Highlights from WCE 2014 - Part 2

Let’s continue our exploration through the World Congress on Endometriosis 2014 and we’re going to delve into some of the research about what makes women with endo different from those without and how this could give us clues as to what causes endo in the first place.

A team from Australia made an interesting discovery regarding stem cells and endometriosis. You have probably heard about stem cells before, but why would they be of interest in endometriosis? Stem cells are the precursors to the different types of cells in your body and are mostly of use during the very early part of your development when you were a foetus growing new organs. But they still have some use as an adult, for example, inside the uterus there are a population of stem cells that your body uses to regrow the endometrium after each menstruation, which are unsurprisingly referred to as endometrial stem cells. If these cells can grow endometrium and endometriosis is endometrium-like tissue, it becomes clear how these stem cells could play a role in endometriosis. Some researchers believe that genetic changes associated with endometriosis result in some endometrial stem cells becoming displaced during embryo development, which go on to produce endometriotic lesions as a girl approaches adolescence. Others believe these stem cells are shed into the pelvic cavity by retrograde menstruation (where the menstrual blood goes into the pelvic cavity) and implant around the pelvis and then develop into endometriotic lesions.

This investigation by the Australian team looked at the number of endometrial stem cells in the blood, menstrual blood and peritoneal fluid of women with and without endometriosis. What they found was that, although the amount of peritoneal fluid was similar between the two groups, the number of viable endometrial stem cells in the peritoneal fluid was massively higher in women with endo. So how did those cells get there? Retrograde menstruation is a likely explanation, but they found no difference in the amount of stem cells in the menstrual blood between women with and without endo.  It could be that the immune system of women with endo doesn’t clear the refluxed stem cells and they just accumulate or maybe there is some other way these cells are getting into the pelvic cavity, at this moment nobody knows for sure.

Speaking of peritoneal fluid, a group from the US and Brazil analysed the peritoneal fluid looking for inflammatory factors that are related to endometriosis associated pain. What they found was that dyspareunia (painful sex), non-cyclic pain and infertility were not related to the inflammatory factors they were studying. What they did find though was that certain inflammatory factors were associated with dysmenorrhea (excessively painful periods). This has some potentially very interesting implications, particularly as dysmenorrhea is the most common symptom of endometriosis. This suggests that dysmenorrhea is caused by areas of chronic inflammation around the sites of endometriosis regardless of stage or location. If it were possible to find out how these inflammatory factors are being produced and find a way to reduce the level of these factors, in the future this could be a new way of treating the pain associated with endo. 

More highlights on the way soon...