Understanding endometriosis
Millions and millions of Americans suffer from endometriosis. It can cause infertility, severe chronic pain and pain during sexual intercourse. Additionally, individuals with endometriosis face greater risk of heart disease, which is especially problematic because, on average, endometriosis remains undiagnosed for seven years.
In individuals with endometriosis, tissue that is similar to the uterine lining grows outside the uterus. Uterine tissue regrows every menstrual cycle and is shed during a woman’s period, but the body does not have a method to remove tissue outside the uterus. The buildup of this tissue causes pain. Systemic inflammation and scarring make endometriosis one of the leading causes of infertility.
Endometriosis and heart disease
Endometriosis and heart disease are both disorders of inflammation in the body, but research has not yet explained the link between the two. Troublingly, heart disease risk in women is typically treated with estrogen, but estrogen exacerbates the symptoms of endometriosis. In fact, endometriosis is typically treated by suppressing estrogen production in women, according to the researchers. This means that endometriosis treatment actually may be increasing the risk of heart disease for women who already live with elevated risk.
In this study, the researchers will examine the link between estrogen suppression and cardiovascular disease risk in women with endometriosis. Two alternative therapies will be tested.
New insights
Over the next several years, Lacy Alexander, professor of kinesiology at Penn State, and Nina Stachenfeld, fellow at John B. Pierce Laboratory and senior research scientist of obstetrics, gynecology and reproductive sciences at Yale School of Medicine, will lead a research team that includes physicians and research faculty across Penn State University Park campus, Yale School of Medicine, Penn State Health Milton S. Hershey Medical Center, and Johns Hopkins University.
The researchers’ first goal is to document whether reducing the amount of estrogen in a woman’s body causes inflammation of her blood vessels.
“Understanding how estrogen suppression affects the function of blood vessels is a critical step to understanding how to treat endometriosis without increasing a woman’s risk of heart disease,” Stachenfeld said. “Women who live with endometriosis suffer pain, miss work and may suffer a significantly reduced quality of life. Science can and should provide more insights about how to treat and manage this condition.”
As alternatives to the standard course of estrogen suppression, the researchers will test two existing drugs. One drug is a statin, a class of drugs that are typically used to lower cholesterol but are also anti-inflammatories. The researchers will also test the effect of a breast cancer drug known as a "selective estrogen-receptor modulator" on blood vessel function.
“Much remains unknown about endometriosis and how it works, but these trials could provide some important insights,” said Alexander. “This work could lead to larger trials of these drugs so that clinicians can treat endometriosis without an increasing — and possibly even decreasing — heart disease risk.”
A personal endeavor and an endeavor for women
As a scientist, Alexander is excited to apply her expertise to this little-understood condition that affects millions of women. As a person who lives with endometriosis, Alexander understands first-hand how debilitating the condition can be.
“My research has traditionally focused on blood vessel function and cardiovascular disease,” said Alexander. “So, my background is extremely relevant, but I had never worked directly on endometriosis before. This entire research project was conceived when I went to Yale for endometriosis treatment.
“In that sense, this is a passion project for me," added Alexander. "Having suffered from endometriosis, I am really excited to be able to make a difference in other women’s lives.”
Research has shown that women’s health issues are underfunded relative to men’s health issues, but the research team believes that the situation may be improving for endometriosis research. More funds have been designated for the study of endometriosis in the past few years. Some celebrities with endometriosis — notably Lena Dunham, creator and star of the television show “Girls” — have been public about their experience with the condition. Most importantly, society is beginning to destigmatize conversations about reproductive health.
The convergence of these factors gives the researchers hope that society will come to understand and address the problems caused by endometriosis and challenges associated with reproductive health.
“We have a lot to learn about endometriosis,” Alexander said. “But that means our research has a chance to make a real contribution and point the way toward improving the lives of millions of people.”