Endometriosis Linked with Hundreds of Comorbidities
/By Pat Anson
Endometriosis is one of the most frustrating and debilitating conditions a woman can have, causing physical, sexual and emotional pain that’s difficult to diagnose and treat.
Patients who have endometriosis are often told it’s “all in your head” or that “you’ll grow out of it.” Few of them do. Nearly 200 million people worldwide suffer from endometriosis, including about one in 10 American women.
A new study at the University California-San Francisco (UCSF) is providing new insights into endometriosis, linking it with hundreds of comorbidities such as cancer, Crohn's disease, and migraine. The research could improve how endometriosis is diagnosed and treated – ending some of the silence and misconceptions about the disease.
Researchers analyzed the electronic health records of over 43,000 people with endometriosis, comparing them to a large control group without the disease. Their findings are published in the journal Cell Reports Medicine
“We now have both the tools and the data to make a difference for the huge population that suffers from endometriosis,” says senior author Marina Sirota, PhD, a professor of pediatrics and interim director of the UCSF Bakar Computational Health Sciences Institute. “We hope this can spur a sea change in how we approach this disorder.”
Endometriosis or “endo” occurs when blood-rich tissue that grows in the uterus is expelled each month during menstruation, spreading to the ovaries, fallopian tubes, abdomen and other nearby organs. The misplaced endometrial cells implant themselves in the new host tissue and grow, causing internal bleeding, inflammation and pain.
The wayward cells can be removed by surgery, but endometriosis is usually treated with hormones to suppress the menstrual cycle. Not everyone responds to surgery or hormonal therapy, which can have side effects. Removal of the uterus is a last-ditch treatment usually reserved for older women, but some women continue to have pain even after a hysterectomy.
“Endo is extremely debilitating,” said co-author Linda Giudice, MD, a physician-scientist in UCSF’s obstetrics, gynecology and reproductive sciences department. “The impact on patients’ lives is huge, from their interpersonal relationships to being able to hold a job, have a family, and maintain psychological well-being.”
In analyzing patient data, researchers looked for comorbidities linking endometriosis with other medical conditions, and found over 600 of them. Some were previously known, such as infertility, autoimmune disease, and migraine. Some were unexpected: certain cancers, asthma, and eye-diseases. The findings support the growing understanding of endometriosis as a “multi-system” disorder that causes dysfunction throughout the body.
“This is the kind of data we need to move the needle, which hasn’t moved in decades,” Giudice said. “We’re finally getting closer to faster diagnosis and, eventually, we hope, tailored treatment for the millions of women who suffer from endometriosis.”
The association of endometriosis with migraine, for example, opens the possibility of treating endometriosis pain with medications that block calcitonin gene–related peptides (CGRPs), a relatively new class of migraine drug. In recent years, the FDA has approved over half a dozen CGRP medications for migraine prevention and/or treatment.
CGRP medications tend to be expensive, but so is endometriosis. One study estimates that the lifetime cost of having endometriosis in the U.S. is about $27,855 per year per patient, or about $22 billion annually.
