Endometriosis Update
By Dr Rose McDonnell, Obstetrician and Gynaecologist Claremont
Endometriosis is characterized by the presence of tissue similar to the lining of the uterus that grows outside of the uterus, most commonly on the ovaries, fallopian tubes, and pelvic cavity. This tissue responds to hormonal changes in the menstrual cycle and can cause a range of symptoms, including pelvic pain, infertility, and painful menstrual periods. While there is no cure for endometriosis, there have been significant advancements in our understanding and treatment of this condition in recent years. The exact prevalence of endometriosis is unknown, but estimates range from 2 to 10% within the general female population but up to 50% in infertile women.
One of the most significant developments in the field of endometriosis research has been the recognition of the role of the immune system in the development and progression of the disease. One promising approach is the use of immunomodulatory drugs, which work by altering the activity of the immune system to reduce inflammation scarring and pain associated with endometriosis.
While hormonal therapies and immunomodulatory drugs have shown promise in the treatment of endometriosis, surgical intervention remains an important treatment option for many women. Laparoscopic surgery is the most common type of surgery used to treat endometriosis, involving the removal of endometriotic lesions and adhesions from the pelvic cavity.
Biobank projects are currently underway to collect samples of endometriotic lesions in patients who have undergone laparoscopy for confirmed or suspected endometriosis to better understand the pathophysiological disease process and how this correlates with metabolic markers. One such biobank exists locally, ENDOORIGINS supported by the University of Western Australia. In time subgroups of endometriosis suffers may be characterised and allow us to understand why some people that suffer from endometriosis have slow growing lesions and others have lesions that are fast growing with a tendency for deep infiltration of surrounding tissue and organs. This will allow the creation of models that will help determine disease progression and novel drug targets and potentially delineate specific immune dysfunction markers and cellular anomalies.
Diagnosing endometriosis can be challenging due to its varied clinical presentations and lack of specific symptoms. Biomarkers have emerged as promising tools in the diagnosis and management of endometriosis, providing valuable insights into disease pathogenesis, aiding in early detection, and monitoring treatment response.
A biomarker is a unique protein fingerprint in the blood and can be used as a screening test. Proteomics International recently presented results at the international conference for the Society of Reproductive Investigation at their 70th Annual Scientific Meeting held in Brisbane. They showed that their biomarker test for endometriosis was able to correctly identify up to 90 percent of patients with moderate or severe endometriosis in a study of over 900 participants.
The European Society of Human Reproduction and Embryology (ESHRE) 2022 guideline on Endometriosis does not recommend biomarker testing for diagnosis of endometriosis. They suggest that large, multi-centre prospective studies with independent validation sample sets are needed to investigate the potential benefit of biomarkers in the detection and prognosis of endometriosis. These recommendations were largely based on a Cochrane database systematic review which looked at the diagnostic potential of biomarkers for the diagnosis of endometriosis. So far, no reliable biomarkers are available for clinical use but it is thought that an effective biomarker may reduce the number of laparoscopies done for assessment of the pelvis for endometriosis. For now, laparoscopy remains the gold standard for diagnosis of endometriosis.
The Australian government has recently announced funding for two general practices, Garden Family Medical Clinic in Murdoch, and Pioneer Health in Albany to develop endometriosis and pelvic pain clinics. According to media statements these clinics will provide expert, multidisciplinary primary care for women living with one or both conditions. Funding has been provided to improve provision of diagnosis, treatment and management of endometriosis and pelvic pain with an ability to link to relevant primary and tertiary care services in the public and private sector.
It is expected that the introduction of such clinics will reduce the average time to diagnosis, which is currently 6.5 years. Both conditions are known to have a devastating impact on the daily lives of women who suffer from these conditions with long term mental, physical, financial, and social costs. With an overstretched public service, it would be desirable to see further clinics open to improve access to services which could provide medical, nursing, and allied support to women who suffer from endometriosis and pelvic pain.
References available on request
