INFERTILITY

Early life sexual and physical abuse dramatically increases risk of endometriosis

Early life sexual and physical abuse dramatically increases risk of endometriosis

By I.Soussis MD

A prospective cohort study found that women reporting severe and/or chronic abuse of multiple types during childhood and adolescence had a 79% higher risk of laparoscopically confirmed endometriosis.

Severe abuse was defined as being kicked, bitten, punched or physically attacked more than once, or choked or burned ever, whereas severe sexual abuse was considered forced sexual activity during both childhood and adolescence.

“We saw stronger associations among women whose endometriosis was most likely diagnosed as a result of pelvic pain symptoms,” said lead author Holly Harris, ScD, an assistant professor of epidemiology at the Fred Hutchinson Cancer Research Center in Seattle, Washington.

Previous studies led by members of Dr. Harris’ research team had shown a connection between early life abuse and both uterine fibroids and hypertension. “Given recent links found between endometriosis and hypertension, one of the next logical steps was to examine the association between abuse and risk of endometriosis,” Dr. Harris told Contemporary OB/GYN.

For the study, which appeared in the journal Human Reproduction, data were collected from 60,595 premenopausal women from 1989 to 2013 as part of the Nurses’ Health Survey II cohort.

Participants completed a questionnaire on exposure to violence.

A total of 3,394 cases of endometriosis were diagnosed during 24 years of follow-up.

Overall, 34% of study participants reported moderate or severe physical abuse during early life and 11% of study participants reported forced sex, while 14% of women diagnosed with endometriosis had severe sexual abuse history.

“It is extremely important for readers, clinicians and women with or those who care about women with endometriosis to understand that these results absolutely do not imply that all women who have endometriosis have been abused,” Dr. Harris said. “Abuse in early childhood and adolescence is common among both women with and without endometriosis.”

The associations between abuse and endometriosis were stronger in women presenting without infertility. This group was also more likely to report pelvic pain.

“Sadly, childhood abuse is real, is a major public health issue, and can have long-lasting impacts on health,” Dr. Harris said. “In addition, for women with pelvic pain with or without endometriosis, it is important that they know that these symptoms are not normal.”

When these women raise concerns about their pain with clinicians, they should not be dismissed, no matter their age or history, according to Dr. Harris. “There is a growing body of evidence that pain sensitization can result from a physiologic response to the stress and trauma of abuse,” she said. “This occurs not only among women with endometriosis but also among women with other pain conditions.”

 

Read more: https://academic.oup.com/humrep/article-abstract/33/9/1657/5055017?redirectedFrom=fulltext

 

Source: http://www.contemporaryobgyn.net/endometriosis/does-abuse-affect-risk-endometriosis?rememberme=1&elq_mid=4894&elq_cid=607376&GUID=69980457-AFA5-43B0-B217-28D67525EA6C

Discovery promises early diagnosis of endometriosis

Discovery promises early diagnosis of endometriosis

By I.Soussis, MD, MSc, FRCOG, Fertility Specialist

 

Scientists from the Feinstein Institute for Medical Research announced an experimental, rapid and non-invasive way to diagnose endometriosis, which may lead to earlier and more effective treatments for this disorder that affects approximately 176 million women globally.

The scientists found that a particular feature of cells found in menstrual blood suggests that a patient has endometriosis, according to findings published in Molecular Medicine.

The simple test uses menstrual blood and takes only a few days to report. This is a dramatic improvement over current diagnostic methods that rely on laparoscopy, which patients try to avoid, delaying diagnosis typically five to 10 years from the onset of symptoms.

Endometriosis is a chronic condition in which the endometrium grows outside the uterus, typically in the abdominal cavity or on internal organs. Patients often experience significant pain and discomfort during their period or intercourse.  Endometriosis may also lead to infertility or hysterectomy.

Researchers at the Feinstein Institute established the Research Out-Smarts Endometriosis (ROSE) program to study the genetic basis of endometriosis and what is occurring at the cellular level in this disease. As part of ROSE, healthy women and others with endometriosis, provide peripheral and menstrual blood samples which are stored in a biobank so that they can be analysed in current and future research studies.

The recently-published study focused on the role of stromal fibroblasts, a type of stem cell found in menstrual blood, and the immune system. Professors Christine N.Metz, PhD and Peter K.Gregersen, MD, along with Laura A. Warren, an MD-PhD student at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell have led this research effort.

“The cause of endometriosis is not known. One theory is retrograde menstruation, which is where menstrual blood containing uterine tissue is transported into the abdominal cavity instead of out of the body. Almost all women experience retrograde menstruation, but we’re unsure why in some women this endometrial tissue latches on to the abdominal wall and internal organs and grows causing endometriosis,” said Dr. Metz. “In this study, we found that the stem cells in the menstrual blood of women with endometriosis are very different from those of healthy women and we are learning from these differences to develop a novel non-invasive diagnostic test.”

Metz and her colleagues observed that the menstrual blood of endometriosis patients contained a significantly smaller number of uterine natural killer (uNK) cells compared with healthy participants. In addition to this decrease, they observed that endometriosis patients’ stem cells showed impaired decidualization, a process that prepares the uterus for embryo implantation.

“Instead of having to undergo surgery to accurately diagnose endometriosis, these findings will enable us to develop a rapid test for endometriosis based on menstrual blood, which can be easily collected. This will allow medical professionals to know if someone is at risk of developing endometriosis and start treatment sooner, and it will help them monitor patients’ responses to treatment,” said Dr. Gregersen. “Endometriosis is a chronic, complex condition and improved understanding of this disease through studying menstrual blood is likely to drive personalization of new therapies.”

 

You can read the data published in Molecular Medicine, here:

https://molmed.biomedcentral.com/articles/10.1186/s10020-018-0009-6.

Source: https://www.feinsteininstitute.org/2018/03/feinstein-institute-discovery-promises-improved-diagnosis-understanding-endometriosis/

Image credit: http://healthizmo.com/endometriosis-what-you-need-to-know

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