Early Detection of Endometriosis: Research Into New Diagnostic Methods

Endometriosis is a common, debilitating chronic disease that affects more than 190 million women worldwide. Early diagnosis remains a major clinical and health policy challenge. The average time to diagnosis of endometriosis is seven years after the onset of symptoms, which include pelvic pain and cramps before, during, and after menstruation. Endometriosis occurs when tissue that is normally found in the lining of the uterus migrates to other areas and grows there, most commonly in the ovaries, fallopian tubes, and other organs. These conditions can have life-changing consequences such as chronic pain, infertility, and a reduced quality of life.

Ideal Test for Early Detection of Endometriosis

In a commentary published in The Journal of Reproductive Medicine, Gynaecology & Obstetrics, researchers from Florida Atlantic University’s Schmidt College of Medicine and colleagues conducted a PubMed search to identify promising approaches for the early detection of endometriosis. “Currently, the diagnosis of endometriosis involves a thorough medical history and physical examination of the patient,” said Panagiota ‘Yiota’ Kitsantas, Ph.D., first author and corresponding author, as well as professor and chair of the Department of Population Health and Social Medicine at FAU Schmidt College of Medicine. “The most commonly used and accurate diagnostic methods are gynecological examinations, abdominal ultrasound, MRI, and laparoscopy. Laparoscopic surgery is considered the gold standard among gynecologists for diagnosing endometriosis, but it can be expensive and carry potential risks for surgical complications. In addition, the accuracy of laparoscopy can vary depending on the surgeon’s experience and the stage of the disease.

The authors say that the ideal test for early detection of endometriosis would be to use symptoms to determine who should undergo examination and then establish optimal cut-off values to maximize sensitivity and specificity. A test with high predictive value would accurately confirm endometriosis if the result is positive and rule it out if the result is negative. Less ideal tests may not provide clear results, but they can help reduce the number of patients who need to undergo more invasive procedures such as laparoscopy.

New Technologies Refine

Endometriosis is associated with hormonal imbalances that trigger angiogenesis, apoptosis, immune responses, and inflammation. Diagnostic tools have been developed to detect biomarkers such as mRNA fragments in blood and saliva to diagnose endometriosis, but these have shown low accuracy. “Non-invasive methods such as MRI and transvaginal ultrasound are only effective in advanced stages of endometriosis,” said Dr. Charles H. Hennekens, M.D., co-author, first Sir Richard Doll Professor of Medicine and Preventive Medicine in the departments of medicine and population health and social medicine, and senior academic advisor at FAU Schmidt College of Medicine. “Recent research has focused on a novel non-invasive method for detecting myoelectric activity in the gastrointestinal tract as a potential diagnostic tool. Electroviscography, or EVG, may detect unique myoelectric patterns associated with endometriosis, although this approach is promising but not yet proven.”

Currently, there is no FDA-approved non-invasive test for endometriosis, and further analytical studies leading to peer-reviewed publications are needed to refine these new technologies and establish effective diagnostic criteria. “Early diagnosis of endometriosis remains a challenge, as a number of promising approaches have ultimately failed to bear fruit,” the researchers said. Once new technologies such as EVG are more fully evaluated, they could give physicians the confidence they need after testing to move from symptom-based to diagnosis-based treatment.