Endometriosis and Barriers in Women’s Healthcare
While healthcare is an ever-progressing field, gender bias and racial discrimination continue to create barriers. These barriers can make it nearly impossible for people to receive the care they need. One such disease that is surrounded by these obstacles is endometriosis. Endometriosis affects 1 in 10 people, and on average, it takes up to 11 years to be diagnosed (DotLab | Bringing You DotEndo for Endometriosis, n.d.-b). Currently, there is no cure, and the recommended diagnosis and treatment options are difficult to receive.
One challenge that delays the identification of endometriosis is the lack of disease-specific symptoms, leading to it often being misdiagnosed. Additionally, many of the symptoms that are experienced are seen as normal, which makes it harder for those with endometriosis to receive a diagnosis (DotLab | Bringing You DotEndo for Endometriosis, n.d.-b). The current way of being diagnosed with endometriosis is through laparoscopic surgery, which can be hard to access for many people. Because of these challenges, many people are unable to receive treatment.
What is Endometriosis?
Endometriosis is a chronic disease caused when tissue similar to the lining inside a uterus grows outside the uterus. This can result in growths and cysts forming on the ovaries, fallopian tubes, and pelvic tissue. Some of the obvious symptoms are pelvic pain, painful periods, pain during sex, pain with urination, excessive bleeding, and infertility. (Endometriosis - Symptoms and Causes - Mayo Clinic, 2023). In contrast, some people may not experience any symptoms, while others may suffer from excruciating symptoms that impact their daily lives (Horne & Missmer, 2022). In addition to this, the level of pain and symptoms experienced often fluctuates for each individual. It is typically classified into four stages, with stage 1 being the most mild and stage 4 being the most severe. (Endometriosis Foundation of America, 2021). The Endometriosis Foundation of America likes to use more descriptive categories for the stages of endometriosis by focusing on the anatomical location of the growths. Category 1 is peritoneal endometriosis when endometrial tissue is found in the membrane that lines the abdomen. Category 2 is Ovarian Endometriosis when it has grown in the ovaries. Category 3 is Deep Infiltrating Endometriosis I when it grows in the pelvic organs such as the ovaries, rectum, and uterus. Category 4 is Deep Infiltrating Endometriosis II when endometriosis grows on organs outside the pelvic cavity (Endometriosis Foundation of America, 2021). “This can include the bowels, appendix, diaphragm, heart, lungs, and even the brain” (Endometriosis Foundation of America, 2021).
Diagnosis
Laparoscopic surgery is the traditional method for diagnosing endometriosis. During a laparoscopy, a surgeon will insert a slender instrument into the abdomen through a cut near the navel. The inserted instrument allows the surgeon to look for endometrial growths and cysts, informing the surgeon about the size, location, and extent of endometriosis growths (Endometriosis - Diagnosis and Treatment - Mayo Clinic, 2023). Because laparoscopy is an invasive procedure, it creates a diagnostic barrier that prevents many from receiving treatment (Moustafa et al., 2020). Before a laparoscopy, a patient may undergo a pelvic exam, ultrasound, or MRI to detect cysts (Endometriosis - Diagnosis and Treatment - Mayo Clinic, 2023). These initial tests cannot formally diagnose endometriosis, but provide insight on whether a patient will need to undergo a laparoscopy.
A noninvasive diagnostic test would significantly reduce the time to diagnosis, this could lead to improved patient outcomes by reducing surgical risk, discomfort, disease progression, and associated comorbidities (Moustafa et al., 2020).
Since endometriosis is incurable, treatment focuses on managing symptoms. This may involve pain medicine, undergoing fertility treatment when looking to conceive children, and sometimes hormone therapy or surgery (Endometriosis - Diagnosis and Treatment - Mayo Clinic, 2023). This may raise the question: If there is no cure for endometriosis, why strive for an earlier diagnosis? Early diagnosis allows patients to begin treatment sooner and prevent the further progression of the disease. This will benefit the healthcare field in a myriad of ways. It can help people experiencing unexplained infertility and other gynecological issues understand if endometriosis is the cause.
DotLab
Although there are things that remain unknown about endometriosis, scientists are continually conducting research and discovering new knowledge. DotLab, a female-founded women’s healthcare company, is developing innovative technology that advances women’s health through precision medicine. DotLab was named after Dorothy Crowfoot Hodgkin, who won a Nobel Prize in Chemistry in 1964. (DotLab | Bringing You DotEndo for Endometriosis, n.d.-b). She worked with X-ray crystallography, discovering the structures of penicillin, insulin, and vitamin B12, making advances in medicine and biochemistry (Science History Institute, 2024). Her work inspired many, including the founder of DotLab, Heather Bowerman. The team at DotLab is dedicated to making advances in medicine and addressing the problems women face in healthcare. Through their research, they have developed an easier and more accurate way to diagnose endometriosis. This is a breakthrough in the restrictions facing women in healthcare.
DotEndo
The DotLab team and their scientific advisory board worked to develop DotEndo, a non-invasive blood test. “DotEndo measures biomarkers in the blood which act as a unique signature to identify active endometriosis across all stages of the disease, regardless of hormones, cycle, or symptoms” (DotLab | Bringing You DotEndo for Endometriosis, n.d.-b).
How does this work? First, let’s look at what a biomarker is. Biomarkers are measurable characteristics of the body. For example, pulse, blood pressure, and even molecules found in body fluids are all biomarkers (Condrat et al., 2020). By examining them, we can learn about diseases and functions of the human body. These indicators have been used throughout history and have become more and more precise over time.
MicroRNAs (miRNAs) are tiny molecules that can be extracted from blood, urine, and other bodily fluids. These molecules were first found to be accurate biomarkers for cancer in 2008, and have been used to diagnose various other diseases since (Condrat et al., 2020). A study by Moustafa et al. (2020) showed that miRNA biomarkers can detect endometriosis. Dotlab uses this science in their new blood test called DotEndo. Not only is this test accurate in diagnosing endometriosis, but it could also help millions of people, especially those who don’t have access to or cannot afford to undergo a laparoscopic surgery.
The work of DotLab is a great step forward in pushing the boundaries of science, though more research still needs to be done. By continuing to oppose the hurdles that exist within the healthcare field, strides can be made in improving women’s medicine.
Works Cited
Condrat, C. E., Thompson, D. C., Barbu, M. G., Bugnar, O. L., Boboc, A., Cretoiu, D., Suciu, N., Cretoiu, S. M., & Voinea, S. C. (2020). miRNAs as Biomarkers in Disease: Latest Findings Regarding Their Role in Diagnosis and Prognosis. Cells, 9(2), 276. https://doi.org/10.3390/cells9020276
DotLab | Bringing you DotEndo for Endometriosis. (n.d.-b). https://www.dotlab.com/
Endometriosis - Diagnosis and treatment - Mayo Clinic. (2023, October 12). https://www.mayoclinic.org/diseases-conditions/endometriosis/diagnosis-treatment/drc-20354661
Endometriosis Foundation of America. (2021, March 18). Endometriosis stages: Understanding the different stages of endometriosis | Endofound.org. Endometriosis : Causes - Symptoms - Diagnosis - and Treatment. https://www.endofound.org/stages-of-endometriosis
Endometriosis - Symptoms and causes - Mayo Clinic. (2023, October 12). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/endometriosis/symptoms-causes/syc-20354656
Horne, A. W., & Missmer, S. A. (2022). Pathophysiology, diagnosis, and management of endometriosis. BMJ, e070750. https://doi.org/10.1136/bmj-2022-070750
Moustafa, S., Burn, M., Mamillapalli, R., Nematian, S., Flores, V., & Taylor, H. S. (2020). Accurate diagnosis of endometriosis using serum microRNAs. American Journal of Obstetrics and Gynecology, 223(4), 557.e1-557.e11. https://doi.org/10.1016/j.ajog.2020.02.050
Science History Institute. (2024, April 18). Dorothy Crowfoot Hodgkin | Science History Institute. https://www.sciencehistory.org/education/scientific-biographies/dorothy-crowfoot-hodgkin/
The Nobel Prize in Chemistry 1964. (n.d.). NobelPrize.org. https://www.nobelprize.org/prizes/chemistry/1964/summary/
