Endometriosis--a missed malady

Female Perspectives on Endometriosis: Findings from the Uterine Bleeding and Pain Women'S Research Study

Purpose

The symptoms of endometriosis are heterogeneous and overlap with those of other conditions, resulting in misdiagnoses and/or delayed diagnosis and treatment. The Uterine Bleeding and Pain Women's Research Study (UBP-WRS) collected data to elucidate differences in diagnoses and treatment experiences of women, and to assess the impact of endometriosis on their quality of life.

Methods

The UBP-WRS interviewed women aged 15 to 49 in eight countries using an online methodology. Quotas were applied for the age, region, level of education, and income of respondents. Questions assessed menstruation, diagnoses of endometriosis or other gynecological conditions (e.g., uterine fibroids), symptoms, impact on life, and perceptions of treatments.

Results

Of the total of 21 749 women, 2.7% reported surgically diagnosed endometriosis, 2.4% reported nonsurgically diagnosed endometriosis, 5.5% had physician-suspected endometriosis, and 6.2% reported symptoms indicative of endometriosis but no diagnosis. Prevalence of the different diagnoses was comparable between countries. Mean age at diagnosis was 28 years and estimated time-to-diagnosis was 6.1 years. Pain symptoms were generally more common and severe in women with diagnosed endometriosis than in those with suspected disease, whereas the reverse was true for their quality-of-life. Of women receiving treatment for diagnosed endometriosis, 60% were satisfied and 40% were dissatisfied with efficacy. However, 29% of women with diagnosed endometriosis were not receiving any treatment.

Conclusions

Approximately 17% of women in the UBP-WRS reported diagnosed, suspected or symptoms of endometriosis; this is comparable to previously published studies. The UBP-WRS – among the largest surveys of its kind – may help to improve understanding of this enigmatic disease and guide therapeutic practices.

Involvement of nuclear factor-kappaB in macrophage migration inhibitory factor gene transcription up-regulation induced by interleukin- 1 beta in ectopic endometrial cells

OBJECTIVE

To investigate the involvement of the nuclear factor (NF)-kappaB in the interleukin (IL)-1 beta-mediated macrophage migration inhibitory factor (MIF) gene activation.

DESIGN

Prospective study.

SETTING

Human reproduction research laboratory.

PATIENT(S)

Nine women with endometriotic lesions.

INTERVENTION(S)

Endometriotic lesions were obtained during laparoscopic surgery.

MAIN OUTCOME MEASURE(S)

The MIF protein secretion was analyzed by ELISA, MIF mRNA expression by quantitative real-time polymerase chain reaction (PCR), NF-kappaB translocation into the nucleus by electrophoresis mobility shift assay, I kappaB phosphorylation and degradation by Western blot, and human MIF promoter activity by transient cell transfection.

RESULT(S)

This study showed a significant dose-dependent increase of MIF protein secretion and mRNA expression, the NF-kappaB translocation into the nucleus, I kappaB phosphorylation, I kappaB degradation, and human MIF promoter activity in endometriotic stromal cells in response to IL-1 beta. Curcumin (NF-kappaB inhibitor) significantly inhibited all these IL-1 beta-mediated effects. Analysis of the activity of deletion constructs of the human MIF promoter and a computer search localized two putative regulatory elements corresponding to NF-kappaB binding sites at positions -2538/-2528 bp and -1389/-1380 bp.

CONCLUSION(S)

This study suggests the involvement of the nuclear transcription factor NF-kappaB in MIF gene activation in ectopic endometrial cells in response to IL-1 beta and identifies a possible pathway of endometriosis-associated inflammation and ectopic cell growth.

Why do they do it? A pilot study towards understanding participant motivation and experience in a large genetic epidemiological study of endometriosis

OBJECTIVE

This exploratory, pilot study aimed to investigate motivations and reflections of participants who had provided epidemiological information, blood samples and access to clinical records and data in a large genetic epidemiological study of endometriosis, a common multifactorial disorder affecting women. We also aimed to explore understanding of complex genetic or multifactorial conditions in general.

METHODS

In-depth interviews were conducted with 16 endometriosis study participants with diverse characteristics.

RESULTS

Interviewees generally described their participation in the genetic study using altruistic frameworks of reference. Themes that emerged included unquestioning willingness and consent to participate, little concern about privacy issues, desire for more information from the researchers about the condition rather than scientific progress, the benefits of research participation to family communication, and differing ideas about genetic influences on endometriosis. Specific features of endometriosis also influenced reflections on research participation experience.

CONCLUSIONS

As increasing numbers of individuals and families in the community become involved in genetic epidemiological studies of common diseases, more extensive research will be needed to better understand their expectations with a view to improving researchers' communications with study participants.

Tumour necrosis factor-α up-regulates macrophage migration inhibitory factor expression in endometrial stromal cells via the nuclear transcription factor NF-κB

BACKGROUND

A series of controlled changes including proliferation, secretion and menstrual shedding occur in the human endometrium during every normal menstrual cycle. Macrophage migration inhibitory factor (MIF), a multifunctional cytokine with numerous proinflammatory, immunomodulatory and angiogenic properties, appears to be expressed in the human endometrium and to follow a regulated cycle phase-dependent expression, but the mechanisms underlying endometrial MIF expression remain to be fully elucidated.

METHODS AND RESULTS

Results from enzyme-linked immunosorbent assay (ELISA) demonstrated a significant dose- and time-dependent increase in MIF secretion by human endometrial cells in response to tumour necrosis factor-alpha (TNF-alpha) (0.1-100 ng/ml). This increase was also observed at the mRNA level as shown by reverse transcription (RT)-PCR. Curcumin (10(-8) mol/l), a known nuclear factor (NF)-kappaB inhibitor, inhibited the TNF-alpha-induced pIkappaB phosphorylation as shown by western blotting, NF-kappaB translocation into the nucleus as shown by electrophoretic mobility shift assay, and MIF synthesis and secretion as measured by ELISA and RT-PCR. The expression of a dominant-negative NF-kappaB inhibitor (IkappaB) significantly decreased the TNF-alpha-induced MIF promoter activity as analysed by transient cell transfection.

CONCLUSIONS

These results indicate clearly that TNF-alpha up-regulates the expression of MIF in endometrial stromal cells. This took place possibly through NF-kappaB activation, and may play an important role in the physiology of the human endometrium.