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Noted Scientist Puts New and Important Spotlight on Endometriosis

Posted Jan 08 2010 12:00am

Endometriosis has fascinated me for my entire medical career dating back to my sophomore pathology lab. As far as I can tell, little more is known about the disease today than what I was taught more than four decades ago. For example, here's a passage from Google Health regarding causality. Also see: Endometriosis: An Overview of the Disease and Its Treatment. Both sources make mention of the retrograde menstrual flow theor:

Each month a woman's ovaries produce hormones that stimulate the cells of the uterine lining (endometrium) to multiply and prepare for a fertilized egg....If these cells, called endometrial cells, implant and grow outside the uterus, endometriosis results. Unlike cells normally found in the uterus that fall off during menstruation, the ones outside the uterus stay in place....This ongoing process leads to symptoms of endometriosis (pain) and can cause scarring and adhesions of the tubes, ovaries, and surrounding structures in the pelvis. The cause of endometriosis is unknown, but there are a number of theories. One suggests that the endometrial cells....may "back up" through the fallopian tubes into the pelvis, where they implant and grow in the pelvic or abdominal cavities. This is called retrograde-menstruation. Other theories include: a faulty immune system causes menstrual tissue to implant and grow in areas other than the uterine lining; cells lining the abdominal cavity may develop endometriosis; certain families may have problems with their genes that make a woman more likely to develop endometriosis

I suspect that the continuing lack of basic understanding of the etiology of this disease is related to the fact that it causes significant morbidity but not mortality. In essence, it gets lost in the barrage of publicity about more "serious" diseases such as heart disease and cancer.This situation may be about to change (see: Scientist With Endometriosis Seeks Insights Into Her Disease). Here is an excerpt from a recent news article

Linda Griffith, an MIT professor has launched a new center to study endometriosis and other diseases of the female reproductive tract, the Boston Globe reports. There are a few interesting elements to the story. For one, the professor, Linda Griffith, has endometriosis, which occurs when tissue that lines the uterus grows in other places and can cause problems such as pain and infertility. Griffith has had nine surgeries, including a hysterectomy to treat the disease. And she was inspired to start the center in part by the experience of her niece, who showed similar symptoms, including debilitating pain — and who, like Griffith, wasn’t properly diagnosed. For another, Griffith is something of a star researcher....Griffith hopes to bring attention to the disease, which the NIH says affects at least 5.5 million women in North America, but which often goes undiscussed and undiagnosed....Along those lines, much of the work at the new center will be basic research, trying to get a better understanding of the physiology of gynepathology, a blanket term for endometriosis and other non-cancerous diseases of the female reproductive tract.

I personally view the retrograde menstrual flow theory as hogwash and favor the idea that the cells lining the peritoneum undergo metaplasia to functioning benign endometrial glands. These metaplastic cells on the surface of solid organs like the uterus and ovary then undergo invagination to explain the presence of endometrial glands deep in muscle or stroma. This transformation could be on the basis of inflammation, atypical hormonal or immune status, or heredity. Note the references above to late and incorrect diagnosis. At the very least, this new research center could pursue new and more efficient ways to diagnose the disease.

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