Pharmacist is important in managing symptoms of endometriosis

Endometriosis affects 2% to 10% of women aged 25 to 40 in the United States, but like many diseases that specifically affect women, clinical research is severely underfunded. In 2019, according to the Endometriosis Foundation of America, only $13 million of her uterus was in federal funding, even though her 1 in 10 women have endometriosis. It was not assigned to an endometriosis study.¹

Inflammatory diseases cause the endometrium to grow due to estrogen in places such as the outside of the uterus, the ovaries, fallopian tubes, the pelvic cavity, and even the abdomen, such as the intestines and bladder.² Endometriosis, which is often painful, can seriously affect quality of life and cause infertility.^2,3 It is also associated with a 34% increased risk of stroke.^4,5

As with research, there is a paucity of endometriosis treatment options available. Treatment goals typically include pain control and suppression of endometrial proliferation. In some cases, surgery is required. The type of treatment depends on whether the patient wants to have children, the patient’s age, and the severity of the symptoms and illness.²

Endometriosis and autoimmune diseases

Although not considered an autoimmune disease, the association between endometriosis and autoimmune diseases was examined in a 2019 meta-analysis published in Human Reproduction Update.⁶ Researchers found that endometriosis and inflammatory bowel disease (IBD), systemic lupus erythematosus (SLE), Addison’s disease, Sjögren’s syndrome (SS), multiple sclerosis (MS), rheumatoid arthritis (RA), autoimmune Identified associations with thyroid disorders, and celiac disease⁶ However, “Of the 26 studies, only 5 were able to provide high-quality evidence, and 4 of those found a statistically significant relationship between endometriosis and at least one autoimmune disease.” The results of this study highlight the need for health care providers to continue to recognize autoimmune diseases as comorbidities. Endometriosis is also associated with inflammation.A 2016 study published in The forefront of life science “Inflammation is important in the etiology of endometriosis.”⁷ Tumor necrosis factor alpha, one of the key cytokines, plays a key role in endometrial inflammation that can lead to endothelial dysfunction.⁷

available treatment options

Pharmacists play an important role in helping patients manage endometriosis, according to Veronica Vernon, PharmD, an assistant professor of pharmacy in the School of Health Sciences and Pharmacy at Butler University in Indianapolis, Indiana. For patients receiving pharmacological treatments such as nonsteroidal anti-inflammatory drugs (NSAIDs), hormonal contraceptives, and gonadotropin-releasing hormone (GnRH) antagonists/agonists, pharmacists can help manage side effects and monitor symptoms. .

“Pharmacists can also recognize medical conditions and advocate for patients,” Vernon added. “Many patients feel ignored by family, friends and health care providers when discussing their endometriosis symptoms.” Vernon, a study conducted by the Alliance for Endometriosis He found that 90% of patients were dismissed when discussing their pain, and 42% were dismissed by their healthcare providers.⁸

These patients may turn to their pharmacist for pain relief recommendations. “Dysmenorrhoea may be a common reason people seek self-care, and pharmacists may find it helpful to identify whether an evaluation for endometriosis or another secondary dysmenorrhoea is warranted. It helps,” Vernon said.
NSAIDs such as ibuprofen and naproxen are often recommended as first-line pain relievers, but sometimes prescription pain relievers are needed. NSAIDs should be used with caution due to cardiovascular and gastrointestinal risks.⁹ It is recommended to use the lowest dose possible and patients who are allergic to aspirin should avoid taking NSAIDs.⁹ Patients with endometriosis who require surgery also require pain management. Several hormone therapies can be used to treat pain and reduce symptoms. GnRH drugs can significantly reduce pelvic pain^Ten and prevent ovulation. 2018, Elagolix (Orilissa) – GnRH antagonist¹¹— It is the first FDA-approved oral treatment for moderate-to-severe pain associated with endometriosis in over a decade.¹² Take the lower dose version (150 mg) for 24 months only to prevent bone loss. The high dose version (200 mg) should be taken within 6 months.¹²

Birth control pills can also be used to treat endometriosis to slow growth and reduce pain. However, pain relief is often lost when treatment is stopped, and side effects of this treatment include breakthrough bleeding, bloating, and weight gain.

In August 2022, the FDA approved relugolix 40 mg, estradiol 1 mg and norethindrone acetate 0.5 mg (Myfembree).¹³ A once-daily tablet for 2 years to treat moderate to severe endometriosis pain. Its effectiveness is supported by two of his clinical studies, the results of which were published in The Lancet.¹⁴ Of note with this drug is a list of possible side effects, including stroke and pulmonary embolism, mood disorders and suicidal thoughts, elevated blood pressure, liver damage, and hair loss. Patients should not use hormonal contraceptives while taking this medicine.¹³

A 2022 study published in Cannabis and Cannabinoids Research found that patients could use cannabis to treat endometriosis during the COVID-19 pandemic, when access to healthcare was limited. I found myself relying more and more on¹⁵ Another study published in PLOS One found that¹⁶ Cannabis is effective for pelvic pain, mood, and gastrointestinal issues, and has been found to “depend on how it’s taken.”¹⁶ With more states legalizing cannabis products, pharmacists are asking patients whether they’re using this form of therapy themselves, as it may pose fewer risks than long-term use of NSAIDs and other drugs. The researchers behind the study, published in PLOS One, have prompted additional research into this promising treatment.

“By understanding the drugs used to treat endometriosis, pharmacists will be able to provide better care to their patients,” said Vernon. “It is imperative that pharmacists advocate for patients with endometriosis by acknowledging and validating their symptoms.”

References

1. endometriosis Foundation of American: Commitment to Research. Endometriosis Foundation of America. Accessed 13 February 2023. https://www.endofound.org/research

2. Fourquet J, Sinaii N, Stratton P, et al. Characteristics of women with endometriosis in the United States and Puerto Rico. J Endometr Pelvic Pain Disord. 2015;7(4):129-135.doi:10.5301/je.5000224

3. Endometriosis. National Institute of Child Health and Human Development at the National Institutes of Health (NIH). Updated 02/21/2020. Accessed 02/02/2023. https://www.nichd.nih.gov/health/topics/endometriosis

4. Scientific Update: Endometriosis is linked to an increased risk of stroke, suggests an NIH-funded study. Eunice Kennedy Shriver National Institute of Child Health and Human Development. Published July 27, 2022. Accessed 13 February 2023. https://www.nichd.nih.gov/newsroom/news/072722 – Endometriosis – Stroke

5. Farland LV, Degnan WJ 3rd, Bell ML et al. Laparoscopy-confirmed endometriosis and stroke risk: a prospective cohort study. stroke. 2022;53(10):3116-3122. doi:10.1161/STROKEAHA.122.039250

6. Shigesi N, Kvaskoff M, Kirtley S, et al. Association between endometriosis and autoimmune diseases: a systematic review and meta-analysis. Hum Reprod update. 2019;25(4):486-503.doi:10.1093/humupd/dmz014
7. Jiang L, Yan Y, Liu Z, Wang Y. Inflammation and endometriosis. Front Biosci (landmark edition). 2016;21(5):941-948. Doi: 10.2741/4431

8. The Alliance for Endometriosis Survey identifies actions needed to improve the experience of patients with endometriosis. news release. Alliance for Endometriosis. November 30, 2021. Accessed 13 February 2023. https://www.prnewswire.com/news-releases/the-alliance-for-endometriosis-survey-reveals-actions-needed-to-improve-the-endometriosis-patient-experience-301431226.html

9. Vonkeman HE, van de Laar MA. Non-steroidal anti-inflammatory drugs: side effects and their prevention. Semin Rheumatoid Arthritis. 2010;39(4):294-312. doi:10.1016/j.semarthrit.2008.08.001

[ PubMed ]10. Rafique S, DeCherney AH. Medical management of endometriosis. Clin Obstetrics and Gynecology. 2017;60(3):485-496. doi:10.1097/GRF.000000000000029211. Features to consider. Orilissa. Accessed February 13

11. Features to consider. Orilissa. Accessed 13 February 2023. https://www.orilissa.com/hcp/about-orilissa/mechanism-of-action

12. AbbVie has US FDA approval of Orilissa (Elagolix) for the management of moderate to severe pain associated with endometriosis. news release. AbbVie. July 24, 2018. Accessed 13 February 2023. https://news.abbvie.com/news/abbvie-receives-us-fda-approval-orilissa-elagolix-for-management-moderate-to-severe-pain-associated-with-endometriosis.htm

13. Myovant Sciences and Pfizer received US FDA approval for MYFEMBREE, a once-daily treatment for managing moderate to severe pain associated with endometriosis. news release. Myovant science. August 5, 2022. Accessed 02/02/2023. https://investors.myovant.com/news-releases/news-release-details/myovant-sciences-and-pfizer-receive-us-fda-approval-myfembreer

14. Giudice LC, As-Sanie S, Arjona Ferreira JC, et al. Once-daily oral relugolix combination therapy versus placebo in patients with endometriosis-related pain: two replicated, phase 3, randomized, double-blind trials (SPIRIT 1 and 2). lancet. 2022;399(10343):2267-2279. Doi: 10.1016/S0140-6736(22)00622-5

15. Armer M, Sinclair J, Cheng J, et al. Endometriosis and cannabis consumption during the COVID-19 pandemic: an international cross-sectional survey. Cannabis Cannabinoid Res. 2022;7(4):473-481. doi:10.1089/can.2021.0162

16. Sinclair J, Collett L, Abbott J, Pate DW, Sarris J, Armor M. Effects of cannabis intake on endometriosis-related pelvic pain and related symptoms. PLoS One. 2021;16(10):e0258940.doi:10.1371/journal.pone.0258940