Defining Future Directions for Endometriosis Research: Workshop Report From the 2011 World Congress of Endometriosis in Montpellier, France

Abstract

Endometriosis, defined as estrogen-dependent lesions containing endometrial glands and stroma outside the uterus, is a chronic and often painful gynecological condition that affects 6% to 10% of reproductive age women. Endometriosis has estimated annual costs of US $12 419 per woman (approximately €9579), comprising one-third of the direct health care costs with two-thirds attributed to loss of productivity. Decreased quality of life is the most important predictor of direct health care and total costs. It has been estimated that there is a mean delay of 6.7 years between onset of symptoms and a surgical diagnosis of endometriosis, and each affected woman loses on average 10.8 hours of work weekly, mainly owing to reduced effectiveness while working. To encourage and facilitate research into this debilitating disease, a consensus workshop to define future directions for endometriosis research was held as part of the 11th World Congress on Endometriosis in September 2011 in Montpellier, France. The objective of this workshop was to review and update the endometriosis research priorities consensus statement developed following the 10th World Congress on Endometriosis in 2008. 1 A total of 56 recommendations for research have been developed, grouped under 6 subheadings: (1) diagnosis, (2) classification and prognosis, (3) clinical trials, treatment, and outcomes, (4) epidemiology, (5) pathophysiology, and (6) research policy. By producing this consensus international research priorities statement, it is the hope of the workshop participants that researchers will be encouraged to develop new interdisciplinary research proposals that will attract increased funding support for work on endometriosis.

Endometriosis Is Associated With a Shift in MU Opioid and NMDA Receptor Expression in the Brain Periaqueductal Gray

“…1 Endometriosis is commonly characterized by chronic pelvic pain, pain during intercourse (dyspareunia), and painful periods (dysmenorrhea). 2,3 Unfortunately, endometriosis negatively impacts the daily life activities of women who suffer from it, often more so than other chronic conditions. [4][5][6] Other chronic conditions that produce pelvic pain have been shown to produce plastic changes in the brain, especially on structures functionally involved in pain and stress processing.…”

Tubal origin of ovarian endometriosis

“…Endometriosis, most commonly involving the ovary, affects approximately 10% of women in their reproductive age and up to 50% of women suffering infertility and abdominal pain. [1][2][3][4][5] The pathogenesis of endometriosis remains unclear and elusive since it was first described by Von Rokitansky over 100 years ago. 6 Sampson's retrograde menstruation theory 7,8 has been widely accepted since 1920s, but remains controversial as retrograde menstruation occurs in up to 90% of women in reproductive age 9 but only 6-10% of those women have endometriosis.…”

Chlamydia muridarum Induction of Glandular Duct Dilation in Mice

“…The glandular duct cysts vary in size but are restricted within the endometrium. Adenomyosis refers to the invasion of hyperplastic glands into the myometrium (35), which can be difficult to differentiate from endometriosis (36) when the dislocated endometrial tissue is still associated with the uterus. Hydrometra may also cause uterine horn dilation (34), which is, however, due to uterine horn lumenal distension without involving the uterine glands.…”