ARTICLE steroid and cytokine productions , and the presence of immune components . 18 The migration of uterine endometrial cells into the pelvic cavity form lesions on multiple sites across multiple organs . 10 Endometriosis is one of the most common gynaecological diseases in women , 19 affecting around 15 %
14 , 19
of women of reproductive age . Women with endometriosis experience dysmenorrhoea , dyspareunia , 2-8 development of scarring and adhesions , 20 pelvic floor muscle spasm , 9 pelvic pain , 2-7 chronic pelvic pain , 10 , 11 , 21 chronic pain , 9 irritable bowel syndrome , 10 inflammatory bowel disease , 12 constipation , 2-7 fatigue , 20 stress , 12 , 22 chronic stress , 22 and
20 , 23
negative impacts on quality of life .
10 , 20
There are increased inflammation , vascular inflammation , 8 neurogenic inflammation , 10 and oxidative stress . 19 An impairment of immunologic mechanism and inflammatory responses has been suggested to be involved in the pathogenesis of endometriosis . 17 Women with endometriosis experience autoimmune diseases ( such as systemic lupus erythematosus and multiple sclerosis ), 12 thyroid conditions , 12 headaches , 9 and orofacial pain . 9 There is peripheral sensitisation , central sensitisation , and enhanced pelvic nociception . 10 The intensity of stress correlates with pain severity and severity of endometriosis . 22 Endometriosis is the most common cause of chronic pelvic pain . 11 Chronic pain frequently returns in patients within 12 months of lesion removal , even in the absence of lesion regeneration . 10 It is noted that pain is a multidimensional experience that involves sensory , cognitive , and affective factors . 24 Around 30-50 % of women with endometriosis experience infertility . 5 , 25 Endometriosis can be also asymptomatic , 19 leading to years of silent suffering .
Vitamin D
Optimum nutrition is the foundation for optimum health . 13 Vitamin D is involved with the absorption and metabolism of calcium , 26-29 calcium homeostasis , 26 mineral homeostasis , 17 metabolism of phosphate , 27-29 26 , 28 bone metabolism ,
16 , 18
modulating inflammation , differentiation , 17 , 26 regulation of cellular growth , 17 anti-proliferation , 18 regulation of genes that are crucial for glucose and lipid metabolism , 16 and overall metabolic function . 29 Vitamin D stimulates anti- Müllerian hormone production , which is highly correlated with ovarian reserve preservation . 30 Vitamin D modulates insulin action by stimulating the expression of insulin receptor and enhancing insulin responsiveness for glucose transport . 16 Vitamin D and its metabolites are steroid hormones and hormone precursors . 26 Vitamin D plays an essential role in both cell-mediated and humoral antibody response 31 and in the regulation of the response of the immune system . 32 It increases the oxidative burst potential of macrophages , 32 and supports a Th2-mediated anti-inflammatory cytokine profile . 31 It is interesting to note that most cells and organs in the body have a vitamin D receptor , 29 including the endometrium , myometrium , and ovary . 18 Endometrial tissue expresses enzymes involved in the metabolism of vitamin D . 18 With this in mind , vitamin D can be seen as being important in everyday health .
A deficiency of vitamin D has been associated with endometriosis , 17 menstrual dysfunction , 16 polycystic ovary syndrome , 17 impaired fertility , 17 higher occurrence of uterine myomas ( fibroids ), 30 bacterial vaginosis , 17 insulin resistance , 16 osteoporosis , 33-35 osteopaenia , 33 osteomalacia , 34 , 35 and rickets . 30 , 34 , 35 Vitamin D deficiency has been associated with increased
16 , 17 , 33 , 35
risk of cardiovascular disease , insulin resistance , 17 autoimmune diseases , 16 , 17 , 28 , 30 , 36 30 , 33 , 35
multiple sclerosis , rheumatoid arthritis , 30 , 33 , 35 systemic lupus erythematosus , systemic sclerosis , 30 risk of fracture , 33 neuromuscular disorders , 16 muscle weakness , 28 pre-eclampsia , 33 neurocognitive dysfunction , 28 type 1 diabetes , 16 , 28 , 30 , 33 , 35 28 , 33 , 36
type 2 diabetes , and inflammatory bowel diseases . 30 Vitamin D deficiency is correlated with
28 , 31 , 33
a higher susceptibility to infections due to impaired localised innate immunity and defects in the antigenspecific cellular immune response . 31
Vitamin D is an essential , underutilised nutrient .
Conclusion
Endometriosis is a chronic multifactorial complex disease that has significant impacts on physical , mental , and emotional health . Vitamin D may be beneficial in the management of endometriosis via modulating inflammation and immune responses , enhancing insulin responsiveness , differentiation , regulation of cellular growth , and overall metabolic function . More research is suggested to further investigate the benefits of vitamin D in endometriosis .
REFERENCES 1 . Jones G , Jenkinson C , Kennedy S . The impact of endometriosis upon quality of life : a qualitative analysis . J Psychosom Obstet Gynaecol 2004 ; 25 ( 2 ): 123-33 .
2 . Kong S , Zhang YH , Liu CF , et al . The complementary and alternative medicine for endometriosis : a review of utilization and mechanism . Evidence-based complementary and alternative medicine : eCAM 2014 ; 2014 : 146383 .
3 . Kennedy S , Bergqvist A , Chapron C , et al . ESHRE guideline for the diagnosis and treatment of endometriosis . Hum Reprod 2005 ; 20 ( 10 ): 2698-704 .
4 . Giudice LC . Clinical practice . Endometriosis . N Engl J Med 2010 ; 362 ( 25 ): 2389-98 .
5 . Facchin F , Barbara G , Saita E , et al . Impact of endometriosis on quality of life and mental health : pelvic pain makes the difference . J Psychosom Obstet Gynaecol 2015 ; 36 ( 4 ): 135- 41 .
6 . Eskenazi B , Warner ML . Epidemiology of endometriosis . Obstet Gynecol Clin North Am 1997 ; 24 ( 2 ): 235-58 .
7 . Buggio L , Barbara G , Facchin F , et al . Selfmanagement and psychological-sexological interventions in patients with endometriosis : strategies , outcomes , and integration into clinical care . Int J Womens Health 2017 ; 9 : 281-93 .
8 . Harris HR , Chavarro JE , Malspeis S , et al . Dairy-food , calcium , magnesium , and vitamin D intake and endometriosis : a prospective cohort study . American journal of epidemiology 2013 ; 177 ( 5 ): 420-30 . 9 . Phan VT , Stratton P , Tandon HK , et al .
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