According to Endometriosis.org, “Endometriosis is a condition in which tissue similar to the lining inside the uterus (called “the endometrium”), is found outside the uterus, where it induces a chronic inflammatory reaction that may result in scar tissue. It is primarily found on the pelvic peritoneum, on the ovaries, in the recto-vaginal septum, on the bladder, and bowel.”
This disease affects at least one in every 10 women during their reproductive years, which is usually between the ages of 15 to 49. What this statistic equates to is having around 176 million women worldwide suffering from this disease.
While data shows that endometriosis affects a huge number of women all over the world, unfortunately treatment isn’t as available for this chronic health issues. And at other times, it’s widely ineffective as well. In this Special Feature article, we will share whether the data regarding some new and upcoming endometriosis treatment is truly promising.
One huge problem when it comes to endometriosis is that while it’s a health problem that can affect females from birth, many times it actually goes undiagnosed. And the fact that it is a chronic health condition means that there is no cure for it either.
With the month of March being Endometriosis Awareness Month, this is an informative article that will better help you understand what this disease is all about, it’s causes, as well as any new and developing treatments.
What Exactly is Endometriosis?
Womenhealth.gov cites that one of the main symptoms of endometriosis is pain. This usually happens due to the natural characteristic of this disease where it causes swelling and bleeding in a very similar way that happens to the uterine tissues when one has their period.
When this happens, heavy and painful periods occur that tend to become worse over time. Another common issue is pelvis pain or chronic lower back pain as well. And these aren’t the only challenges that endometriosis can cause. Other such issues are bloating, spotting or bleeding in between periods, nausea, pain during sex or when going to the bathroom, constipation, and diarrhea.
In order to get a formal diagnosis, most patients are required to undergo laparoscopic surgery, a procedure that requires small incisions in the abdomen, leading to discomfort or pain immediately afterwards.
For many that don’t have symptoms, they normally find out that they have endometriosis when trying to conceive becomes difficult or impossible. In fact, statistics show that at least 4 out of 10 women that are diagnosed with infertility normally have undiagnosed endometriosis. In addition, many of them are also diagnosed well into their 30s or 40s, which are also said to take around 8 years on average as well.
In fact, Endometriosis UK cites that around 62% of women between the ages of 16 to 54 tend to delay their treatment because they believe that their issue isn’t worth discussing with a doctor. Some reasons why are due to being too embarrassed about it, that they think their symptoms won’t be taken seriously, or because they think painful periods are no reason to be concerned.
Unfortunately, endometriosis and the growths that occur because of this condition can actually cause infertility due to a number of reasons, as explained below.
- Creates problems with the development of the uterine lining, which then makes egg implantation challenging
- It can block the fallopian tubes or also cause fluid-filled ovarian cysts to form, otherwise known as endometriomas. These can also cause the ovaries to twist or worse, rupture, which can also cut off blood supply to these organs and actually kill them.
- Impact egg and sperm function and movement negatively, as well as causing problems with implantation, fertilization and embryo development as well.
- Making it difficult to allow the egg and sperm to meet and unite because of how it changes the shape of the pelvis or reproductive organs
- Allowing the immune system to accidentally yet negatively affect a health embryo
Endometriosis Causes and New Research
Although there are studies and new research when it comes to endometriosis, researchers are still attempting to understand and uncover the actual reason or reasons why it actually happens in the first place.
The Office on Women’s Health explains that endometriosis probably ‘happens when tissue similar to the lining of the uterus (womb) grows outside of the uterus,’ like the pelvis.
These growths could also develop because of elevated levels of hormones and immune cells like prostaglandins, estrogen, cytokines, and a ‘reduced response to the hormone progesterone.’
Endometriosis could also have a genetic basis, which means that it normally runs in families. But, there is also some consideration that it’s because of the immune system, which lacks the ability to find or kill off certain growths that are considered endometriosis.
It is also more common in women that suffer from ovarian or breast cancer. Another reason that some doctors believe is due to accidentally moving around endometrial tissue from one portion to another part of the body during surgeries.
A number of key factors also linked with the development of endometriosis in particular cases are as follows:
- Lengthened periods that are longer than 1 week
- Health issues that may stop or block menstruation
- Menstrual cycles that are only 27 days or less
- Infertility or never having kids
Meanwhile, researchers have continued to look into new reasons why endometriosis happens and what possibly influences the severity of the condition too.
Research that was published in PLOS Genetics back in 2020 have shown that women with endometriosis even have chemical modifications to their DNA, which people without the condition do not have.
Such differences are in DNA methylation, which is a process where methyl group compounds bind to one’s DNA and change the gene’s activity. Such methyl changes actually alter depending on how bad their case of endometriosis is.
Looking forward, scientists share that they can use these DNA modifications to enable doctors to diagnose endometriosis without having patients undergo surgery.
Some newer evidence also shows that environmental factors also play a key role in the development of endometriosis, as well as it’s severity.
In 2018, a large study was published in Human Reproduction which showed that ‘severe-chronic sexual and physical abuse of several types increased the risk of a formal endometriosis diagnosis by 79%.’
Animal research has also found that environmental toxins, like dioxin, could possibly impact the immune system, reproductive system, and hormone functioning by increasing the risk of developing endometriosis. But human links have yet to be proven. There are studies looking at a potential link between endometriosis and exposure to toxins, but more research is needed.
Research groups are also examining what other health conditions could be possibly linked to endometriosis, such as allergies, fibromyalgia, chemical sensitivities, chronic fatigue syndrome and asthma.
What Are the Existing Treatments?
Unfortunately, there is no current cure for endometriosis. Yet, in most cases the symptoms can improve with the use of medication, surgery or possibly both. Certain over-the-counter medication like nonsteroidal anti-inflammatory meds could actually help control pain associated with endometriosis.
Many times, physicians will prescribe hormonal medications to help deal with symptoms of endometriosis. Some of the most common ones are birth control pill, gonadotropin-releasing hormone (GnRH) meds, and progestin-only medication.
How these hormonal medications aid in endometriosis treatment is by reducing the excess tissue growth, which lessens the formation of new adhesions or growths. Endometriosis adhesions is normally were the chronic inflammation creates scar tissue, mostly found within the pelvic area, most commonly around the bladder, ovaries and uterus.
When using GnRH meds, it can also stop ovulation and menstruation as it also stops the endometriosis growths that usually occur. In other severe cases, when these types of hormonal medications don’t work, some doctors perform surgery where they physically take out the growths.
Presently, it’s still too hard for surgeons to find and remove all the excess growths when performing laparoscopic surgeries. This is why, more often than not, patients symptoms never go away, which leads them to getting additional surgery later on.
Sadly, up to 80% of patients end up feeling symptoms again within the first two years after their first surgery. Many times after their surgeries, patients are also advised to go on hormone treatments to lessen or maintain their current condition and whatever symptoms they still have.
In worse case scenarios were all other treatments fail and the pain is just too severe, most doctors will advise their patients to undergo hysterectomies to remove the uterus, and sometimes, the ovaries as well.
What Are the Emerging Treatments?
Unfortunately, none of the current treatments – which are mostly hormonal medications – are completely effective or even safe, and some have major drawbacks and potential risks. In fact, most hormonal medications actually cause headaches, anxiety, weight gain, bone density loss, digestive problems and depression.
Plus there is always a risk when it comes to surgery such as scarring, excess bleeding and possible infection. This is why researchers are continuously trying to come up with new types of treatment.
Another huge factor when it comes to the current endometriosis treatments is that they normally are solutions that prevent pregnancy or possibly keeping a pregnancy. This also means that for women attempting to get pregnant but are diagnosed with endometriosis normally have very little options when it comes to treatment.
One clinical trial that is ongoing is attempting to see whether dichloroacetate (DCA) could be a non-contraceptive and effective treatment for women suffering from endometriosis. Normally, DCA is used by doctors to help treat children with metabolic disorders.
Ongoing research also shows that women with endometriosis often have excess lactate within the pelvis. What DCA does is lower lactate production, which can reduce the survival rate and creation of endometriosis growths.
Meanwhile, a study on cannabis or cannabinoids has also shown increased evidence that could possibly aid in endometriosis treatment by restoring imbalances in one’s endocannabinoid system (ECS) which could possibly cause endometriosis symptoms. The study shows how cannabidiol interacts with the ECS in order to lessen the enzyme production that aids in inflammation and the spreading of cells.
A 2020 study shows how 59% of women that use cannabis as self-treatment for endometriosis symptoms clam they managed to stop using pain medications, such as opioids, completely.
More research on finding medications that are designed specifically to target endometriotic tissues while keeping healthy tissues left unharmed is still ongoing. Such peptide (small strings of amino acids) medications could help work towards regulating any defective molecular processes that are responsible for the growth of the these excess tissues that define endometriosis. The hope is that they will also aid in destroying such tissues as well.
Research teams have been looking into medications that can assist in treating cases of endometriosis by changing or lessening the levels of macrophages. Macrophages are actually ‘immune cells that aid ‘encourage blood flow to, innervation (nerve sensation) of, and growth of endometriosis growths.’
A 2019 study of mice with endometriosis showed signs of reverse pain behaviors by decreasing the macrophage levels.
Research teams are also looking an noninvasive – otherwise considered nonsurgical – types of therapy such as physical therapy, to see whether it can help lessen endometriosis symptoms.
A study conducted this 2021 of the regular pelvic floor physiotherapy managed to lessen pain during sex, as well as chronic pelvic pain, and even improved pelvic relaxation in females diagnosed with endometriosis.
Scientists are also attempting to see if nanomedicine, which is used for cancer patients, will work for treating and diagnosing endometriosis as well. Nanomedicine, as the name suggests, is described by Britannica.com as a’ branch of medicine that seeks to apply nanotechnology – that is, the manipulation and manufacture of materials and devices that are roughly 1 to 100 nanometres in size – to the prevention of disease and to imagine, diagnosis, monitoring, treatment, repair, and regeneration of biological systems.’
A first-of-its-kind clinical study is currently on going in the Netherlands to figure out if nanomedicine, such as fluorescence imaging, can actually help physicians picture excess tissues. What this does is use injectable fluorescent dyes to highlight any internal structures to make it easier for doctors to see.
Meanwhile, another study conducted in 2020 had researchers using nanoparticles packaged with dye that had the ability to create fluorescent signals and cell-destroying heat when they are placed close to near-infrared light to both identify, as well as destroy, any abnormal endometriosis growths found in study mice.
Emerging Knowledge in Endometriosis
There is still a lot that of information that researchers are looking into to help diagnose endometriosis at an earlier stage, to enhance and improve types of treatment, and basically lessen any risk from possible serious complications from endometriosis.
Women’s health advocates are also lean on the research community to help gather more knowledge, as well as help figure out better treatment and diagnosis procedures.
One such group of experts, researchers, clinicians and patients, called the Society for Women’s Health Research, conducted a 2019 review that found that ‘despite the high prevalence and emotional and economic impact associated with endometriosis,’ they share that this particular medical issue continues to be underfunded, which means that it is also under-researched.
This group also shares that it’s because of these particular factors that new development, as well as diagnostic and treatment options, are not easily available to those that need them. One major reason could also be due to the stigma surrounding women’s menstruation, as well as the lack of attempt to normalize female pain associated with menstruation and endometriosis itself.
Since March is Endometriosis Awareness Month, this is the time to take some steps to help lessen any harmful stigmas, as well as support further research for endometriosis. You can help by simply speaking about endometriosis with family, friends, and best of all, a doctor, using tips from a number of websites such as SPEAKENDO.com and Endometriosis.org.
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