Endometriosis Association NEWSLETTER 
VOL. 26 No. I, 2005                                                                               

 International Headquarters,
8585 N. 76th PI. Milwaukee
WI 53223 USA
www.EndometriosisAssn.org


ENDOMETRIOSIS ASSOCIATION 25TH ANNIVERSARY CONFERENCE, OCTOBER 7-8, 2005
Highlights: Debate  Deborah Metzger, M.D., Ph.D. vs. David Redwine,

• M.D. Metzger: "Endo is a Body-Wide Immune System Disease Requiring Comprehensive Treatment
• Redwine: "Endo is a Locally-Focused Disease Only Requiring Good Surgery"
• Cancer and Endo: What are the Facts? presented by the U.S. National Cancer Institute expert, Louise Brinton, Ph.D.
• A Unifying Theory on Endo: Inflammation, Autoimmunity, and Cancer presented by Roberta Ness, M.D., M.P.H.
• Will My Children and Family be Affected? presented by the Science Director of the Science and Environmental Health Network, Ted Schettler, M.D., M.P.H.
• Preventing Endo-Related Cancers
• Preventing Endo-Related Hormonal Problems in Menopause
• Preventing and Minimizing Environmental Factors that Worsen Endo and Related Diseases
• Surgery-New Techniques and Important Tips New Medical Treatments for Endo
• Autoimmune Diseases and Endo (including the leaders in the field and the lead scientist at NIH who helped document the six auto­immune diseases, including rheumatoid arthritis, multiple sclerosis, and chronic fatigue immune dysfunction syndrome, that affect women with endo and their families)
• New Approaches to the Pain of Endo, Especially Pain with Sex Detoxification-Getting These Lifelong Chemicals and Their Toxic Effects Out of Us!
• Infertility and Environmental Contaminants
• Traditional Chinese Medicine and Endo
• Nutritional Approach to Endo

 Oregon Doctor in International Spotlight for Women's Health (Endometriosis) 

(Bend, Ore.) David B. Redwine, MD, an Oregon gynecologist and the director of the St. Charles Endometriosis Treatment Program in Bend, was featured on the cover of the February 2005 issue of the Italian magazine Leadership Medica. The magazine includes an article, "Redefining Endometriosis in the Modern Era," in which Dr. Redwine explains the identification and treatment of a disease that affects more than five million American women and millions more across the world.

Dr. Redwine has published more than two dozen articles in peer-reviewed national and international medical journals, contributed endometriosis-related chapters to nearly 40 medical books and is the primary author and editor of the book "Surgical Treatment of Endometriosis" (Dunitz, 2003), a compendium of information from some of the world’s leading endometriosis experts. He has been a presenter at international medical conferences in a dozen countries on five continents. To read the Leadership Medica article (in English),

see http://www.leadershipmedica.com/indice/index_2005.htm.
For more information on Dr. Redwine, see www.endometriosistreatment.org

OB.GYN. NEWS • May 1, 2005   New Treatment Approved For Endometriosis Pain
BY MICHELE G. SULLIVAN Mid-Atlantic Bureau

Subcutaneous medroxyproges­terone acetate has been ap­proved for the treatment of en­dometriosis-related pelvic pain. It is the first new treatment to be approved for this indication in 15 years. Depo subQ provera 104 (DMPA-SC), which contains 104 mg medroxyprogesterone ac­etate, treats endometriosis pain as effectively as leuprolide ac­etate, but is associated with sig­nificantly less bone loss and few­er vasomotor symptoms, according to data provided by Pfizer Inc., which manufactures the agent. 

The Food and Drug Adminis­tration granted approval for the endometriosis pain indication in March. Depo-subQ provera 104 received FDA approval for use as a contraceptive in December 2004. Pfizer said depo subQ prover a 104 would be widely available this month. Depo subQ provera 104 is a new formulation of medrox­yprogesterone acetate, which is the active ingredient in Depo­Provera Contraceptive Injection (medroxyprogesterone acetate injectable suspension), but with 30% less hormone.

Depo subQ provera 104 is available in prefilled syringes each containing 0.65 mL (104 mg) of medroxyprogesterone acetate sterile aqueous suspension. Administered by subcutaneous injec­tion four times a year (every 12-14 weeks), DMPA-SC halts menstruation, which re­sults in thinner, more compact endome­trial tissue, the company said. This in turn halts the growth of endometrial im­plants, relieving endometriosis-associat­ed pain.

The package insert contains a black box warning concerning possible bone loss: Women who use DMPA-SC may lose sig­nificant bone mineral density. Bone loss is greater with increasing. duration of use and may not be completely reversible. It is unknown if use of depo-subQ provera 104 during adolescence or early adult­hood, a critical period of bone accretion, will reduce peak bone mass and increase the risk of osteoporotic fracture in later life. Depo-subQ provera 104 should be used as a long-term birth control method (that is, longer than 2 years) only if other birth control methods are inadequate.

Pfizer's phase III randomized controlled trial showed that DMPA-SC is associated with significantly less bone loss than le­uprolide acetate for depot suspension, the only other drug ap­proved for treatment of endometriosis-re­lated pain. The 18-month study included 274 women aged 18-49 years who had diag­noses of endometriosis-associated pelvic pain. They were ral1­domized to 6 months of treatment with either DMPA-SC (104 mg every 3 months) or leuprolide (11.25 mg IM every 3 months), and 12 months of follow-up. ;

There were no significant differences in pain symptom reduction. Women in both groups showed some bone mineral densi­ty declines at the end of treatment, but th~ mean losses were significantly less for women taking DMPA-SC in both the femur (0.3% vs. 1.65%) and the spine (1.1 % vs. 3.95%).  In women who had been taking DMPA­SC, bone mineral density return to pre­treatment levels 12 months after discon­tinuing treatment. Those who had been taking leuprolide showed continued bone mineral density losses of 1.3% in the fe­mur and 1.7% in the spine. DMPA-SC was also associated with sig­nificantly fewer vaso­motor symptoms, es­pecially hot flashes.

It's important to remember that the only cure for en­dometriosis is aggressive surgical excision, David Red­wine, M.D., Endometriosis Association advisor, said in an interview. Surgery has been repeatedly shown to have a cure rate of about 60% in even resistant cases.

"Excision is the only treatment which has documentation of cure, although this in­formation is typically withheld from pa­tients as they consider their treatment op­tions. The result is that patients undergo repeated rounds of medical therapies with­out eradication of their disease," Dr. Red wine said. 'Depo subQ 104 adds another form of medical therapy for endometriosis to be used by physicians who cannot treat the disease effectively by surgery."

The bone loss associated with any hor­monal therapy for symptoms is worri­some, he said, especially in women who are still actively laying down bone. "I am concerned about young women being ex­posed to medicines that do not treat a dis­ease and that can produce systemic side ef­fects, the permanency of which are not fully known," said Dr. Redwine, medical director of the endometriosis treatment program at St. Charles Medical Center in Bend, Ore.

Daniel Watts, a Pfizer spokesman, said depo subQ provera 104 will offer a much­needed alternative to women who don't elect surgery.

"Not all patients are appropriate candi­dates for surgery," Watts said in an inter­view: "There are also associated risks with surgery, thus making it a less attractive op­tion for some women. Depo provera sub­Q is a valuable option, because it has sig­nificantly less decline in bone mineral density and lower incidence and severity of menopausal symptoms, such as hot flashes, compared with leuprolide acetate, the commonly used treatment."