1 of 10: raising awareness of endometriosis

Although March is widely recognized as the month in which we celebrate International Women’s Day, it also marks another important occasion: Endometriosis Awareness Day. It is estimated that one in ten women suffers from endometriosis, yet no cure for this condition has been found. What exactly is endometriosis, and is the development of new therapies on the horizon?

What is endometriosis?

Endometriosis is a chronic disease characterized by the presence of endometrial tissue, normally found in the uterus, outside of the uterine cavity, most commonly on pelvic organs. In more severe cases, endometrial lesions may infiltrate the muscular tissue of surrounding organs or even spread beyond the pelvis, such as to the lungs.

The exact mechanism of endometriosis remains unclear, but it is believed that the disease originates from retrograde menstruation—a process in which endometrial tissue flows back into the peritoneal cavity during menstruation, leading to the formation of lesions.

While some women with endometriosis remain asymptomatic, the majority experience symptoms such as pelvic pain and dysmenorrhea. These symptoms can significantly impact quality of life and daily activities, potentially contributing to the development of psychological symptoms. Additionally, endometriosis is a common cause of infertility.

Treatment of endometriosis

The diagnosis of endometriosis is a complex process due to the nonspecific nature of symptoms, the variability in the presentation of the disease, and the stigma associated with gynecological conditions and symptoms. The primary diagnostic method is laparoscopy, an invasive procedure used to identify and remove lesions, while additional imaging techniques such as ultrasound and magnetic resonance imaging (MRI) may also be utilized.

Laparoscopy and similar surgical procedures are not only diagnostic tools but also serve as a treatment method by excising existing lesions. In addition, a combination of hormonal therapy and anti-inflammatory medications is commonly used. Hormonal therapy includes oral contraceptives and gonadotropin-releasing hormone (GnRH) analogs, aiming to reduce estrogen levels, as estrogen is believed to promote lesion proliferation. Non-hormonal therapy primarily involves analgesics, particularly nonsteroidal anti-inflammatory drugs (NSAIDs), which provide both pain relief and anti-inflammatory effects.

New developments

New insights into endometriosis and a greater awareness of its impact on the daily lives of many women have led to advances in both its diagnosis and treatment. In diagnostics, the development of more advanced imaging techniques is reducing the need for invasive diagnostic procedures. Additionally, potential biomarkers are being investigated as indicators of the disease, with particular interest in various microRNAs (miRNAs), whose elevated or reduced levels may signal the presence of endometriosis.

As the pathophysiology of endometriosis becomes better understood, new therapeutic candidates are emerging. One notable finding in women with endometriosis is an elevated level of lactate, suggesting that lesion cells exhibit increased glycolytic activity. This has led to the investigation of dichloroacetate, a glycolysis inhibitor, as a potential treatment option.

What comes next?

Although significant progress has been made in recent years regarding the pathophysiology, diagnosis, and treatment of endometriosis, this condition remains poorly understood and incurable. For patients, this often means that it can take several years after the onset of symptoms to receive a diagnosis, leading to unnecessary physical and psychological pain.

Further research is essential to discover new diagnostic methods, such as biomarkers, and novel therapies that would enable patients to lead normal lives despite the disease. In the meantime, it is crucial to raise awareness about endometriosis—not just in March, but every day.

Translated by: Josip Kokanović