The Future of Endometriosis Research & Treatment

Endometriosis was first reviewed in scientific literature as far back as 1860 by Von Rokitansky. 141 years later, how far have we come in understanding this enigmatic disease?

The disease still remains under diagnosed, under treated and under staged. Lack of awareness and insufficient support of those with Endometriosis is still prevalent. However, we have indeed made great strides.

Breakthroughs in research are being made by the scientists who have dedicated their lives to understanding and finding a cure for Endometriosis. Newer, more effective treatments are being developed and alternative methods are being more readily accepted. Myths have been dispelled and advances in surgical methods and equipment bode well for the next generation of Endometriosis patients. Better still, women are becoming more educated and empowered over their disease, so that they can take active roles in their own healthcare.

So what does the future hold for us?

Better Understanding of the Biology of Pain

We know that reasons for chronic or acute pain in Endometriosis patients on a cellular level include the release of such inflammatory agents at the implant sites as prostaglandins, bradykinin, norepinephrine and adenosine, all inflammatory mediators of hyperalgesia. It has also been shown in studies that "message centers" at the site of inflammation, called "nociceptors," have a lower threshold for pain. By understanding how and why pain occurs, healthcare providers can offer more effective management strategies of the painful symptoms associated with Endometriosis to their patients. In addition, many patients today are incorporating alternative therapies and pain management programs into their lives to combat their chronic symptoms.

Recognition and Eradication of Disease

Gone are the days when "powder-burn" lesions were considered the only form of Endometriosis, present only on the reproductive organs. Today we know that the disease comes in colors ranging from red to clear and that it can present itself nearly anywhere in the body. Disease previously classified as "rare" is now shown instead to be common. We know all forms of the disease hurt, and any stage can cause infertility. More treatment centers are cropping up all over the United States and the world, with practices dedicated solely to the treatment of Endometriosis patients. Surgeons know that Endometriosis can actually be present inside adhesions (which are painful in and of themselves), and the medical community is realizing that the most effective treatment for the disease is to thoroughly remove it through excision. Finally, we know that one does not need a uterus to suffer from Endometriosis.

Using expert techniques, adhesion prevention, patient assisted laparoscopies and many other advances in surgery, Endometriosis patients can expect better - and more effective - surgical care in the years to come. Remove disease, remove the symptoms.

Rapid Diagnosis

Unfortunately, invasive surgery like the laparoscopy is still the gold standard for diagnosis, treatment and disease staging. However, next-generation MRIs and other non-invasive diagnostics can indicate that a patient might be suffering from Endometriosis. Coupled with an increased awareness by physicians of the broad range of symptoms Endometriosis brings about, we can expect quicker diagnoses and faster treatment of the disease in the future.

Medical Therapy: Not a Cure, but Might Offer Help

Thirty years ago, Danazol was considered the drug of choice to "cure" Endometriosis. Of course, we now know that there is currently no cure. While still prescribed by some, Danazol is no longer the first medical therapy offered to Endometriosis patients. Today, GnRH (gonadotropin releasing hormones) agonist drugs like Lupron, Synarel and Zoladex are widely prescribed in an attempt to treat the disease. But what's on the horizon?

Abarelix:

It is a GnRH antagonist currently in clinical trials all over the United States. Abarelix was designed to be more effective than GnRH agonists, without some or all of the side effects.

Aromatase Inhibitors:

New to Endometriosis but not gynecology, Aromatase Inhibitors have been used in the treatment of 30,000 cases of breast cancer over the past 20 years. It has been suggested in some studies that Aromatase Inhibitors offer anti-estrogenic effects with therapeutic value. Endometriosis Research Center Advisory Panel Member Dr. Serdar Bulun and others are currently researching the efficacy of this treatment method.

SERMs (selective estrogen receptor modulators):

These are drugs that have been called "designer estrogens" because they mimic the action of estrogen where it's wanted, such as in the cardiovascular and skeletal systems, but avoid estrogenic action where it's not; i.e. breast and uterine tissue. SERMs have been shown in animal studies to prevent bone loss and estrogenic proliferation; in one study on rat models, the SERM raloxifine was administered versus no treatment. Within 2 weeks, models who received raloxifine had a significant decrease in uterine weight and exhibited overall anti-estrogenic effects. In another study on rhesus monkeys with Endometriosis, treatment with SERMs resulted in decreased uterine size and significant decreases in lesion size. There are several SERM studies underway, including one at the National Institutes of Health on the use of raloxifine in patients with Endometriosis.

Extracellular Matrix Modulators:

As outlined above, the proliferative endometrium expresses enzymes. Isolating and destroying these enzymes through the use of anti-estrogenics may be the future in medical therapy of Endometriosis.

Terbutaline:

Currently used to prevent premature labor, studies are underway to determine the efficacy of this drug as potential treatment for Endometriosis pain. Terbutaline relaxes the uterine muscles and can be helpful in easing menstrual pain related to the disease.

RU-486:

The controversial so-called abortion drug may have implications in treating Endometriosis. RU-486, an anti-progestin, binds itself to progesterone receptors on the wall of the uterus and blocks the effect of the woman's natural progesterone. In addition to its anti-progestin and anti-glucocoritcoid properties, RU-486 is also a non-competitive anti-estrogen. As such, RU-486 blocks the capacity of the endometrial tissue to grow in response to estrogen, making Mifepristone a possible hormonal treatment for Endometriosis.

Angiogenesis: Stopping the Lesion at it's Source

Professor Stephen Smith, well known for his extensive research in this exciting area, has indicated this may be a promising new treatment; though cautions that we are still 5-10 years out from using it as a formal alternative. The Angiogenesis theory holds that ectopic tissue requires blood supply, regardless of size, location or theory of implantation. Without blood vessel development, hormone impact can be negated. Hence, Endometriosis lesions can be potentially destroyed by cutting off their blood supply. Angiogenesis has interesting implications on the prevention of adhesion formation as well. It may be shown through further studies that this highly complex and unique technique holds real opportunity for treatment in Endometriosis, whether alone or as an adjunct therapy.

Endocrine Disruptors: Cleaning up our Act (and our Environment)

We have indeed come a long way in recognizing the role of environmental factors as contributors to Endometriosis and other health maladies. Dioxin is one such pollutant. Endocrine disruptors are chemicals present in our environment that, by virtue of their ability to interact with the endocrine system, are causing a variety of adverse health effects in humans and animals. Because the endocrine system plays such a critical role in normal growth, development and reproduction, even small disturbances in function may have profound and lasting effects. The Committee for Environment and Natural Resources notes, "the seriousness of the endocrine disruptor hypothesis and the many scientific uncertainties associated with the issue are sufficient to warrant a coordinated federal research effort."

The US Environmental Protection Agency clearly describes dioxin as "a serious public health threat." The EPA report states, there is no "safe" level of exposure to dioxin - even trace amounts are a risk. Further, the EPA report confirmed that "dioxin is a cancer hazard to people; that exposure to dioxin can also cause severe reproductive and developmental problems (at levels 100 times lower than those associated with its cancer causing effects); and that dioxin can cause immune system damage and interfere with regulatory hormones."

Dioxin exposure to women in particular, poses additional risks than just that of their own health: it crosses the placenta into the growing infant and is also present in the fatty breast milk, thereby exposing the child. Evidence of dioxin as a catalyst for Endometriosis has been well documented. In a 1996 Environmental Protection Agency study, dioxin exposure was linked with increased risks for Endometriosis, as well as the increased risks of pelvic inflammatory disease, reduction of fertility, and interference with normal fetal and childhood development. The EPA conclusions regarding dioxin exposure are particularly alarming in light of a 1989 Food and Drug Administration report, which stated that "possible exposures from all other medical device sources would be dwarfed by the potential tampon exposure."

According to a February 2000 report from the Food & Drug Administration, tampons and feminine hygiene products currently sold in the U.S. are made of cotton, rayon, or blends of rayon and cotton. Even though these products are now produced using elemental chlorine free or totally chlorine free bleaching processes, these methods can still generate dioxins at "trace levels." Thus, there may be low amounts of dioxin present from environmental sources in cotton, rayon, or rayon/cotton tampons and feminine hygiene products.

In April 2000, Assemblyman Dennis Cardoza of California (D-Merced) passed AB 2820 out of the Assembly Committee on Health. Supported by testimony before the Assembly by organizations like Planned Parenthood and the Endometriosis Research Center, AB 2820 is a study bill designed to research the biological effects of feminine hygiene products on women and their offspring. While the industry states their products are perfectly safe, there are conflicting studies performed by research institutes stating these products may contain low levels of a dioxin. Assemblyman Cardoza said that he "hopes this study will clear up the current hysteria and confusion. I think consumers have a right to know, without a doubt, that the products they use are completely safe." Never before has a study been conducted outside of the industry to measure the biological effects feminine hygiene products may have on their consumers. Currently, the FDA regulates these products, but rely on industry studies as proof that the products are not harmful. Industry research cannot be shared with the public because it is of a proprietary nature, so the public is left without firm knowledge of the product's safety.

Is your Food Harmful to your Health?

Did you order pesticides the last time you ate out? Did you serve your family steroids at dinner yesterday? Current research shows you might have. Pesticides are used to control weeds and pests. These chemicals are abundant in the American diet because they are found in meat, fish, chicken, pork, dairy, coffee, fruits and vegetables. Even though they are banned within United States borders, they can reach us through products grown in other countries. Steroids and hormones are fed to our livestock in order to induce growth - these harmful additives are then passed on to our families and ourselves. To avoid ingesting these substances which we now know can be hazardous, you can purchase organic products and meats that are certified drug free and/or reduce your red meat, dairy and egg intake; scrub and peel your fruits and veggies; avoid imported produce; caffeine, alcohol, tobacco and processed (canned/prepackaged) or smoked foods; and eat a diet high in fiber and antioxidants.

By educating ourselves and each other, doctor and patient alike, we are on the road to unlocking the mysteries of this disease. As we enter the millennium, we can be hopeful and encouraged in knowing that our daughters will not suffer as we have.

References and Additional Information:

"Coping with Endometriosis," Motta & Phillips, 2000. ISBN #1583330747.

"Endometriosis: Healing Through Nutrition," Shepperson Mills & Vernon, 1999. ISBN #1862043000.

Proceedings of the 7th Biennial World Congress on Endometriosis, London, United Kingdom. May 2000. Presentations in part by Olive, David MD; Kennedy, Professor Stephen; Thomas, Professor Eric; Garry, Professor Ray.

"Aromatase Inhibitor update," Serdar Bulun, MD & the Endometriosis Research Center. http://www.endocenter.org / 800-239-7280.

Committee for Environment and Natural Resources, http://www.epa.gov/endocrine/

"4 Pillars of Healing," Metzger, Deborah MD, Ph.D. http://www.helenahealth.com

United States Food & Drug Administration. http://www.FDA.gov/

National Institutes of Health. http://www.nih.gov/

United States Environmental Protection Agency. http://www.epa.gov

© 2000-2001 HCG. All Rights Reserved. Not for Republication Without Express Permission from Author.

Heather Guidone is the Director of Operations of the Endometriosis Research Center. For more articles by this author, visit: http://hcgresources.com/articles.htm