Blutung (34% der Fälle), gefolgt von prä/perimenopausaler Bltung (26%), einem sonographisch suspekten Endometrium und anderen Indikationen. Hysteroskopisch fand sich in 40% (336 Fälle) ein unauffälliges Endometrium. Bei diesem Befund fanden sich in 2% (6 Fälle) histologisch Karzinome. Korpuspolypen und polypöse Schleimhautveränderungen wurden hysteroskopisch in 21% (174 Fälle) diagnostiziert, davon waren histologisch 7% (12 Fälle) maligne. Bei anderen makroskopisch als gutartig klassifizierten Befunden (126 Fälle) fand sich in 3% (4 Fälle) ein bösartiger Tumor. Das wichtigste hysteroskopische Ergebnis war ein „suspektes Endometrium bzw.unklare Veränderungen“ (7%, 55 Fälle). Hier fanden sich histologisch 14 Endometrium-Karzinome und 6 Karzinome anderer Art (36% maligne Befunde). Bei Patientinnen mit postmenopausaler Blutung konnte man in 9% (25/285) ein Endometrium-Karzinom und in 1% (4/285) ein anderes Karzinom nachweisen, Die Häufigkeit nachgewiesener Tumoren bei prä/perimenopaualer Blutung war mit 1% (2/220) deutlich niedriger. 55 Fälle des Krankengutes hatten wegen eines Mamma-Karzinoms Tamoxifen bekommen. Bei diesen Patientinnen wurde die Hysteroskopie besonders häufig wegen eines sonographisch verdickten Endometriums durchgeführt. In jedoch nur 1% (1/55) wurde bei zusätzlich postmenopausaler Blutung ein Endometrium-Karzinom verifiziert.
Medizinische Fakultät - Digitale Hochschulschriften der LMU - Teil 08/19
ZUSAMMENFASSUNG Das Endometriumkarzinom ist eines der häufigsten gynäkologischen Malignome und macht circa 6% aller bösartigen Neubildungen bei Frauen aus. Das humane Endometrium exprimiert Estrogen- (ER) und Progesteronrezeptoren (PR), welche in Zusammenhang mit endokrinen, autokrinen und parakrinen Prozessen stehen und auf die Hormone Estrogen und Progesteron antworten. Die Korrelation zwischen der Expression klassischer Steroidrezeptoren, Estrogenrezeptor alpha (ER-alpha) und Progesteronrezeptor A (PR-A) und dem Stadium, dem histologischen Grad und dem gesamten Überleben wurde in mehreren Studien nachgewiesen. Das Ziel dieser Arbeit war es, die Verteilung der Steroidrezeptoren Estrogenrezeptor alpha (ER-α), Estrogenrezeptor beta (ER-β), Progesteronrezeptor A (PR-A) und Progesteronrezeptor B (PR-B) in bösartigen humanen Endometriumzellen zu bestimmen, sowie dies in Assoziation mit verschiedenen klinisch-pathologischen Merkmalen des Endometriumkarzinoms und mit klinischem Outcome zu bewerten. Es wurde eine Serie von 293 Endometriumkarzinomen mit immunohistochemischen Methoden und mit monoklonalen Antikörpern gegen vier Steroidrezeptoren analysiert. Der Verlust der Rezeptorpositivität für ER-α, PR-A und PR-B hatte eine geringere Überlebenschance für Patientinnen mit Endometriumkarzinom zur Folge, während die ER-β Expression keinen Zusammenhang mit verschiedenen klinisch-pathologischen Merkmalen zeigte und auf das Überleben keinen Einfluss hatte. Zusätzlich zeigte die multivariate Überlebensanalyse, dass PR-B ein signifikant unabhängiger prognostischer Faktor für das ursachespezifische Überleben ist. Obwohl ER-α und PR-A einen signifikanten Zusammenhang zwischen verschiedenen histologischen Subtypen und den histologischen Graden zeigten, haben beide Rezeptoren unabhängig voneinander keinen Einfluss auf das Überleben bei Patientinnen mit Endometriumkarzinom. Deswegen könnte eine immunohistologische Bestimmung von PR-B als ein leichter, einfacher und hocheffizienter Marker für die Identifikation von High-risk-Patientinnen sein. Diese Bestimmung könnte auch bei der Auswahl der Patientinnen helfen, die eine wirksamere adjuvante Therapie brauchen. Schlüsselwörter: Endometrium; Karzinom; Imunohistochemie; Estrogenrezeptor alpha (ER-α); Estrogenrezeptor beta (ER-β); Progesteronrezeptor A (PR-A); Progesteronrezeptor B (PR-B); Gesamtüberleben. SUMMARY Cancer of the endometrium is the most common gynecological malignancy and accounts for 6% of all cancers in women. Human endometrium expresses estrogen- (ER) and progesterone receptors (PR), which are related to endocrine, autocrine and paracrine processes that respond to hormones estrogen and progesterone. The expression of the classic steroid receptors estrogen receptor alpha (ER-α) and progesterone receptor A (PR-A) have been correlated with stage, histological grade and survival in several studies. Therefore, aims of this study were, to determine the distribution of steroid receptor estrogen receptor alpha (ER-α), estrogen receptor beta (ER-β), progesterone receptor A (PR-A) and progesterone receptor B (PR-B) in malignant human endometrial tissue and the assessment of an association with various clinicopathological tumor features and clinical outcome. A series of 293 endometrial cancer samples were immunohistochemically analyzed with monoclonal antibodies against the four steroid receptors. The loss of receptor positivity for ER-α, PR-A and PR-B resulted in a poorer survival in endometrial cancer patients, while ER-α expression did not demonstrate any correlations with several analyzed clinicopathological characteristics and did not affect survival. Additionally, multivariate survival analysis demonstrated that PR-B was a significant independent prognostic factor for cause-specific survival. In contrast, although ER-α and PR-A showed a significant association between the different endometrial histological subtypes and histological grading, both receptors were not independent factors with survival in endometrial patients. Therefore, the PR-B immunostaining might be used as an easy, simple and highly efficient marker to identify high-risk patients and may aid in the selection of patients for a more aggressive adjuvant therapy. Keywords: endometrium; cancer; immunohistochemistry; estrogen receptor alpha (ER-α); estrogen receptor beta (ER-β); progesterone receptor A (PR-A); progesterone receptor B (PR-B); survival.
Medizinische Fakultät - Digitale Hochschulschriften der LMU - Teil 06/19
Die Regulation der endometrialen Zytokinexpression steht im Zentrum der aktellen Forschungen zum Phänomen rezidivierender Frühaborte. Ziel der Arbeit war es die Auswirkungen der endometrialen Regulationsmechanismen Hormonstimulation, Hormonentzug, Zytokinstimulation und Hypoxie auf die mRNA Expression dreier verschiedender, für die Implantation der Blastozyste bedeutsamer Zytokine, am Kulturmodell endometrialer Zellen zu untersuchen, wobei eine getrennte Kultivierung von epithelialen und stromalen Zellen erfolgte. VEGF hat eine wichtige Funktion bei der Regulation der Angiogenese und wird im humanen Endometrium v.a. von Epithelzellen exprimiert. IL-1ß beeinflußt maßgeblich die Rezeptivität des Endometriums und spielt eine wichtige Rolle beim embryo-maternalen Dialog. G-CSF ist wichtig für die utero-plazentare Kommunikation und die Dezidualisierung der Stromazellen. Die ungestörte endometriale Differenzierung ist Basis einer normalen Rezeptivität. Diese wird durch Steroidhormone gesteuert, weshalb wir in dieser Arbeit die Auswirkungen der Steroidhormone 17-ß-Östradiol und Progesteron auf die Expression der genannten Zytokine untersuchten. Entgegen der Ergebnisse vorausgehender Studien konnte hierbei kein Effekt der Steroide auf die Zytokinexpression festgestellt werden. Des Weiteren stellte sich uns die Frage einer unmittelbaren Beeinflussung durch andere autokrine oder parakrine Faktoren wie z.B. Zytokine. Die Stimulation der Zellen mit IL-1ß und IL-6 führte bei den Stromazellen zu einem signifikanten Anstieg der mRNA-Expression von IL-1ß und G-CSF. Schließlich untersuchten wir den Einfluß von Hypoxie, welche bereits in vielen vorausgehenden Studien als entscheidender Regulationsfaktor für eine gesteigerte endometriale VEGF Expression beschrieben wurde. Dies konnte durch unsere Untersuchungen bestätigt werden, was gleichzeitig als Beweis der Funktionsfähigkeit unserer Kulturmodelle bei hypoxischen Bedingungen diente. Darüberhinaus konnte durch Hypoxie auch für die Zytokine Il-1ß und G-CSF ein signifikanter Expressionsanstieg verzeichnet werden.
Tierärztliche Fakultät - Digitale Hochschulschriften der LMU - Teil 02/07
An intact embryo-maternal communication in the pre-implantation period is particularly critical for establishment of pregnancy and early embryonic losses have been identified as the major cause of reproductive failure in cattle. Thus, to gain deeper insight into this complex embryo-maternal crosstalk, a combination of subtracted cDNA libraries and cDNA array hybridization was applied to identify mRNAs differentially regulated genes in the bovine endometrium by the presence of a conceptus. One cDNA library was constructed according the suppression subtractive hybridization method (Diatchenko et al., 1996) with minor modifications; a second cDNA library was constructed of subtracted cDNA purchased from the vertis Biotechnologie AG. As biological model endometrial tissue samples of monozygotic twins (generated by embryo splitting) collected at day 18 of gestation were used, which is a unique possibility to eliminate genetic variability as a factor potentially affecting the results of gene expression analyses. Array hybridization was carried out using 33P-labeled cDNA probes obtained from five monozygotic twin pairs. Sequence analysis revealed 87 different genes or mRNAs, respectively, which displayed a difference in signal intensity of 2.0 fold or more in at least four out of five twin pairs. Eighty genes corresponded to genes with known or inferred function, either the bovine gene or the human orthologue. For 7 mRNAs a match with bovine ESTs was obtained only. For nine selected genes the expression in the bovine endometrium was quantified by the use of quantitative real-time RT-PCR to verify the results obtained by array hybridization and to perform more precise quantitative measurements for these genes. Overall, the results of array hybridization and real-time RT-PCR correlated very well. Almost half of the identified genes are known to be stimulated by type I interferons reflecting the response to IFNt, which is the pregnancy recognition signal in ruminants. Of particular interest among the interferon stimulated genes is ISG15, one of the most markedly upregulated genes in the present study, which is hypothesized to stabilize intracellular endometrial proteins through conjugation processes. For the ISG15ylation system mRNAs of four potential components (IFITM1, IFITM3, HSXIAPAF1, and DTX3L) were found in addition to ISG15 and UBE1L, and in situ hybridization revealed similar mRNA expression patterns of these genes. It is therefore suggested, that modification of endometrial proteins through ISG15ylation plays a fundamental role in the IFNt signaling. A classification of the identified genes according to their assignment to Gene Ontologies revealed the orchestrated interaction of various processes and mechanisms with regard to the preparation of the maternal endometrium for embryonic implantation. As particular interesting, genes were identified involved in modulation of the maternal immune system at the humoral and cellular level, cell adhesion, cell communication, regulation of transcription, cell differentiation, cell growth, and cell proliferation. These findings underline that an intense embryo-maternal dialogue takes place during the pre-implantation period, which culminates in a receptive endometrium prepared for implantation of the conceptus. To conclude, this is the first study of its kind for cattle in the pre-implantation stage of embryonic development and revealed the orchestrated upregulation of genes important for embryonic implantation during the pre-implantation period in the bovine endometrium. The presented results provide new starting points for detailed investigations of the embryo-maternal dialogue by which the endometrium is prepared for conceptus attachment.
Tierärztliche Fakultät - Digitale Hochschulschriften der LMU - Teil 02/07
Ziel der vorliegenden Arbeit war es, durch Vergleich unterschiedlicher Auswertungsmethoden ein Verfahren mit möglichst geringer Varianz in den Ergebnissen der Echotexturanalyse am Endometrium der Stute zu finden und so zur Etablierung eines Untersuchungsstandards beizutragen. Darüber hinaus wurden die Auswirkungen des Zyklus auf die Ergebnisse der Texturanalyse bei gesunden Stuten untersucht, um so die Basis für entsprechende Studien über den Einfluss von patho-logischen Veränderungen des Endometriums zu schaffen. Zweiter Teil dieser Arbeit war die Erstellung eines Computerlernprogramms über die Anwendung der Ultra-schallmethode im Rahmen der gynäkologischen Untersuchung bei der Stute. Dazu wurden sechs Traberstuten jeweils während eines Zyklus an den Tagen -2, 0 (Tag der Ovulation), 5, 10 und 15 sonographisch mit dem Doppler-Ultraschall-gerät SSH 140 A (Toshiba, Tokio/Japan), das mit einer 7,0 MHz Mikrokonvexsonde ausgestattet war, untersucht. Die Bilder wurden direkt digital mit einem Still-Recorder DKR 700 (Sony, Tokio/Japan) gespeichert. Die Auswertung erfolgte mit dem Echo-strukturanalyseprogramm MaZda (Technische Universität Lodz, Polen). Neben den biologischen Variablen individuelle Stute, Zyklusstadium und Seitenvergleich zwischen rechtem und linken Uterushorn wurden die methodischen Variablen Größe und Platzierung der region of interest (ROI), sowie 4 verschiedene Texturparameter (mittlerer Grauwert, Homogenität, Kontrast und Korrelation) hinsichtlich ihrer Auswirkungen auf die Ergebnisse der Echostrukturanalyse überprüft. Die ROI-Größe (256, 1024 und 2500 Pixel) wirkte sich nicht erheblich auf die Genauigkeit der Untersuchung aus. Dagegen waren in Abhängigkeit von der Platzierung der ROIs signifikante Unterschiede festzustellen. Der oberste Quadrant des Uterusquerschnitts wies den höchsten Variationskoeffizienten auf (je nach Texturparameter 43,8 % bis 49,8 %), im linken und rechten Quadranten war die Variation geringer (25,5 % bis 31,7 %). Deutlich geringere Schwankungen von 11,7 % für den mittleren Grauwert, mit 14,7 % für die „Homogenität“, für „Kontrast“ mit 15,4 % und für „Korrelation“ mit 9,4 %, ergaben sich, wenn an Stelle der flächenmäßig begrenzten ROIs die Gesamtfläche des Uterusquerschnitts verwendet wurde. Der Vergleich der oben genannten Variationskoeffizienten (9,4% bis 15,4%) lässt den Schluss zu, dass der verwendete Texturparameter keinen deutlichen Einfluss auf die Genauigkeit der Ergebnisse hatte. Deutliche Abweichungen zwischen den Untersuchungen des linken und rechten Uterushorns, die auf pathologische Veränderungen des Endometriums hätten schließen lassen, wurden bei keiner Stute gefunden. Es bestanden beträchtliche Unterschiede zwischen den Ergebnissen der sechs Stuten. Die Variationskoeffizienten schwankten, je nach verwendetem Texturparameter, zwischen 7,5 % für den Texturparameter „Korrelation“ (Min.) und 19,8% für „Homogenität“ (Max.). Der Einfluss des Zyklusstadiums auf die Ergebnisse der Echotexturanalyse wurde an Hand der Gesamtflächenauswertung beurteilt. Es konnte keine Zyklusab-hängigkeit der Präzision der Ergebnisse gefunden werden. Die Variationskoeffizien-ten bewegten sich zwischen 8,0 % bei dem Texturparameter „Korrelation“ am Tag 5 und 17,7 % für „Kontrast“ am Tag -2. Nur bei dem Texturparameter „mittlerer Grauwert“ konnte ein deutlicher Zyklusverlauf festgestellt werden. Gegen Ende des Diöstrus (zwischen Tag 10 und Tag 15) kam es bei 5 von 6 Stuten zu einem signifikanten Anstieg der Werte, kurz vor der Ovulation (zwischen Tag -2 und 0) fielen die Werte wiederum bei 5 von 6 Stuten signifikant ab. Die „Korrelation“ erlaubte eine Unterscheidung von Tag -2 und Tag 5 (Abfall) bei 5 Stuten. Die übrigen Parameter wiesen keinen eindeutig erkennbaren Zyklusverlauf auf. Die vorliegenden Untersuchungen lassen den Schluss zu, dass die Methode der Gesamtflächenauswertung als Standard für die Echotexturanalyse des Endo-metriums der Stute geeignet ist. Dagegen bedürfen Aussagen über den Zyklusstand anhand von Echotexturanalyse zusätzlicher Überprüfungen mit anderen Textur-parametern oder Texturparameterkombinationen. Eine weitere interessante Aufgabe wäre es, die Auswirkungen pathologischer Veränderungen des Endometriums auf die Ergebnisse der Echotexturanalyse zu untersuchen.
The human endometrium prepares for implantation of the blastocyst by reorganization of its whole cellular network. Endometrial stroma cells change their phenotype starting around the 23rd day of the menstrual cycle. These predecidual stroma cells first appear next to spiral arteries, and after implantation these cells further differentiate into decidual stroma cells. The phenotypical changes in these cells during decidualization are characterized by distinct changes in the actin filaments and filament-related proteins such as α-actinin. The carboxyterminal LIM domain protein with a molecular weight of 36 kDa (CLP36) is a cytoskeletal component that has been shown to associate with contractile actin filaments and to bind to α-actinin supporting a role for CLP36 in cytoskeletal reorganization and signal transduction by binding to signaling proteins. The expression patterns of CLP36, α-actinin and actin were studied in endometrial stroma cells from different stages of the menstrual cycle and in decidual stroma cells from the 6th week of gestation until the end of pregnancy. During the menstrual cycle, CLP36 is only expressed in the luminal and glandular epithelium but not in endometrial stroma cells. During decidualization and throughout pregnancy, a parallel upregulation of CLP36 and smooth muscle actin, an early marker of decidualization in the baboon, was observed in endometrial decidual cells. Since both proteins maintain a high expression level throughout pregnancy, a role of both proteins is suggested in the stabilization of the cytoskeleton of these cells that come into close contact with invading trophoblast cells. Copyright (C) 2005 S. Karger AG, Basel.
Medizinische Fakultät - Digitale Hochschulschriften der LMU - Teil 02/19
Mon, 15 Dec 2003 12:00:00 +0100 https://edoc.ub.uni-muenchen.de/1731/ https://edoc.ub.uni-muenchen.de/1731/1/Gutsche_Stefanie.pdf Gutsche, Stefanie ddc:610, ddc:600, Medizinische Fa
Medizinische Fakultät - Digitale Hochschulschriften der LMU - Teil 02/19
Das Endometrium stellt ein komplexes Gewebe dar, das sehr genauen Kontrollmechanismen unterliegt. Die zyklischen Veränderungen und damit auch die Vorbereitung auf die Implantation einer Blastozyste werden durch verschiedene Faktoren reguliert. Hierzu gehören endokrine Mechanismen, vermittelt durch die Steroidhormone Östradiol und Progesteron, die Abstimmung des Immunsystems und die Anpassung der Gefäßversorgung. So spielen sowohl eine Vielzahl an Zytokinen als auch Wachstumsfaktoren, wie zum Beispiel VEGF, eine entscheidende Rolle. Das Ziel unserer Untersuchung war eine genauere Betrachtung der Regulationsmechanismen im endometrialen Zellverband anhand von Zellkulturen, durch Immunhistochemie sowie durch Analyse des Uterussekretes. IL-6, ein gut bekanntes Phospho-Glykoprotein, wird im endometrialen Gewebe sowohl von Epithel- als auch von Stromzellen produziert. IL-6 erfüllt im menschlichen Organismus vielfältige Funktionen. Eine entscheidende Rolle scheint ihm bei Entstehung und Erhalt einer frühen Schwangerschaft zuzukommen. IL-6 zeigt ein typisches Verteilungsmuster im Menstruationszyklus mit niedrigen Spiegeln in der Proliferationsphase und einem deutlichen Anstieg in der Sekretionsphase. Bei den zyklischen Veränderungen des Endometriums ist die Revaskularisierung des Gewebes und deren Regulation durch VEGF ein entscheidender Prozess. VEGF existiert in fünf Isoformen, die durch alternatives Spleißen der mRNA entstehen. Es kann sowohl in Stroma- wie auch in Epithelzellen nachgewiesen werden. Im Vergleich zur Proliferationsphase tritt VEGF ebenso wie IL-6 verstärkt in der Sekretionsphase auf. Dieses Verhalten konnte von uns mit Hilfe der Immunhistochemie bestätigt werden. Im Uterussekret steigt die VEGF-Konzentration im Verlauf des Zyklus an. Diese Tatsachen legen eine Regulation von IL-6 und VEGF durch die Steroidhormone 17ß-Östradiol und Progesteron nahe. Das Verhalten von Interleukin-6 in Bezug auf die Stimulation durch die Steroidhormone 17ß-Östradiol und Progesteron wird in der Literatur widersprüchlich dargestellt. So wird zum einen die Erhöhung der IL-6-Konzentration in endometrialen Stroma- und Epithelzellen beschrieben, zum anderen deren Abfall. In den von uns angelegten Versuchen konnte keine statistisch signifikante Änderung von IL-6 durch Östradiol oder Progesteron festgestellt werden. Einige vorhergehende Studien legten die Regulation von VEGF durch Östradiol und Progesteron nahe. Jedoch scheint es keinen direkten Weg der Regulation durch diese Faktoren zu geben. Östrogen verstärkte den mitogenen Effekt von parallel applizierten Wachstumsfaktoren, Progesteron inhibierte diesen. In endometrialen Stroma- und Epithelzellkulturen wurde die Stimulation von VEGF durch Östrogen von anderen Autoren nachgewiesen. Diese Stimulation konnte von uns nicht bestätigt werden. Es stellt sich die Frage, ob eine indirekte Beeinflussung von VEGF durch andere auto- beziehungsweise parakrine Mechanismen vorliegt. Unser Ziel war es nun, die Regulation von IL-6 und VEGF durch andere Faktoren, wie beispielsweise Zytokine, zu untersuchen. IL-1ß erweist sich in diesem Zusammenhang als relevant. Es zeigt ein zyklisches Verhalten im Endometrium mit hohen Spiegeln in der Sekretionsphase zur Zeit der Implantation. Gleichzeitig steigt auch seine Serumkonzentration an. IL-1ß stimuliert IL-6 in endometrialen Stromazellkulturen, nicht jedoch in Epithelzellen. Eine Stimulation von VEGF durch IL-1ß konnte von uns nicht festgestellt werden. Ein weiterer bedeutender Faktor, der von uns genauer untersucht werden sollte, war LIF. LIF erfüllt breite biologische Funktionen, was die Vielzahl an Zielzellen im menschlichen Organismus verdeutlicht. Auch im Endometrium spielt LIF vor allem bei der Implantation eine entscheidende Rolle. Die von uns untersuchte Regulation von VEGF und IL-6 durch LIF erbrachte kein signifikant positives Ergebnis. So konnte eine Stimulation durch LIF weder in Stroma- noch in Epithelzellkulturen nachgewiesen werden. Des weiteren analysierten wir die Regulation von VEGF durch IL-6. Auch hier zeigte sich weder in den Stroma- noch in den Epithelzellkulturen eine statistisch erfassbare Veränderung. Unter verringerter Sauerstoffversorgung finden im Zellverband bestimmte Veränderungen statt, die eine optimale Anpassung an die veränderten Umweltbedingungen ermöglichen. Die Hypoxie erweist sich als relevanter Faktor für eine gesteigerte Produktion von Interleukin-6 in verschiedenen Zelltypen. Es wurde gezeigt, dass sowohl endometriale Stroma- als auch Epithelzellen auf ein verringertes Sauerstoffangebot im Sinne einer IL-6 Erhöhung reagieren. Auch VEGF wird in endometrialen Stroma- und Epithelzellkulturen durch eine Reduktion des Sauerstoffangebots induziert. Hierbei kann man eine deutlichere Steigerung von VEGF in Stroma- als in Epithelzellkulturen beobachten. Unsere Versuchsansätze an Zellkulturen, am Uterussekret und an Endometriumsschnitten haben einen Beitrag zum genaueren Verständnis der Regulationsmechanismen im endometrialen Zellverband geleistet. Die Komplexität der Abläufe jedoch erfordert weiterhin intensive Forschungsarbeit in vivo sowie in vitro, um einen vollständiges Bild des Endometriums zu vermitteln. In diesen Erkenntnissen liegt die Chance, Therapieansätze für einige Erkrankungen, wie zum Beispiel Endometriose oder auch Infertilität zu entwickeln.
Medizinische Fakultät - Digitale Hochschulschriften der LMU - Teil 02/19
Thu, 13 Nov 2003 12:00:00 +0100 https://edoc.ub.uni-muenchen.de/1757/ https://edoc.ub.uni-muenchen.de/1757/1/Zepf_Claudia.pdf Zepf, Claudia ddc:610, ddc:600, Medizinische Fakultät
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