Self-management and psychological-sexological interventions in patients with endometriosis: strategies, outcomes, and integration into clinical care

Figures & data

Table 1 Relationship between endometriosis and 25(OH)D serum levels (literature data 1990–2016)

Study	Country	Number of patients enrolled	25(OH)D serum levels
Hartwell et al^Citation68	Denmark	42	Normal
Somigliana et al^Citation69	Italy	140 (endometriosis, n=87; controls, n=53)	Increased
Agic et al^Citation70	Germany	79 (endometriosis, n=46; controls, n=33)	Normal
Harris et al^Citation71	US	70.556 (endometriosis, n=1,385; controls n=69,171)	Decreased
Miyashita et al^Citation66	Japan	76 (endometriosis n=39;a controls n=37)	Decreasedb
Ciavattini et al^Citation72	Italy	49c	Decreased

Notes:

a Mild endometriosis (n=17, stages 1 and 2), severe endometriosis (n=22; stages 3 and 4);

b serum levels of 25(OH)D in samples from patients with severe endometriosis were significantly lower than the levels detected in samples from the controls and the patients with mild endometriosis;

c only patients with singleton endometrioma were included.

Abbreviation: 25(OH)D, 25-hydroxyvitamin D.

Table 2 Summary of modifiable factors and complementary alternative factors associated with endometriosis

Intervention	Processes potentially involved	Effect on the disease
Diet
– Fish, ω3 PUFAs	Anti-inflammatory profile and reduce proinflammatory prostaglandin production and cytokines	Debated ↓
– Red meat	High amount of fat (ω6 FAs) involved in the production of proinflammatory prostaglandins; increased plasma concentration of estradiol and estrogen-mediated disease maintenance	Debated ↑
– Fruit and vegetables	Antioxidant properties; potential beneficial effects counterbalanced by large use of pesticides and dioxins in cultivation process	Debated
– Coffee	Aromatase inhibitor; ability to act on SHBG, reducing the bioavailability of testosterone	No association
– Gluten-free diet	Avoids the consumption of gluten, a nutrient with proinflammatory properties	Improvement in pain symptoms
Physical activity	Reduction in estrogen levels and frequency of ovulation (when performed at high levels of intensity); increase of SHBG levels with a subsequent reduction of bioavailable estrogens; reduction of insulin resistance and hyperinsulinemia	Debated ↓
Osteopathy and massage	Improvement of musculoskeletal symptoms could reduce inflammation of internal organs	Improvement in pain symptoms (low level of evidence)
Acupuncture	Release of endogenous opioids, anti-inflammatory systemic effect, deactivation of brain areas linked to the transmission of pain sensations, and intensification of local blood flow at needle-insertion site	Improvement in pain symptoms (low level of evidence due to small sample sizes)
Chinese herbal medicine	Anti-inflammatory activity; on animal model, suppression of endometriotic implants	Debated (limited quality of data)
Vitamins
– Vitamin D	Antiproliferative, anti-inflammatory, and immunomodulatory properties	Debated
– Vitamin A, vitamin C, and β-carotene	Antioxidant properties; involved in the production of ROS and cell proliferation	Debated
N-acetylcysteine	Reduction in the release of proinflammatory cytokines; reduction of cell proliferation and downregulation of the inflammatory cascade	Improvement in pain symptoms and reduction of ovarian endometrioma-lesion size
Resveratrol	Antiangiogenic, anti-inflammatory, and antioxidant properties	Reduction in the number and volume of endometriotic lesions (experimental studies)
Endocrine disruptors (ie, dioxin, dioxin-like compounds, and bisphenol A)	Alteration of hormone synthesis and receptor activity	Debated ↑

Note: Arrows indicate risk direction.

Abbreviations: FAs, fatty acids; PUFAs, polyunsaturated fatty acids; ROS, reactive oxygen species; SHBG, sex hormone binding globulin.

HartwellDRødbroPJensenSBThomsenKChristiansenCVitamin D metabolites: relation to age, menopause and endometriosisScand J Clin Lab Invest19905021151212339276

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SomiglianaEPanina-BordignonPMuroneSDi LuciaPVercelliniPViganoPVitamin D reserve is higher in women with endometriosisHum Reprod20072282273227817548365

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AgicAXuHAltgassenCRelative expression of 1,25-dihydroxyvitamin D3 receptor, vitamin D 1α-hydroxylase, vitamin D 24-hydroxylase, and vitamin D 25-hydroxylase in endometriosis and gynecologic cancersReprod Sci200714548649717913968

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HarrisHRChavarroJEMalspeisSWillettWCMissmerSADairy-food, calcium, magnesium, and vitamin D intake and endometriosis: a prospective cohort studyAm J Epidemiol2013177542043023380045

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MiyashitaMKogaKIzumiGEffects of 1,25-dihydroxy vitamin D3 on endometriosisJ Clin Endocrinol Metab201610162371237927035829

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CiavattiniASerriMDelli CarpiniGMoriniSClementeNOvarian endometriosis and vitamin D serum levelsGynecol Endocrinol201733216416727809683

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