Reducing the Effects of Endometriosis: How Anti-Inflammatories, Including Melatonin, May Help

Endometriosis is a severely debilitating disease characterised by dysmenorrhea, pelvic pain, dyspareunia, and infertility. The true prevalence of endometriosis is largely underestimated due to the reliance on laparoscopy for diagnosis. The current estimate is 10-15% of women between the ages of 25 and 35 years old and 70% of women with chronic pelvic pain have endometriosis.¹ This lack of understanding in its diagnosis and management is reflected by the fact that diagnosis is often delayed by 8-10 years after the onset of symptoms.

The effect of endometriosis goes beyond debilitating pain. The disease process changes the environment of the whole pelvic bowl, leading to chronic inflammation and adhesions in the surrounding structures. These changes have a significant effect on the health of our reproductive system and fertility. In females with infertility, it is estimated that 20-50% of them have endometriosis. In those already diagnosed with endometriosis, 35-50% of people have been diagnosed with infertility.³

Research shows the most effective treatment for advanced endometriosis is surgery, followed by suppressive therapy, which may include hormonal contraception. As endometriosis is an estrogen-dependent disease, therapies involving progesterone are beneficial. Additional progestogens have the ability to control the growth of endometriotic tissue and manage symptoms.⁴ However, the recurrence rate of endometriosis after surgery is extremely high, and hormonal contraceptives are not suitable or completely effective for everyone, particularly those desiring to get pregnant. It is important to explore other possible options for managing pain and disease progression.

ENDOMETRIOSIS IS A COMPLEX DISEASE

While research for this disease has been marginalised for decades, current researchers have been making strides in understanding its pathophysiology. We know that endometriosis is driven by multiple cellular factors, including hormone dysfunction, inflammation, oxidative stress, oncogenic cellular proliferation, invasion into surrounding tissues, and neuromodulation.