For Your Patients: New Directions in Endometriosis

Despite affecting nearly 180 million girls and women across the globe, endometriosis has traditionally been underdiagnosed and undertreated -- even dismissed as nothing but the ordinary menstrual aches and pains of being female. But new knowledge of the debilitating condition has redefined it as a chronic, whole-body inflammatory disease -- not dissimilar to rheumatoid arthritis -- that can affect many body systems beyond the uterus and pelvic cavity and cause pain at times other than the monthly menses.

That new take is good news for those suffering from the disabling chronic pain and infertility the condition can cause.

More Awareness and Screening

More emphasis is now being placed on making healthcare professionals, medical students, and the public aware of the risk factors and early signs of the disease – along with its toll on patients and their families, as well as the healthcare system and the economy through lost school and work days and productivity.

In the future it is likely that family doctors and gynecologists will be trained to ask more endometriosis-specific questions during the medical exams of young women, which will help to better distinguish ordinary dysmenorrhea from endometriosis.

Earlier and Non-Invasive Diagnosis

While endometriosis is often diagnosed and treated based on a woman's clinical symptoms and risk factors, definitive diagnosis still requires laparoscopy surgery to remove and examine tissue. But researchers are now looking at genetic markers in blood that will detect or rule out the presence of endometriosis in the circulation and allow for faster and easier diagnosis.

An easy test will allow girls to be screened for endometriosis just as they are routinely screened for cervical cancer, which although potentially lethal, strikes far fewer women over their lifetimes than does endometriosis. In turn, easy definitive diagnosis will prompt earlier treatment before the adhesions have a chance to progress, impair fertility, and perhaps require surgical removal.

New Treatments

Since endometriosis is fueled by estrogen, reducing or blocking the production of this hormone is likely to remain the mainstay of therapy for the near future.

But researchers are investigating new non-hormonal treatments that may curb the disease and related pain without affecting fertility for women who want to become pregnant during treatment.

Some investigators are following the example of cancer scientists in order to avoid the surgical removal of endometriotic tissue. One group found that adapting a heat-based technique used for killing cancerous tissue can quickly and safely remove endometriosis. In this heat-based treatment, minute magnetic particles are given by intravenous infusion to target a blood vessel growth factor found in endometriotic tissue. When exposed to an external magnetic field, the particles generate high heat and quickly and safely destroy endometriotic lesions.

Other cell-targeted treatments applied against malignant tumors are under study for curbing or clearing endometriosis lesions. For example, anti-angiogenic drugs that block the growth of the blood vessels that feed tumors are being studied in the context of this gynecologic condition.

In addition, inflammation-fighting agents used in chronic immune-based diseases such as psoriasis, rheumatoid arthritis, and Crohn's disease are being considered for endometriosis.

Reducing Environmental Triggers

Studies are also underway on the possible role of common chemicals in the environment that could disrupt a woman's hormones and raise endometriosis risk. These chemicals are found in a wide range of everyday consumer products as well as the water supply. Clarifying the possible role of these endocrine disruptors in the development and severity of disease may lead to policies to reduce exposure.

More Research Funding

Endometriosis is finally starting to get more of the funding it deserves. In 2020 the U.S. Congress voted to double federal support for endometriosis to $26 million. In 2019 available funding amounted to the equivalent of just $1 for each patient diagnosed.

As financial support increases, more scientists will be able to investigate the genetic and cellular basis of this disease and develop preventive measures and new treatments with fewer side effects. The future is looking brighter for those who develop endometriosis.

Read previous installments in this series:

For Your Patients: What Is Endometriosis?

For Your Patients: Will Your Doctor Diagnose Endometriosis?

For Your Patients: What to Know About Endometriosis Treatment

For Your Patients: Fertility and Pregnancy in Endometriosis

For Your Patients: Managing Endometriomas: What to Know

For Your Patients: Tips for Talking to Your Doctor About Endometriosis

For Your Patients: 10 Q&As About the Burden of Endometriosis

For Your Patients: The Links Between Endometriosis and Other Diseases

For Your Patients: Lessening the Risk and Severity of Endometriosis

"Medical Journeys" is a set of clinical resources reviewed by doctors, meant for physicians and other healthcare professionals as well as the patients they serve. Each episode of this 12-part journey through a disease state contains both a physician guide and a downloadable/printable patient resource. "Medical Journeys" chart a path each step of the way for physicians and patients and provide continual resources and support, as the caregiver team navigates the course of a disease.