Endometriosis Awareness Month

Endometriosis is a chronic disease that affects approximately one in 10 women around the world during their reproductive years. I am one of them.  

Only after I was diagnosed with endometriosis five years ago did I become aware of all the nuances and misinformation around this invisible disease. In honor of Endometriosis Awareness Month,  all of us who have been diagnosed with this disease, and the women who are affected by it but may not even know it yet, here are some facts I have learned and wish I knew before.

What is endometriosis?

Endometriosis is a condition where tissue similar to the one located in the lining of the uterus, called endometrium, is found outside the uterus. Endometrial lesions are more commonly present in the outer surface of the uterus, ovaries and Fallopian tubes but can also be present in the vagina, bladder, bowel and rectum.

With each menstrual cycle, estrogen causes the endometrium to grow and thicken to prepare the uterus for pregnancy. The endometrial tissue that is found outside of the uterus also responds to estrogen, causing inflammation and pain.

How is it diagnosed?

Pain is the most common symptom of endometriosis, and it presents itself in different ways, such as painful menstrual cramps, back and pelvis pain, painful bowel movements or pain during sex. Additionally, there are cases in which patients don’t experience pain but may show other symptoms, such as bleeding between menstrual periods, infertility and digestive issues like diarrhea, bloating and constipation that aggravate during menstrual periods.

The lack of a straightforward diagnostic tool and the wide range of symptoms experienced by women with this disease makes the diagnostic process slow and difficult, with many cases going undiagnosed for years because symptoms are often confused with normal menstruation and are overlooked by patients and their physicians.
The first steps to get a diagnosis are procedures used to determine the presence of endometrial growths, including pelvic exams and ultrasounds. The bottom line is that endometriosis can  be diagnosed only during surgery, when doctors can see the growths and take a sample of tissue to examine under a microscope.

What is the treatment?

Unfortunately, there is no cure for endometriosis. The symptoms can be managed with medication. Hormonal birth control in the form of pills, shots or an intrauterine device, or IUD, help reduce or eliminate pain and bleeding. Surgery can help women who are having infertility problems by removing endometriosis patches.

What are researchers doing?

Here is a collection of research articles from ASBMB journals that elucidate important ideas and findings regarding endometriosis and the function of the endometrial tissue.

Understanding endometrial tissue motility: Decidualization is the process by which cells in the endometrium undergo changes in preparation for pregnancy. A recent publication in the Journal of Biological Chemistry explains findings supporting the hypothesis that during decidualization FOSL1 (short for estrogen induced FOS like 1) regulates the expression of matrix metalloproteinases and the motility of human endometrial/decidual stromal cells.

Epigenetic modifications play an important role in the decidualization process: Another study published in JBC describes the relationship between histone acetylation and decidualization of endometrial stromal cells. The researchers report that trichostatin A, a specific histone deacetylase inhibitor, enhances decidualization by promoting progesterone action. Read the full report.

Nuclear proteins and phosphoinositide complexes: Phosphoinositide signaling is important for normal cellular function, and aberrant regulation can play a role in human disease. However, the mechanisms involving phosphoinositide signaling in the nucleus is not well understood since many nuclear phosphoinositides can exist freely in the nucleoplasm with the help of nuclear proteins. In a study published in the Journal of Lipid Research, researchers identified two nuclear proteins responsible for solubilizing phosphoinositides along with two enzymes that remodel these phosphoinositide/protein complex. This discovery will allow researchers to one day identify the functions of these phosphoinositides in human diseases like endometriosis and offers much-needed opportunities to develop therapies and diagnostic tools.

Menstrual blood vs. circulating blood: A paper published in the journal Molecular and Cellular Proteomics in 2012 reported five different methods used to define the menstrual blood proteome. It compared the menstrual proteome with that of circulating blood and found 385 proteins unique to menstrual blood. This study highlights the importance of establishing a normal menstrual blood proteome that can eventually be used as a diagnostic tool for diseases, including endometriosis. Read more about this study.