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The Effectiveness of Phalleria macrocarpa Bioactive Fraction in Alleviating Endometriosis and/or Adenomyosis Related Pain

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The Effectiveness of Phalleria macrocarpa Bioactive Fraction in Alleviating Endometriosis and/or Adenomyosis Related Pain

Budi Wiweko, Caroline G. Puspita, Raymond Tjandrawinata, Herbert Situmorang, Achmad K. Harzif, Gita Pratama, Kanadi Sumapraja, Muharam Natadisastra, Andon Hestiantoro

Abstract


The overexpression of estrogen receptor-beta (ER-ß) and the cyclooxygenase-2 (COX-2) enzyme coupled with the absence of expression of progesterone receptors (PR) is critical to thepathogenesis of endometriosis and adenomyosis associated pain.  DLBS1442, a novel bioactiveextract of Phaleria macrocarpa, exerts its action by downregulating the overexpressed ER-ß andCOX-2 products and up-regulating PR gene expression. This pilot study was conducted to evaluatethe effectiveness of DLBS1442 treatment in alleviating endometriosis- and/or adenomyosis-relatedpain. Ten endometriosis and/or adenomyosis patients were recruited consecutively at YasminClinic Dr. Cipto Mangunkusumo General Hospital in January - March 2013. Pain associated withmenses, including pre-menstrual pain, dysmenorrhea, dyschezia and dysuria, was measuredusing the visual analog scale (VAS) at each of the next three menstrual cycles. Patients reportingone or more pain symptoms with a VAS score = 4 were given 100 mg of DLBS1442 three timesdaily for 12 weeks. VAS score reduction was noted in the first post-treatment menstrual cycle(approximately 5.3 weeks after treatment initiation) and VAS scores continued to decline overthe final two cycles. DLBS1442 was effective in alleviating endometriosis- and/ or adenomyosisrelatedpain, as demonstrated by early pain reduction as evaluated using the VAS.

Keywords: DLBS1442, dysmenorrhea, endometriosis, adenomyosis

Efektivitas Ekstrak Bioaktif Phaleria macrocarpa pada Masalah NyeriTerkait Endometriosis dan/ atau Adenomiosis

Abstrak
Over-ekspresi reseptor estrogen beta (ER-ß) dan enzim siklo-oksigenase-2 (COX-2) akan menekan ekspresi reseptor progesteron (PR) di endometrium; hal tersebut penting dalampatogenesis endometriosis dan adenomiosis. DLBS 1442, ekstrak bioaktif Phaleria macrocarpa,bekerja dengan menekan over-ekspresi ER-ß dan COX-2 serta meningkatkan regulasi ekspresigen PR. Studi awal dilakukan untuk mengevaluasi efektivitas pengobatan DLBS1442 padamasalah nyeri terkait endometriosis dan/ atau adenomiosis. Sepuluh penderita endometriosis dan/atau adenomiosis di klinik Yasmin RSCM pada bulan Januari - Maret 2013 yang memiliki keluhannyeri diikutsertakan dalam penelitian ini. Dilakukan penilaian skor visual analog scale (VAS) untukkeluhan nyeri pre-menstruasi, dismenorea, diskezia dan disuria setiap 3 siklus menstruasi. Pasienyang memiliki keluhan satu atau dua gejala nyeri dengan skor VAS > 4 diberikan DLBS1442sebanyak 3 x 100 mg sehari selama 12 minggu. Penurunan skor VAS diperoleh pada siklus pertamamenstruasi pascapengobatan (sekitar 5,3 minggu setelah inisiasi pengobatan) dan penurunanskor VAS terus berlanjut setelah melewati 2 siklus terakhir pengobatan. DLBS 1442 efektif dalammengatasi masalah nyeri pada endometriosis dan/ atau   adenomiosis.

Kata Kunci: DLBS 1442, dismenorea, endometriosis, adenomiosis


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