Endometriosis impacts over 11% of women of childbearing age in the U.S. and approximately 190 million women globally. On average, it takes about seven years to receive a diagnosis after symptoms begin. These symptoms can include abdominal pain and cramping around the menstrual cycle, leading to severe life changes such as chronic pain, infertility, and impaired quality of life. Researchers have been exploring effective strategies for the early diagnosis of endometriosis to tackle this significant clinical and public health issue.
Endometriosis is a widespread and debilitating chronic condition affecting more than 11% of reproductive-age women in the U.S. and 190 million women around the globe. The challenge of early diagnosis continues to be a significant one for both medical professionals and public health.
Endometriosis happens when tissue that typically lines the uterus grows outside of it, usually on organs like the ovaries and fallopian tubes. This can lead to serious consequences, including chronic pain and infertility, which can heavily impact a person’s life.
In a commentary in The Journal of Reproductive Medicine, Gynaecology & Obstetrics, researchers from Florida Atlantic University’s Schmidt College of Medicine, along with collaborators, carried out a search on PubMed to discover potential methods for early endometriosis diagnosis.
“Currently, diagnosing endometriosis requires a detailed examination of the patient’s medical history and a physical check-up,” explained Panagiota “Yiota” Kitsantas, Ph.D., the first and corresponding author, who is also a professor and head of the Department of Population Health and Social Medicine at FAU Schmidt College of Medicine. “The most reliable diagnostic techniques include pelvic examinations, abdominal ultrasound, MRI, and laparoscopy. While laparoscopic surgery is regarded as the definitive diagnostic method by gynecologists, it can be quite costly and carries risks of complications. Additionally, the accuracy of laparoscopy may differ depending on the surgeon’s skill and the disease stage.”
The authors suggest that the most effective method for early endometriosis diagnosis would involve using symptom-based criteria to identify candidates for testing, followed by establishing precise thresholds to optimize sensitivity and specificity. A diagnostic test with high predictive value would confirm the presence of endometriosis if positive while ruling it out if negative. Although some tests may not give conclusive results, they could significantly reduce the number of patients needing invasive procedures like laparoscopy.
Endometriosis is linked to hormonal imbalances that instigate processes such as angiogenesis, apoptosis, immune responses, and inflammation. Various diagnostic tools have been created to identify biomarkers, like mRNA fragments in blood and saliva; however, these have shown limited accuracy.
“Non-invasive tests such as MRI and transvaginal ultrasound typically only detect advanced stages of endometriosis,” noted Charles H. Hennekens, M.D., a co-author and first Sir Richard Doll Professor of Medicine and Preventive Medicine at FAU Schmidt College of Medicine. “Recent studies are looking into a new non-invasive technique to identify myoelectric activity in the gastrointestinal tract as a potential diagnostic method. Electroviscerography (EVG) might reveal unique myoelectric patterns associated with endometriosis, but this method is still in the experimental phase.”
As it currently stands, there is no FDA-approved non-invasive test for endometriosis available, and additional analytical studies leading to peer-reviewed publications are necessary to enhance these developing technologies and set efficient diagnostic criteria.
“Diagnosing endometriosis early continues to be difficult, with numerous promising approaches not having succeeded so far,” Kitsantas mentioned. “Once new technologies like EVG are properly assessed, they might provide clinicians with the confidence needed to shift from symptoms-based to diagnosis-focused treatment.”
Co-authors include Katerina N. Benson, a pre-med student at FAU; Sadine Al-Farauki, a recent FAU graduate now entering medical school at Ross University; Michelle Keba Knecht, a senior medical librarian at FAU Schmidt College of Medicine; and Lee A. Learman, M.D., Ph.D., a professor of obstetrics and gynecology and dean at Virginia Tech Carilion School of Medicine.
