Endometriosis is a debilitating disease that affects the 10% of women around the world. It can severely affect quality of life, often causing a host of symptoms including chronic pain, fatigue, and pain during intercourse.
Despite how common endometriosis is, in Spain many women wait 10 years to receive a diagnosisand in the UK the average is 7.5 years of delay. This not only means many years without treatment, but also puts them at risk of even greater health problems. Let’s not forget that untreated endometriosis can cause organ damage (including the uterus and intestines) and infertility.
There is currently no cure for endometriosis. This may be due to its complexity, affecting many different parts of the body, as researchers do not yet fully understand all the causes of the disease.
In recent years, studies have found that the immune system may also be involved. It is not yet clear whether the immune system is the cause of endometriosis or is only affected by it. But exploring this link could lead to more targeted treatment of the disease.
inflammation and immunity
To understand the relationship between the immune system and endometriosis, it is first important to understand an immune system process called inflammation.
Inflammation is a key feature of how our immune system works. When the body encounters a harmful pathogen (such as a virus or bacteria), the immune system is activated. The body secretes special proteins called cytokines, which tell immune cells what to do.
The symptoms that we experience as a consequence of inflammation will depend on the reason for which these cells have been mobilized. For example, if the inflammation is due to a cut on your finger, the area around the cut may become hot, red, and swollen as the immune system works to fight pathogens and repair the damage. If the inflammation is caused by a virus, we often experience flu-like symptoms, such as fever.
In most cases, inflammation is a short-lived process. But sometimes the immune system gets it wrong and the body continues to send out inflammatory cells and cytokines even when there is no threat. Autoimmune diseases such as rheumatoid arthritis are one such example, where the body’s immune system continues to attack, leading to long-term inflammation in the joints.
Inflammation in the menstrual cycle
Inflammation is also a normal feature of the menstrual cycle.
The normal menstrual cycle consists of two phases: the follicular phase (from the first day of the period until ovulation) and the luteal phase (from ovulation until the start of the period). Most of the inflammation during the menstrual cycle occurs in the womb, but changes can also occur all over the body.
During the follicular phase, the levels of estrogen circulating in the body increase. Estrogens stimulate the thickening of the lining of the uterus to prepare for the fertilized embryo.
Some immune cells have specific receptors that recognize estrogen, causing them to initiate a immune response. In this way, the body is prepared to fight any foreign invader and, in case fertilization occurs, be healthy for the pregnancy. In this way, women will be less susceptible to infections during the follicular phase. However, women with autoimmune diseases may experience more symptoms in this phase.
But in order not to reject the fertilized egg, the immune system is suppressed during the luteal phase, which can increase the risk of infection and alleviate some autoimmune symptoms.
endometriosis and immunity
Research has noted multiple changes in the immune system of people with endometriosis.
One study found that patients with endometriosis had elevated levels of inflammation (specifically, higher levels of cytokines). Research has also shown that people with endometriosis have impaired immune cell function, especially the so-called natural killer cells.
They play a vital role in fighting viruses and tumors, but research shows that work worse in people with endometriosis. It has also been shown that the uterine lining of patients with endometriosis produces an excess of certain molecules called chemokines that attract other immune cells, worsening inflammation.
Once again, it is not yet known for sure whether impaired immune function is the cause of this disease or simply a symptom. But immune system dysfunction could explain why a link is suspected between people with endometriosis and autoimmune disorders such as lupus, rheumatoid arthritis, and inflammatory bowel disease.
Elevated levels of inflammation also mean that women with endometriosis may be more likely to experience worse symptoms during infections. For example, research has found that when endometriosis patients contract covid-19, their symptoms seem to be worse than people without the disease.
Covid-19 can also worsen endometriosis symptoms, particularly pelvic pain, depression, fatigue and gastrointestinal problems. A recent study It has also found that women with endometriosis were 22% more likely to experience prolonged covid, and their symptoms may last longer.
Although the exact relationship between the immune system and endometriosis (and whether it causes the disease) is currently unknown, working to better understand this relationship could be key to helping develop better treatments.
Research on this disease continues very undergifted, and the time to diagnosis is much longer than would be expected for other chronic diseases, such as asthma or diabetes. It is clear that research into endometriosis and its causes must be given a higher priority to bring new knowledge and better treatments to the millions of women affected.
April ReesBiochemistry Tutor, swansea university
This article was originally published on The Conversation. read the original.
