Molly ParrishToday in 2024, we are living in a momentous time for health and medicine. Despite our growing medical knowledge, there is still much left to understand about women’s health. One poorly understood gynecological disease is endometriosis. Approximately 10% of all reproductive age women suffer from endometriosis. This disease is characterized by uterine-like tissue growing outside of the uterus. Endometriosis tissue can grow on reproductive organs, nearby organs like the bladder or intestines, and organs even as distant as the lungs. The most common symptoms of endometriosis are chronic pelvic pain, heavy menstrual bleeding, fatigue, and bloating, but symptoms are widely ranging. Endometriosis is known to be debilitating, both from severe pain and the depression and anxiety caused by chronic pain.
The exact cause of endometriosis is unknown. Some potential causes are blood transport of endometrial cells, genetic predispositions, and reverse menstruation, the process where menstrual blood flows incorrectly into the fallopian tubes. Additionally, treatment options for endometriosis are often limited or invasive. The most common treatment modalities are medication. This includes non-steroidal anti-inflammatory drugs for pain management and estrogen-progestin combination oral contraceptives or progestin-only oral contraceptives to reduce menstrual bleeding. Additionally, gonadotropin-releasing hormone agonists can be prescribed to suppress the ovaries. The most effective, yet highly invasive treatment requires surgical intervention, such as surgical ablation of tissue, excision, or hysterectomy. Additionally, endometriosis is difficult to diagnose. The only way to definitively diagnose endometriosis is by performing laparoscopic surgery. Furthermore, it takes an average of 7 years to be diagnosed with endometriosis. Commonly thought explanations for a long diagnosis time include a lack of knowledge, dismissal of pain, and lack of healthcare access.
Nevertheless, hope is not lost! There have been recent advances made to test for and treat endometriosis. An innovative study has begun at the Jackson Laboratory in Connecticut to create the first biorepository of endometriosis samples. This study makes history as the first government-mandated study on endometriosis. The goals of this study, named EndoRISE, are to improve health outcomes and awareness for endometriosis and propel research advances. EndoRISE will collect and utilize a combination of patient fluids (whole blood, serum, urine), cells, and tissues. Another exciting breakthrough at Baylor College of Medicine found a link between endometriosis and the gut microbiome. Researchers found a relationship between endometriosis and low 4-hydroxyindole, a byproduct of bacteria, in the gut. This work presents a potential biomarker for detecting endometriosis in a non-invasive manner. In addition to these research studies, the NIH has recently launched an initiative called the RADx Tech ACT ENDO Challenge, which aims to find new, non-invasive tools for endometriosis imaging, diagnostics, and accessibility. Although endometriosis is a debilitating, multi-faceted disease previously understudied in research efforts, these programs are giving hope for the future of endometriosis health care.
Peer Editor: Caroline Yu