Endometriosis is a chronic condition in which cells similar to those lining the uterus, the endometrium, grow outside of the organ. This health problem affects more than 10% of women worldwide, including more than 6.5 million in the United States.
Though patients present with symptoms like intense pain, irregular bleeding and digestive problems, many cases go undiagnosed for seven or more years. According to BIO5 Institute member Dr. Leslie Farland, physicians and researchers likely only see the tip of the “iceberg of endometriosis” – patients with the most severe disease – because of limited diagnostic tools, stigma surrounding menstruation, and vast barriers to reproductive health care. Because of this, Farland is passionate about studying sex- and gender-based disparities in access to care.
Endometriosis is without a cure, but treatments are available to manage symptoms and related problems. For severe cases, surgery is offered to remove endometriosis lesions. Therapeutic interventions like hormonal birth control can help stop bleeding and alleviate pain, but they don’t work for all women. Farland, also an assistant professor of epidemiology at the Mel and Enid Zuckerman College of Public Health, supports development of a precision medicine treatment approach.
The exact cause of this disease is unknown. Many speculate reproductive and hormonal factors, or an abnormal immune system response may contribute, while others point to genetics, as the condition often runs in families. The disease is also linked to other health conditions like infertility, chronic inflammation, some cancers, and cardiovascular disease. By looking for patterns of association between endometriosis and other conditions like Type II Diabetes and stroke, Farland hopes to understand more about the etiology (cause) and risk factors for these conditions.
She and collaborator Dr. Melanie Bell were recently awarded a $442,000 grant from the National Institutes of Health to determine whether endometriosis is an underlying risk factor for stroke using data from more than 120,000 women. If an association is found, researchers and clinicians will better understand the risk factors for both diseases, as well as be able to identify high-risk patients who may need more diligent screening.
“By understanding the relationships between endometriosis and other comorbid conditions, not only can we identify women who may benefit from earlier screening, we may also be able to better understand how these diseases originate, and ultimately, identify treatments that may help treat both conditions,” Farland said.
Farland is also collaborating with BIO5 member Dr. Melissa Herbst-Kralovetz and Dr. Nichole Mahnert from the UArizona College of Medicine – Phoenix on future projects to assess the relationship between endometriosis and the microbiome. Results from these studies may help to inform better disease detection and treatment methods.
“Endometriosis can be an incredibly painful and burdensome condition. Additional research like ours is needed to improve diagnosis, treatment, and quality of life for the large number of women suffering this disease,” Farland said.