The picture that emerged from that was really pretty similar across the board and across different countries. In particularly, endometriosis-associated pain affects women to a considerable extent in their daily lives. And it also affects their working lives.
The women often described that, although they really tried very hard not to have too much absence from work, they found that they were often having to cope with the pain and being less productive.
Endometriosis has an economic cost to society that has been calculated to be similar to Type 2 diabetes and asthma.
So clearly, that impacts society, their own working lives, and whichever employer they're working for, but also society at large. This was a group of women who were surgically diagnosed for the first time with endometriosis, so their symptoms were severe enough for them to receive that diagnosis. On average, they experienced about 11 hours a week of reduced effectiveness at work, which is really substantial.
In addition to that, this obviously has an economic cost to society that has been calculated to be similar to really well-known public health conditions such as Type 2 diabetes and asthma. These are conditions that people are very aware of.
Endometriosis similarly impacts people's lives and the economy. I think it is important for that to be recognized.
Endometriosis: what are the current research lines?
We do not understand enough about how the disease originates.
Quite a bit of progress has been made about understanding biologically, once the disease is there, how it stays there, and how it is maintained.
For example, there's some great work of colleagues worldwide that looked at endometriosis disease deposits and found that these don't just rely on hormones that are circulating through the body, but they produce their own little hormone supplies as well. It almost becomes a way for these disease deposits to maintain their growth. The understanding of how that works and how those deposits manage to stay there — I think that knowledge is now accumulating. It revolves a lot around local hormonal supply.
What we really need to focus on now is to try and see how these deposits get there in the first place and how we can prevent that from happening. One line of our work is a very large-scale collaboration with 25 research centers worldwide to try and see what genetics brings to this. If we understand a bit more about which genes are involved in increasing your risk of disease, that could tell us something about what the underlying biology is. And I think for a condition such as endometriosis that is really important; where we have very little knowledge of what the actual disease process is, that can tell us something.
We can all have research hypotheses and go down certain research avenues, but ultimately those are “hunches.” and they might not be true. Genetics can give us what we call an unbiased approach into what the underlying causes of this disease are. And, hopefully, that will then give us a handle on two important things:
- Identify subtypes of disease that would be differently genetically regulated.
- Inform pharma companies and academia looking at better treatments for endometriosis — non-hormonal treatments. We could say, “These are the genes that are involved. These are the biological pathways that are involved. You could design specific drugs that target those pathways.”
This is not just an approach in endometriosis: genomics is a field that is burgeoning worldwide to help understand many different diseases.
I think another really exciting area in relation to endometriosis, and one that's very complex, is immunology. You know the question always is, “How come these endometrial cells that are shed every month manage to stick to the pelvic walls, but they're not cleared up by the immune system?” Why is that? And there are a lot of groups worldwide that are looking at that specifically and in relation to the inflammation that occurs, which is part of the immune reaction. I think trying to understand that process better may help get better treatments into the market.