The Kids Aren’t Alright – Part III

One of the biggest challenges in endometriosis today is the reduction in the time to diagnosis. Depending on where you are and what healthcare access you have, the time from initial onset of symptoms to diagnosis can be between 4-7 years (on average, but I’ve known individual cases which can be as short as a few months, or as long as 25 years). Obviously this is a continuing and serious issue affecting women with endo - delayed diagnosis means delayed treatment which means prolonged suffering. Of course it’s all very well and good me saying that diagnostic times need to improve, but how might that actually be achieved?

Awareness and education about endometriosis for both young girls and medical professionals is a great way to improve knowledge about the condition and therefore raise the bar in terms of quality of care received. It’s heartening to see that all the hard work of patient advocacy groups and charities has noticeably increased the presence of endometriosis in the collective consciousness. In the UK I’ve noticed far more awareness and promotion of endometriosis in just the last six or seven years. By some measures this appears to be working – in one study conducted in the US girls and women under 18 and over 18 with endometriosis were surveyed about their experience of the disease so far. The average time between symptom onset and surgical diagnosis for the under 18’s was 2 years, for the over 18’s this was 5 years. Hopefully this represents a trend of decreasing diagnostic delay for the future.

One of the key steps here is increasing endometriosis education for young girls (and it should be said, boys too). Why is educating young girls so important? A survey of over 4,000 adult women with endometriosis found that 67% experienced the onset of symptoms during adolescence. I’ve included some links at the bottom of this article that show endometriosis is not a disease of the ‘career woman’ as was the harmful stereotype for so long, it is a disease of the young girl, which becomes a battle for the adult woman.

Education of course would entail teaching girls about the signs and symptoms of endometriosis, along with how it is managed and treated. However, we’re making an assumption that endometriosis symptoms are the same in young women and adults. Several small studies in the past have been inconclusive as to whether adolescent endo is the same as adult endo in terms of symptoms and characteristics of the endometriosis lesions themselves. Some studies indicate that the physical appearance of endometriosis lesions in younger girls tends to represent ‘earlier’ stages of the disease, with atypical, subtle or red lesion types being more common in adolescents. This indicates that 1) endometriosis in young girls may be extra difficult to diagnose due to subtly of the disease, and 2) endometriosis may be progressive, becoming more advanced with age, highlighting a requirement of early intervention for effective pain relief and preservation of future fertility.

A larger systematic review of studies into adolescent endometriosis looked at results of multiple studies into the stages of endometriosis in adolescent and adult women, their findings are represented on the graph below

Adolescent data is that of those girls without failure of hormonal suppression. Adult data taken from this study,

So, while advanced stage endo does occur in adolescents, it is less common than adults. A larger study on the symptoms of endometriosis in women and girls under and over 18 found that, overall, there weren’t many significant differences in the symptom profiles, indicating symptoms of endo tended to be similar in young and adult women. Some of the key symptoms that were more common in adolescents were: non-cyclic pain that did not get better with hormone treatment, and nausea accompanying pelvic pain. These authors also found that, like adults, pain in adolescents interfered with school, work, socialising and sleep, but gastrointestinal symptoms also significantly interfered with these daily activities too. Young girls may find discussing symptoms related to periods, menstruation and gastrointestinal problems embarrassing, therefore are unlikely to openly talk about them. It is therefore important for educators, parents and doctors to have the information in these studies available to give to their children.

So far this post has focussed on the symptoms and type of disease found more frequently in young women and girls with endo. But what about the way in which endometriosis affects their lives? A recent study investigated this by giving quality of life surveys to 360 girls with surgically confirmed endometriosis (cases) and 207 girls with no history of endo (controls) between the ages of 10 and 24.

The quality of life surveys came in two parts, first a physical health component that covered: general health, bodily pain (limitation due to pain), role limitation (problems with work/daily activities) and physical functioning (the ability to perform any physical activity). Secondly, a mental health component that covered: mental health (feelings of anxiety and depression), role limitation – emotional (problems with daily activities due to emotional health), social functioning (interference with social activities due to physical and emotional problems) and vitality (levels of energy/fatigue).

The results of this study showed that the case girls scored significantly worse in every component on both physical and mental health aspects. This was particularly noticeable for general health, bodily pain, role limitation, social functioning and vitality.

A particularly interesting finding was the prevalence of anxiety and depression in young women in this study. The graphs below shows the percentage of participants reporting anxiety, depression and exercise avoidance during menstruation.

As you can see, young women with endo suffer more with mental health conditions and will withdraw from physical activity during menstruation far more than their endo-free counterparts. It is well known that anxiety and depression are more common in adult women with endo than adult women without endo, but seeing that this trend starts so early in life highlights how important early intervention for endometriosis are, not just for physical health, but mental health too.

Perhaps unsurprisingly, this study found that pain was the biggest impactor of quality of life in young women. Pain appeared to be the only factor in this study to be linked with a decrease in mental health quality of life score too. What is quite interesting is that lower quality of life scores, in particular for physical health, were also associated with starting periods before the age of 11. Another interesting finding was that underweight girls with endometriosis had lower physical quality of life scores than their normal weight counterparts. The reason this is interesting is that it fits with other research suggesting that lean or underweight body size during childhood is associated with an increased risk of endometriosis as an adult.

The question therefore arises, does low body weight cause an increased risk of endometriosis, or does endometriosis cause a low body weight in young women? Although there isn’t much research available to answer this question, one study (using a mouse model of endometriosis) suggests that endometriosis is associated with altered gene expression in the liver, leading to altered metabolic activity favouring leanness. Whether or not this is true in humans, remains to be seen.

Although this has not been a comprehensive examination of all the literature related to endometriosis in young women, we have seen that the signs of endometriosis can present at an early age, and that the symptoms of the disease can be just as bad in childhood as they are in adulthood. Given the negative impact that endometriosis can have on a young person’s life both physically and mentally, recognising the signs of the disease, treating girls’ concerns as valid and giving them effective treatment is the only way endometriosis can be tackled for future generations.

  

Want to know more? Here are some links to selected free articles on endometriosis in young women

Endometriosis in Adolescents is a Hidden, Progressive and Severe Disease that Deserves Attention, not just Compassion

Clinical Profile of Young and Adolescent Women with Laparoscopically Diagnosed Endometriosis in a Singapore Tertiary Hospital

Endometriosis in Adolescents

               

The Kids Aren’t Alright – Part II

One of the many misconceptions around endometriosis is that it is a disease solely afflicting adult women in their mid-thirties. This belief was prevalent for many, many years and still lingers today. However, whilst it may be true that most women with endo are usually diagnosed in their twenties or thirties, the truth is the symptoms of endo appear far earlier and, through dismissal of symptoms leading to diagnostic delay, the true age at which endometriosis presents is overlooked.

Fortunately today there seems to be a drive to increase study and awareness about endometriosis in young women. Today I am going to discuss one such study from the US, a free, full text version of the article you can find here.

This study included 25 cases of girls under 21 years old undergoing laparoscopy for pelvic pain who had no previous diagnosis of endometriosis either from laparoscopy or radiological methods (ultrasound, MRI etc). Information was collected from all patients before and after surgery to see what the characteristics of endometriosis in these patients could tell us about adolescent endo (albeit in a small cohort, but you’ve got to start somewhere).

The average age of the patients in this group was 17.2 years old. Interestingly 14 out of the 25 (56%) reported a family history of endometriosis. This is far higher than what you would expect if it was a group of girls selected at random from the general population. What this means is that risk of developing endometriosis at a young age is significantly increased by a family history of endo, a fact that doctors and women with endo who have daughters need to be very aware of. The results of this study do seem to suggest that parents with endo are more than capable of advocating their case though, as 44% of referrals came from the patient’s mother.

In terms of the symptoms the girls experienced, the most common gynaecological symptoms were the ones most typically associated with endo, such as dysmenorrhoea (excessively painful periods) in 64% and abnormal/irregular bleeding in 60%. This is an issue of particular importance as these symptoms can lead to days missed from school every month, potentially damaging a young girls prospects in adulthood. Only 4 out of the 25 patients reported dyspareunia (painful sex), but being as only 8 out of the 25 reported being sexually active, dyspareunia is a poor measure of endo risk in this population. 

Of the gastrointestinal symptoms nausea was the most common, being present in nearly half (44%) of all patients. Between a quarter and fifth of all patients experienced some other gastro symptoms, such as constipation or diarrhoea. Fatigue, an often unrecognised symptom of endo, was also present in around a quarter of all patients and seems to get more common with age.

A very high degree of variation was reported in the time it took from the initial visit to a physician to diagnosis. The range in this cohort varied from 1 month to 9 years, with the delay between onset of symptoms and diagnosis being 2 years on average. This just goes to show how important it is for doctors to be well educated in recognising the signs of endometriosis in adolescent girls and adult women.

The authors of this study mentioned another survey of over 4000 women diagnosed with endo. Two thirds of these women said their symptoms appeared during adolescence and that their symptoms were far less likely to be taken seriously when they were young that when they were adults.

After the 25 patients had received surgery it was discovered that 17 had stage I disease, 5 had stage II, 3 had stage II and none had stage IV. These are similar findings to a study published just a few weeks earlier which included 55 girls aged under 19 who were found to have endo. It is also unsurprising to find that no cases of stage IV endo as previous studies also report a very low rate of ovarian endometriotic cysts in adolescents. However, severe stage endometriosis in young women is not unheard of, particularly after the age of 17, and therefore should not be dismissed. An observation made by the authors was that the appearance of endometriosis in adolescents can be different to that of adult women. For example, they noted that the predominant lesion types were subtle atypical lesions like clear, white and red, whereas in adult women surgeons would be more likely to see the darker, blueish-black lesions. This is an important factor that needs to be taken into consideration by surgeons as the subtler forms of endo can be easily missed.

After a 1 year follow up 80% of the patients had improved or resolved pain, however this was a relatively short follow up period and, as different patients received different post-operative treatment, it’s hard to say how this affected the resolution of symptoms.

Nevertheless, this article raises several important issues surrounding endometriosis in young women. In particular how it can present in a different manner, both symptomatically and physically, to endo in adult women and how better characterisation of adolescent endometriosis can lead to quicker diagnosis, better treatment outcomes and an overall lessening of the burden of endometriosis on women and society.

June Roundup in July

Unfortunately I’ve been a bit behind this month, but I always keep my eye on what going on in the world of endo research.

So with that in mind let’s have a look at what’s been going on

Firstly, a study into surgical treatment for endometriosis of the bladder. This form of the disease isn’t particularly common, but it does add another layer of misery to the sufferer so knowing the optimal treatment is important. This study took sixty nine patients with bladder endometriosis and recorded what surgical procedures they had and how this affected their symptoms afterward. After follow up period of between 4 and 92 months, 92.7% of the women either had no symptoms, or a reduction in symptoms. What this study highlighted was the need for surgeons with specialist training in different types of endo (i.e. bladder, bowel etc) as they may require a different surgical approach.

Speaking of bladder and bowel surgery, up next is a report on the use of robotic assisted surgery for the treatment of just those conditions. This study included 19 cases of bowel surgery and 5 cases of bladder surgery, all of which occurred without complications. Now, robot-assisted surgery is a hot topic at the moment because it is a new and growing technique. But we are also stuck in a catch-22 situation with robotic surgery. You see, people are reluctant to support robotic surgery until there are more studies into its effectiveness, but you can’t have more studies until you support wider use of robotic surgery. Either way it looks like robotic surgery is here to stay and it is a safe and effective tool with a skilled surgeon at the helm.

Speaking of robot-assisted surgery, there are many different types of surgical procedure the robot can be utilised for in the treatment of endometriosis. In severe cases of the disease, doctors may opt for hysterectomy and our next study examines the safety and effectiveness of using the robot for such a procedure. In summary this study looked at 43 cases of women with severe endo (19 with stage III and 24 with stage IV). The results of which were -  operating times averaged at 145 minutes (with a variation of 67-325 mins); 41 out of 43 women only had a 1day hospital stay, with one woman needing to stay for 5days due to needing a laparotomy and one woman staying 3days because of a bowel obstruction that cleared. There were no reported complications during surgery though after surgery one woman had to be readmitted with a vaginal cuff abscess which was treated with antibiotics and drained. The authors of this study make some good points about the pros and cons of robotic surgery, namely – “The robotic platform improves the depth of perception and facilitates the resection of deep infiltrating lesions. In addition, the robotic system improves dexterity, filters the surgeon’s tremor, and improves intuitive movements”; however they also say “Robotic surgery has several disadvantages compared with traditional laparotomy. These include increased cost; the lack of tactile feedback to the surgeon [i.e the ‘feel’ of the toughness or resistance of tissues]; the presence of bulky robotic arms, as well as long and thick cords; the inability to move the surgical table once the robot arms are attached; and a limited range of motion with respect to operating in different quadrants in the same case”.

Sticking with a surgical theme is a study from the US looking at the effectiveness of surgical excision of endometriosis across five different medical centre’s. All the women included in this study were suffering endometriosis associated pain, of which 90 had operative information. Once these women were operated on, 65 were confirmed to have endometriosis and 25 had no confirmation of endo. Interestingly, of all the patients who had endometriosis confirmed at these centres, 84.6% had previously been given hormonal therapy or ablation (burning away of endo) surgery, indicating that these treatments are not very effective at reducing endo pain symptoms.  After their surgeries, all of the women in the different centres noticed a significant reduction in all but bowel symptoms (bowel symptoms were reduced though, but the amount of reduction wasn’t considered statistically significant). Interestingly the authors of this study found there was no significant difference in the pain and quality of life scores between women who were given hormonal therapy after excision surgery and those who weren’t. However, the post-operative information was collected 6 months after surgery, so long term effectiveness couldn’t be gauged. In any case this study shows that excision of endometriosis is still the preferred method of treatment for the disease where possible.

It is rapidly becoming apparent that endometriosis is a disease that begins to present itself in adolescence. This is extremely important to know because it means general practitioners need to be able to spot the signs of endometriosis in young girls and make sure they get treatment as soon as possible. But what are the major signs of endo? A new study looking at diagnosis of endo in adolescent girls found that 75% of girls with chronic pelvic pain (which is any pain in the pelvic area that lasts more than six months) that did not respond to medical treatment and 70% of girls with dysmenorrhoea (excessively painful/heavy periods) were later diagnosed with endometriosis. All doctors need to be aware of these ‘red flags’ and act on them quickly.

Next up is copper, which is great for electrical wiring and making cheap jewellery, but also may be important for endometriosis. Our bodies need miniscule amount of copper to function properly, but as with so very many things in this world, there is fine balance to be kept. In your body copper can float around by itself, but is also carried around by a protein called ceruplasmin and this latest study looked at the levels of both of these in the blood of women with advanced stage endometriosis compared to disease free women. What they found was that levels of copper and ceruplasmin were much higher in the blood of women with endo, but what does this mean? That’s a tricky question to answer because we’re still not sure what role copper might play in endo. Excess levels of copper are known to be a marker for oxidative stress and oxidative stress certainly seems to be elevated in women with endo. Oxidative stress, as the name suggests, is not something you want happening to excess in your body; prolonged exposure to oxidative stress can make you run down and generally feel like crap, in addition localised oxidative stress can actually promote the survival of endometriosis. Further study is needed to find out if copper is a cause or effect of oxidative stress, but as an interesting aside, elevated levels of copper in the blood could possibly be used as an indicator of advanced stage endometriosis.

Finally is a study from Denmark about the risk of endometriosis and fertility problems in the daughters of women with the disease. This was quite a large study, including information from 12,389 women with endometriosis and 52,371 without. Overall daughters of women with endometriosis were just over two times more likely to be diagnosed with endo. However, daughters of women with endo had no difference in the rate of deliveries, risk of miscarriage and ectopic pregnancy compared to the daughters of women without endo.  

Endometriosis Awareness Month 2013 – Part V

So another Endometriosis Awareness Month draws to a close and we should all be very proud of the achievements we made, whether it’s telling a friend about endometriosis or delivering the keynote address at an international symposium, everything we do matters. Of course, raising endometriosis awareness is an ever continuing endeavour, but with ever growing numbers of women having their voices heard it’ll not be long before the harmony of the righteous drowns the words of the ignorant.

So for the last blog post of this month I’ll be doing a quick overview of all the research I haven’t had a chance to cover in more detail.

To start us off is a paper examining other medical conditions young women with endometriosis suffer from. This study took 138 adolescent women who were diagnosed with endometriosis before the age of 21 and recorded the prevalence of any co-morbid pain conditions (interstitial cystitis, irritable bowel syndrome, chronic headaches, chronic low back pain, vulvodynia, fibromyalgia, temporomandibular joint disease, and chronic fatigue syndrome), mood conditions (depression and anxiety), and asthma. This study found that 56% of the girls suffered from co-morbid pain syndromes (with IBS being the most common), 48% had mood disorders (with depression being, unsurprisingly, the most common), additionally 26% also suffered from asthma. Interestingly 27.5% of the girls had a first degree relative with endometriosis. What this study highlights is the importance of recognising the signs and symptoms of endometriosis in young women, both by family and medical practitioners, because endometriosis, like many other chronic conditions, often has a greater chance of being treated successfully if diagnosed early.

 I’ve reported previously about the economic cost of endometriosis; it’s a sad fact, but a fact none the less, that if you want politicians and world leaders to take notice of something, tell them how much money it’s costing them. Recently there has been much greater interest in quantifying the economic burden of endometriosis and every study that does so vastly increases the chance of people standing up and taking notice. A new study from Austria does just that by calculating the healthcare costs of endometriosis in the country. This study concluded that, in total, endometriosis costs Austria €328 million (£278 million or $422 million) per year*, which as the authors point out, is comparable to the cost of Parkinson’s disease. The authors also make a good point with their concluding remarks in the abstract “The question arises as to whether more timely diagnosis, followed by better-targeted treatment, might have the potential to reduce these costs”. No doubt it would, whilst at the same time benefiting the patients.

*This may be a rather conservative estimate. If we take the total population of females of reproductive age in Austria (women aged 15-55) we get a total of 2,339,000 (according to The World Bank HNP Stats 2010). If we then assume an endometriosis prevalence of 10%, which would expected for a developed country like Austria, we get an estimate of 233,900 endometriosis cases. If we then multiply this by the average cost per endo patient (€7,712 according to this latest study), we get a grand total of €1,803,836,800 which is an awful lot more than previously estimated.

The fact that endometriosis has to be confirmed via an invasive laparoscopy is always going to get researchers interested in looking at different ways to assess the disease without operating on a patient. Several different imaging techniques exist today that allow us to peer inside the body without having to open it up. One of the best imaging techniques is MRI (Magnetic Resonance Imaging), therefore researchers will naturally want to investigate the use of MRI for assessing endometriosis before laparoscopic surgery. A recent study from Germany took this line of thinking further and examined what locations of endometriosis MRI is best at detecting. This study took 152 women with suspected endometriosis and gave them an MRI scan before they went for laparoscopic investigation. After the laparoscopies had been performed they then compared these results to the ones from the MRI to see how accurate the MRI was.

What they found was MRI seems to be very good at identifying endometriosis of the bladder, reasonably good at identifying endometriosis in the Pouch of Douglas, colon and ovaries, but not that good at identifying endometriosis of the peritoneum, which is a shame because peritoneal endo is the most common form of the disease. Still, refinement of the technique in the future may allow for better imaging of endometriosis prior to laparoscopic surgery, giving surgeons a ‘heads up’ as to where to expect to find endometriosis and hence, be more efficient with excising the disease.

Next is an interesting piece of research from France; this study took data from the French E3N cohort, which is a massive collection of information from 98,995 women aged 40-65 who were given questionnaires  in 1990, then follow up questionnaires every 2-3 years detailing aspects of their lives, past and present. What this study did was to look for those women who were surgically diagnosed with endometriosis (2,684 in total) and compare their early life activities and exposure with other women.  

The results of this study suggested that women with endometriosis had an earlier menarche and shorter menstrual cycles before the age of 17. In terms of environment, women with endo were more likely to have lived on a farm for 3+ months (although there was no link to a specific farm animal), had more exposure to indoor passive smoking, experienced food deprivation during WWII and walked for more than 5 hours a week between the ages of 8-15.

It’s difficult to know what to make of this information though; the results about menarche and menstrual cycle confirm what has been reported before, but the significance of the link to environmental exposures listed is a little harder to explain. The only link I can think of between farm living and endometriosis would be exposure to pesticides, as there has been some evidence linking organochlorine pesticides to endo, but most women with endo don’t grow up on a farm so it’s hard to draw a definitive conclusion. The association with passive smoking and exercise is even more of a head scratcher. Both smoking and regular exercise are thought to lower or attenuate estrogen production, being as endo is an estrogen dependant disease, one would think lower estrogen meant less disease risk, so these results are a bit puzzling.

Of course there are some sources of error that can creep into studies such as this, the main one being recollection. The questionnaires gathered data about environmental exposures from the ages of 8-17, but the participants were already aged 40-65 when the questionnaires were given. I’m 30 and I don’t think I could confidentially quantify how many hours of exercise I had, per day, when I was 8. So although this study certainly gave some interesting results, we definitely need further investigation into some of the associated environmental exposures and endometriosis.

Continuing with the theme of environmental exposures by moving on to heavy metal now and no I don’t mean men with long black hair and multiple facial piercing thrashing a guitar. I’m talking about a study conducted with Sri Lankan women with endometriosis, the aim of which was to assess the levels of Nickel, Lead and Cadmium metal in their blood (you can read the full article for free here). You might wonder what the point of looking at these specific metals would be, especially in relation to endometriosis. Well, it turns out that these metals have been documented as being able to activate estrogen receptors, effectively mimicking the action of estrogen within the body, earning them the name ‘metalloestrogens’. What this study found was that levels of Cadmium and Lead were not significantly altered in women with endo compared to disease free women. However the level of Nickel in the blood of the women with endo was significantly higher. To date there have been very, very few other such studies examining the levels of these metalloestrogens in women with endo so, at the moment, this field of investigation is in its infancy. Nevertheless, it looks like a promising area to follow for those interested in environmental exposures in relation to endometriosis.

The field of drug treatment for endometriosis moves pretty slowly. Drugs designed specifically for the treatment of endo are basically non-existent. Most of the drugs used for endo treatment today have been co-opted/altered from drugs for the treatment of other conditions. For example:

Leuprolide acetate – Initially used to treat prostate cancer

Medroxyprogesterone acetate – Used as a contraceptive

Birth control pills – Contraceptives

Danazol – Used for menstrual disorders (although Danazol was the first drug specifically to treat endometriosis, it is now over 40 years old and has an unfavourable side effect profile).

Recently there has been the development of Dienogest, which although used primarily as a contraceptive, was also designed with endometriosis treatment in mind. But that still means we’re getting a new endo specific treatment every 40 years or so, which is poor progress even by the most optimistic of standards.

In light of the lack of new drugs, other drugs are still being found that should help treat endo; two classes of which are Aromatase inhibitors and Cyclooxygenase (COX-2) inhibitors, which were designed for the treatment of breast cancer and autoimmune conditions respectively. The reason these are used for the treatment of endo is that they inhibit key enzymes endometriotic cells use to synthesise their own estrogen supply. Wouldn’t it be a good idea then, to use these types of drugs in combination to suppress endometriosis? It turns out maybe not. A recent study on mice examining the effect of an aromatase inhibitor (Anastrozole) and a COX-2 inhibitor (Celecoxib) found that, although these drugs worked well on their own to reduce the reduce of the growth of endometriosis, in combination they actually reversed their effects. Studies such as this highlight the need for better testing of drugs ‘borrowed’ from other treatments and the urgent need for drugs designed specifically for endometriosis.

Next up a study assessing the prevalence of endometriosis in women with adenomyosis and leiomyoma (uterine fibroids). This study took 220 women aged 40-50 who were undergoing hysterectomy for adenomyosis and/or fibroids; during their surgery these women had a thorough examination of the pelvic region conducted to look for any endometriosis. This study discovered endometriosis in 28.6% of all the women. Endometriosis was found in 40.4% of the women with adenomyosis only, endometriosis was found in 22.7% of the women with fibroids only and endometriosis was found in 34.1% of the women who had both adenomyosis and fibroids. These results show that these three conditions are frequently found together. It would’ve been interesting to see if these results were similar for different age groups but that’s something for future study.

It’s interesting that endometriosis and adenomyosis are found together so often because they are both characterised by endometrial-like cell displacement (although in adenomyosis the endometrial cells are found inside the muscle wall of the uterus). All together this provides a bit more evidence that endometriosis and adenomyosis are related, possibly established before birth and may even share a similar origin.

 Penultimately, here are a few case reports from the rogue’s gallery of endometriosis appearing in unusual places. First is a report of endometriosis of the perineum and secondly is a case report of endometriosis of the mons pubis.

Finally on our whistle stop tour through endometriosis research is a reminder that endometriosis is not a uniquely human concern. There are 16 species of primate (including ourselves) that can develop endo and it’s no stretch of the imagination to assume that the disease is as horrible for our monkey cousins as it is for us. So we’ll end on a lighter note with a study from Germany looking at medically treating marmosets with endometriosis. The authors of this study noted that marmosets with endometriosis showed significant deviations in social behaviour and cognitive tasks, which is unsurprising if they’re in pain all the time. The researchers gave the marmosets an unspecified medical treatment and noted that it improved their social and cognitive function. So at least it was a happy ending for the monkeys.

Thus concludes this run of blog posts for endo awareness 2013, hopefully you’ve learned something new, I know I have. It’s heartening to know that research into endometriosis is more popular than ever and looks set to gain ever more interest in the future.