Endometriosis Update from the National Women's Health Network

Endometriosis Info from the
National Women's Health Network

The information below was published in NWHN's newsletter in Sept-Oct 1999 by Andrea DuBrow. You can get an information packet about endometriosis by contacting NWHN directly.

Endometriosis is a puzzling, painful disease that may be linked to environmental toxins. As with any complicated disease, there are numerous aspects that deserve attention: hormonal, surgical, and alternative treatments; (in)fertility issues; pain control; coping strategies; and research directions are among a few. Long-time readers of The Network News may remember that we raved about The Endometriosis Sourcebook in 1996, a comprehensive reference that finally addressed background and emerging issues for women with endometriosis. We still recommend this book for practitioners and women's health advocates, and particularly for anyone experiencing endometriosis. The purpose of this article is to highlight some of the potential connections between endometriosis and environmental causes, and to draw attention to new research showing a heightened risk of some cancers for women with endometriosis and their families.

What is Endometriosis? < Endometriosis occurs when some of the tissue that usually lines the uterus also grows in other parts of the body. This extra endometrial tissue is most frequently found in the pelvic area: on the ovaries, external surface of the uterus, ligaments, or fallopian tubes. These growths may build up and bleed during menstrual periods. They respond to the hormonal influences of the menstrual cycle, and because the tissue has no way to leave the body, it may cause internal bleeding and scarring, inflammation, and/or the formation of cysts and scar tissue.

< Typical symptoms of endometriosis include chronic pain (particularly in the pelvic region), pain when menstruating, pain with sex, infertility, and painful bowel movements or urination. Interesting new findings reported by the Endometriosis Association also link endometriosis to chronic fatigue and chemical sensitivities and/or allergies.

What causes Endometriosis? < Originally thought of as a disease of the endocrine system, new theories are emerging that may link endometriosis to immune dysfunction. In 1992, the Endometriosis Association< published an article reporting on research that showed a very high rate of endometriosis in rhesus monkeys exposed to dioxin.* The study sparked additional interest in the possible link between dioxins, PCBs (polychlorinated biphenyls) and endometriosis. Dioxins and PCBs are organochlorines, made from combining chlorine with organic substances, such as petrochemicals. Organochlorines can take hundreds of years to break down completely and are stored in fatty tissues of animals and humans. Endometriosis may be the first human disease definitely linked to hormonal and immunological disruption due to pollutants.

Banned in the U.S. in 1979, PCBs were used widely as electrical insulators, and in the manufacture of paint and inks. Discharged by industrial plants as wastewater, PCBs now contaminate water and soil. Dioxin, another environmental pollutant, is created from the incineration of toxic waste and municipal garbage, and the manufacturing and use of certain herbicides, pesticides, and solvents. In animals, dioxin is known to cause immune suppression, cancer, and birth defects. Over the past several years, increasing attention has been paid by the scientific community to the possibility that dioxin exposure may be linked to endometriosis. Articles have appeared in Science magazine, Scientific American, and other scientific publications on the dioxin-endometriosis connection, and studies are being conducted to explore this further.

Immunological Findings. Recent studies suggest another link among endometriosis, environmental pollutants, and changes in the immune system. The Endometriosis Association's research registry tracks health problems that are reported by women with endometriosis and their families. This tracking shows higher rates of immune-related problems and diseases than are found in the general population, ranging from allergies and chemical sensitivities to severe autoimmune disorders such as lupus.

Some studies suggest that endometriosis is associated with changes in systemic immunity and, that cytokines (substances produced by cells in the immune system) may influence the ability of endometrial growths to spread and flourish where they don't belong. A fairly recent realization is that environmental pollutants like dioxin also have profound immunological impacts. While the precise impact of environmental pollutants on humans is unknown, endometriosis may be the first human disease definitely linked to hormonal and immunological disruption due to pollutnts. The Endometriosis Association asserts that if dioxins, which are known carcinogens, are capable of causing endometriosis, perhaps women with endomeriosis (and their families who shared their environmental exposures) might be at risk for cancer, too.

Higher Risks of Cancer and Autoimmune Diseases. The Endometriosis Association registry has collected reports which show that women with endometriosis, and their families, are more likely to be diagnosed with a number of cancers and other health problems, including breast cancer, melanoma, ovarian cancer, non-Hodgkin's lymphoma, and diabetes than would be expected in the general population. For example, 26% of the women with endometriosis in the registry have a family member with breast cancer.

Even though endometriosis is very common, there are relatively few published studies that look at its possible link with other diseases. A Swedish study of 20,686 women with endometriosis found an increased risk of breast and ovarian cancer and non-Hodgkins lymphoma. A study conducted at Harvard Medical School found an increased risk of melanoma. Other conditions which were reported statistically significantly more often by women with endometriosis and their families in the registry included thyroid disorders, and autoimmune diseases such as rheumatoid arthritis, lupus, multiple sclerosis and Meniere's disease.

According to the Endometriosis Association, many of the women in these studies may face even higher risks for cancer. This is because the study participants with endometriosis tend to be younger women (in their teens, 20s and 30s), and most cancers occur more frequently in older age groups. Therefore, they may become even more common as the study population ages.

In an effort to advance research on endometriosis and related health problems, the Endometriosis Association is entering a partnership with Vanderbilt University School of Medicine to conduct additional research on endometriosis, including the immunological spects of the disease. This is the first time that a major medical institution has committed $2 million in funding, along with institutional support and laboratory facilities dedicated to studying the endocrine, immune, and environmental elements that may contribute to endometriosis.

For more information, readers may contact the Endometriosis Association at 8585 N. 76th Place, Milwaukee, WI, 53223 or call toll-free 1-800-992-3636.

References

Endometriosis Association newsletter, Volume 13, No. 2,1992.
Ballweg, M. (1996). The Endometriosis Sourcebook, Contemporary Books, Chicago.

Documentary Film on a Related Topic

Those interested in an in-depth exploration of the environment and breast cancer will appreciate Rachel's Daughters: Search for the Causes of Breast Cancer. Co-produced by film documentarians and activists, the film explores the many lines of evidence that connect the stunning 50-year increase of breast cancer in the United States with the simultaneous spread of persistent organic pollutants.

The film is available from: