MANHASSET, N.Y.—Researchers at the Feinstein Institutes for Medical Research recently published new data in Frontiers in Reproductive Health that helps validate the hypothesis that menstrual effluent (ME) may be used to diagnose the disorder and revealed new clues into its potential causes.
Endometriosis is a common, chronic and often misdiagnosed disorder that affects 6-10 percent of women, and is frequently accompanied by chronic pelvic pain and infertility. Endometriosis diagnosis is typically delayed by 6-10 years after symptoms first appear. Diagnosis is complicated by the fact that it requires invasive surgery for confirmation.
In 2013, to better understand the disorder and explore new non-invasive diagnostic methods, professors Christine N. Metz, Ph.D., and Peter K. Gregersen, M.D., formed the Research OutSmarts Endometriosis (ROSE) initiative to collect and study menstrual effluent. To date, over 500 women from across North America have joined the clinical study.
“Drs. Metz and Gregersen are pioneers and leaders in endometriosis research. Their efforts reveal new strategies to diagnose and treat this devastating syndrome,” said Kevin Tracey, M.D., president and CEO of the Feinstein Institutes.
With the collection of ME, researchers examined the genetic basis of endometriosis and what occurs at the cellular level, specifically the analysis of menstrual effluent-derived stromal fibroblast cells (ME-SFCs).
The new research explores the hypothesis that inflammation in the uterine lining promotes the disease, not just in the pelvic cavity. To test this, the ROSE team took healthy women’s ME-SFCs and introduced them to inflammatory cytokines (TNF and IL-1β) in vitro. Researchers then observed that the cells develop the same characteristics as ME-SFCs from endometriosis subjects, which resulted in altered gene and protein expression, as well as increased cell migration.
These observed results are consistent with the hypothesis that chronic intrauterine inflammation influences the development of endometriosis lesions in the pelvic cavity following retrograde menstruation, which delivers endometrial cells found in menstrual effluent to the pelvic cavity — where most endometriosis lesions are found. This finding sheds new light on the pathogenesis of the disease.
“To be able to mimic the development of endometriosis-like cells in a controlled environment is a significant breakthrough to better understand how this disorder develops in a woman’s body,” noted Gregersen. “Observing the formation of endo-like cells opens up the door for developing new, more effective, and better-tolerated treatments and new hope for millions of women suffering from this condition.”
The new research confirms and extends the results of the biomarker study published by the ROSE team in 2018, showing the development of a promising non-invasive diagnostic method for endometriosis based on menstrual effluent. This study has also expanded its patient population to include women who have symptoms of endometriosis, but who have not yet undergone surgery to confirm their diagnosis. By using this patient population, researchers can check before and after diagnosis to validate that menstrual effluent may be used to identify the disorder with accuracy and good sensitivity.
“Endometriosis diagnosis is often delayed up to 10 years because of misdiagnosis, social pressure, and the need for invasive surgery. By expanding the study to include symptomatic women waiting for an official diagnosis, we can cross-check our results, and show that menstrual blood could provide the key to non-surgically identify this debilitating disorder much earlier than in the past,” added Metz.
The study of ME can potentially reduce the burdens of endometriosis by eliminating the diagnostic delay, improving the understanding of the disease and promoting earlier treatments. Women with endometriosis or symptoms of endometriosis — like abdominal bloating, chronic pelvic pain, painful menses, pain during intercourse, and/or pain going the bathroom — who wish to enroll and donate their menstrual effluent samples can fill out an interest form here.