Changes in Immune and Endocrine System in Women with Endometriosis

Changes in Immune and Endocrine System in Women with Endometriosis
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Mark Perloe, MD: “I’m Mark Perloe and I’m here at the American Society of Reproductive Medicine meeting reporting for EndoZone and we’re here with Mary Lou Ballweg who is the President and Executive Director of the Endometriosis Association. You just had a very interesting paper that was published this month in Human Reproduction about endometriosis and changes in the immune system and endocrine system.”

Mary Lou Ballweg: “Yes.”

Mark Perloe, MD: "Can you share information with us?"

Mary Lou Ballweg: “This paper is in the October issue of Human Reproduction and it is very exciting for us because since the days of our first research in 1980, when we started, we had identified certain immune dysfunctions in women with endometriosis which you see in asthma, allergies, eczema, and we kept trying to track down what is going on. Why would this be happening in endometriosis? We’ve tracked this and tracked this and now, with the help of the NIH, have indeed shown that these women have a very high risk of five different
autoimmune diseases, chronic fatigue immune dysfunction syndrome, and fibromyalgia. Which women have the highest risk in the group of women with endometriosis? -- the ones with the atopic diseases.”

Mark Perloe, MD: “Well, one of the things we have seen at this meeting that I think is astounding and opens up a whole new range of research opportunities is looking at the presence of messenger R&A in eutopic endometrium and ectopic endometrium and the expression of these messages to go back and see what’s going on specifically in the tissues."

Mary Lou Ballweg: "Yes"

Mark Perloe, MD: “How do we take the associations and get from the knowledge of an association to a better understanding of the causes or potential treatment manipulation? I mean it’s big jump from this to knowing what’s going on on the molecular basis.”

Mary Lou Ballweg: “Actually, I think what this paper does is it shows us, it gives us evidence for what we’ve seen in the Association for many years, that you can actually predict which children are going to go on to develop endometriosis by looking at their immune function now. Even starting with infancy. And in fact, we are working on our third book now, and in that book I address a major area on prevention, even preconception and then what’s happening pre-natally, and then what’s happening in infancy. We truly believe we actually will, with the help of some wonderful clinicians and researchers, be able to identify ways to forestall the development of endometriosis and these other diseases. But we will have to start very, very early in the life of that organism.”

Mark Perloe, MD: “Well, that’s one of the things as a clinician I’m frequently troubled by and that is the patient who comes in and says, ‘My sister had a hysterectomy, my mother had an early hysterectomy, am I going to get this, do I need a laparoscopy now’, yet they are asymptomatic. Do we know clues in history and then if we find these clues what sort of intervention? Is there a nutritional intervention, blood testing we ought to do that will help us get a handle and maybe forestall the development of more severe disease?”

Mary Lou Ballweg: “I hear you. That’s a very good question. What I’m hearing from clinicians is that even in that asymptomatic patient, she may be asymptomatic as far as pelvic pain, but have other symptoms. Look at the history, (and granted a reproductive endocrinologist and gyns might not be in the best position to do this), but consider sending them to some of our colleagues who can address the immune system. Clearly this person is at risk for development of some of these diseases. Alternatively, as one of the doctors just told me on the floor here, just before I came up here, he said, ‘Whenever I see a patient come in with an autoimmune disease I immediately know I’ve got to look at her pelvis because she is at high risk for endometriosis’. So I think it goes both ways, but clearly we need some collaborations between our field and the field of immunology before we’re really going to be able to say this is the mechanism and this is how we can address it.”

Mark Perloe, MD: “One of the things, and looking at pathogenesis, and we’ve discussed this in other presentations, it’s unclear as to the role of the immune system in endometriosis. We know that every woman has retrograde menstruation and every implant, or every woman has the potential for implantation and invasion, but it appears that either the immune system is being overwhelmed, or is incompetent, or these lesions somehow are massed in women with endometriosis. Do you feel that there are any clues in this that will better help us answer those questions?”

Mary Lou Ballweg: “I think that the clues might be to look at the entire medical history of that woman, what else is going on in this woman besides the gyn things. That might help you determine that you really are going to have to go a little bit further with that patient. But it’s a little bit early days; the paper has just come out. We now are looking at the same data in the families and I think it’s going to take a little bit more before we can say exactly what we should be doing in our field. But I think it’s a heads-up for all of us in our field to really be looking at that bigger picture: The immune system’s role in endometriosis. I’m sure you are aware of this data, that Dr. Laufer at Harvard has now been able to identify endometriosis in young girls even before their first period. He usually identifies GI symptoms first, and that leads him to exploration and discovery of endometriosis. Maybe we can head it off if we get in there a little sooner although I’m not exactly sure how to do that.”

Mark Perloe, MD: “Well, I think us clinicians and researchers are quite lucky to have the Endometriosis Association on our side and helping to support research to get some answers and get direction on moving ahead. Thank you so much.”

Mary Lou Ballweg: “Thank you.”


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