The Risk Factors of Endometriosis

In part 1 of this 2-part episode, Dan Martin, MD, speaks about his team's research titled "The Epidemiology of Endometriosis is Poorly Known as the Pathophysiology and Diagnosis are Unclear," including the risk factors of endometriosis.

Additional Resource:

• Koninckx PR, Ussia A, Adamyan L, et al. The epidemiology of endometriosis is poorly known as the pathophysiology and diagnosis are unclear. Best Pract Res Clin Obstet Gynaecol. 2021;71:14-26. doi:10.1016/j.bpobgyn.2020.08.005

Dan Martin, MD, is the scientific and medical director of the Endometriosis Foundation of America and a professor emeritus at the University of Tennessee Health Science Center (Memphis, TN). 

Listen to part 2 of this episode here. 

TRANSCRIPTION:

Jessica Bard: Hello everyone, and welcome to another installment of Podcast 360, your go-to resource for medical news and clinical updates. I'm your moderator, Jessica Bard, with Consultant 360 Specialty Network. According to the World Health Organization, endometriosis affects roughly 10% of women and girls who are of reproductive age globally. Dr Dan Martin is here to speak with us today about his team's research, "The epidemiology of endometriosis is poorly known as the pathophysiology and diagnosis is unclear." Dr Martin has more than 50 years of experience in the study of endometriosis. He's the Scientific and Medical Director of the Endometriosis Foundation of America and a professor emeritus at the University of Tennessee Health Science Center in Memphis, Tennessee. Thank you for joining us today, Dr Martin. Can you please give us an overview of your research?

Dr Dan Martin: This is a paper on epidemiology that was put together by a wide range of authors from nine different countries. Most of us have worked together and known each other for more than 20 years, and 2 of us have collaborated for more than 30 years. Epidemiology is the study in the distribution of the determinants of a disease in a population. Since a confirmed diagnosis of endometriosis requires surgery, we only have good clinical data in women with pain or infertility who had surgery. There's less data on women who were treated medically or with complementary care or even on those who have incidental asymptomatic endometriosis.

Jessica Bard: What are the risk factors for endometriosis?

Dr Dan Martin: Probably the biggest is genetics. About 50% of all endometriosis cases have a genetic background. The other 50% are more related to environmental toxicants such as endocrine-disrupting chemicals; one example is dioxen. Exposure to exogenous estrogen-like diethylstilbestrol during embryonic growth in the first eight weeks has been implicated. There are probably changes in the vaginal uterine or bowel bacteria and their microbiome. Estrogenic stimuli. It's been thought that an estrogen dominant state is part of the problem but it's not so much excess estrogen as it is progesterone resistance so normal estrogens but resistance progesterone increases a chance.

Dr Dan Martin: Women who have uterine malformations, age at menarche, prematurity, and low birth weight have had an increased chance. There are conflicting data on race, with old data suggesting that white populations had a greater chance and current data suggesting that Black and mixed-race populations have an increased chance, but the data on that's so conflicting that it's hard to say whose endometriosis, it's more to assume that any woman can have it.

Parallel to the risk factors or the symptoms if it's painful, so pain is a primary symptom in about a third to a half of women with endometriosis. The rest have either infertility or no symptoms. The most specific pain that we've found was menstrual pain with bowel movements, any pain that limits work or daily activities, and a past history of surgery for cysts. Pain with menses is also implicated but is not as strongly associated.

Jessica Bard: Thank you very much for your research on this and for your time today, we really appreciate you being on the podcast.

Dr Dan Martin: Thank you, Jessica, it's been a pleasure being with you today.