Een nieuwe diagnostische test voor endometriose ?
20-8-2009 Since 2 days we have a a series of comments concerning the observation that women with (mild and superficial endometriosis have more nerve fibers in the endometrium. A lot of speculation of a new diagnostic test followed
Our Comments
This is another example (as I discussed in https://www.gynsurgery.be and http://www.mondoginecologico.it) that interpretation of research data should be done carefully and that conclusions by researchers often are overstretched and/or biased.
The observation of higher incidences of nerve fibers in the endometrium of women with endometriosis is nice research. To suggest this as a non invasive diagnostic test however is way premature.
1. First, an association does not permit to conclude about cause and effect. We know ( more than 50 articles) since 20 years that the endometrium of women with endometriosis is slightly different from the endometrium of women without endometriosis. It is unclear whether these differences are a consequence of the endometriosis or whether these differences merely signal an ‘endometrioitic’ constitution (as suggested in the endometriotic disease theory). Knowing what happens after surgical excision of endometriosis could give a hint. We previously demonstrated that the decrease in natural killer cells in endometriosis women is not affected by surgical excision of endometriosis whereas CA125 decreases tremendously therafter.
2. Second the article knowingly and willingly disregard subtle endometriosis which is present intermittently in many women and which -I and others think- should not be considered a disease, as discussed in the literature since more than 10 years.
My guess considering the pain symptoms, is that the increased nerve endings is a sign besides many others, that a women will have more retrograde menstruation and also more frequently subtle endometriosis etc, something I am considering since many years as irrelevant findings at laparoscopy since subtle endometriosis does not cause pain or infertility.
The key problem of not recognising or not referring severe endometriosis or doing an incomplete excision or doing unnecessary bowel resections will remain.