Endometriosis - a systemic disease?

A biochemical investigation.

Endometriosis is a condition where the cells that are normally found lining the uterus are also found in other areas of the body: usually within the pelvis. Each month this tissue outside the uterus, under normal hormonal control, is built up and then breaks down and bleeds in the same way as the endometrium. This internal bleeding into the pelvis, unlike a period, has no way of leaving the body. This leads to inflammation, pain and the formation of scar tissue. Endometrial tissue may also be found in the ovary where it can form 'chocolate' cysts. Other sites within the body that endometriosis can invade include the colon, bladder, lung and abdominal scar tissue. Endometrial tissue that grows in the muscle layer of the wall of the uterus is called adenomyosis. The only site that endometriosis has not been found is the spleen.

The cause of endometriosis is unknown but several theories have been put forward.

Retrograde menstruation.

Lymphatic or circulatory spread

Genetic predisposition to the condition

Immune dysfunction

Environmental causes - such as dioxin exposure

Of the theories, the most widely accepted is retrograde menstruation. What is not known is why these endometrial cells implant in some women and not in others. This suggests immune system involvement. Endometriosis is the second most common gynaecological condition. The National Endometriosis Society (UK) estimates that 2 million women in the UK have endometriosis. Endometriosis can occur at any time from the onset of menstrual periods and in many cases symptoms persist throughout life, and in some women even after the menopause or surgically induced menopause.

Presently, the only way to diagnose endometriosis is by a laparoscopy, allowing the surgeon to see the pelvic organs and any endometrial implants and cysts. Endometriosis causes significant pain and symptoms associated with chronic pain, such as depression and fatigue. While endometriosis is not a fatal condition it has a marked impact on the quality of life for women with the disease.

Scans, blood tests and internal examinations alone are not a conclusive way to diagnose endometriosis. In 1994 the National Endometriosis Society carried out a survey among its members that revealed that the average time between first reporting symptoms and receiving a diagnosis was 7 years. In spite of the evidence suggesting an immune imbalance in women with endometriosis, little attention has been paid to treating the immune system. Women with endometriosis may have chronic immune activation due to the presence of endometrial deposits. The immunologic alterations in patients with endometriosis are associated with an exaggerated B-cell response, which can be measured as elevated serum levels of autoantibodies and soluble CD23. Women with endometriosis show a defect in natural killer activity resulting in a decreased cytotoxicity to autologous endometrium. This immune defect in women with endometriosis may account for the incidence of the disease occurring in some women rather than all who experience retrograde menstruation; it may also contribute to symptoms and conditions that women with endometriosis frequently report. In this study it will be important to determine whether women with endometriosis display evidence of an altered immune system. From this it may be evident that endometriosis is indeed a systemic disease, with associated symptoms that are not necessarily gynaecological. Alone these indices cannot determine the presence of endometriosis, however when tested together as a profile along with other indices that indicate chronic inflammation and immune activation, they may assist in diagnosis.

This study will demonstrate the usefulness of these serum indices as a diagnostic tool to be used alongside medical history and symptoms. It will also show that endometriosis has systemic effects, measurable by biochemical markers.

Aims / Objectives
To demonstrate that endometriosis is a systemic disease, defined by a collection of symptoms, not just a gynaecological manifestation.

To determine evidence of the immune system involvement by measuring key factors, and use this evidence as a supplemental diagnostic indicator for women with suspected endometriosis.

To assess a group of women with endometriosis versus women without any gynaecological / health problems, to determine any differences in areas that may indicate that endometriosis does have a characteristic biochemical pattern.

Endometriosis- A Systemic Disease?

A Biochemical Investigation.

Kathleen M King

A dissertation submitted in partial fulfilment of the requirement for

the award of M.Sc. in Biomedical Sciences to:

Virtual School of Biomedical Sciences,

University of Ulster at Coleraine

Coleraine

Northern Ireland

Submitted: November 2001

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Date: November 2001

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