20-8-2009 Since 2 days we have a a series of comments concerning the observation that women with (mild and superficial endometriosis have more nerve fibers in the endometrium. A lot of speculation of a new diagnostic test followed

Our Comments

This is another example (as I discussed in https://www.gynsurgery.be and https://www.mondoginecologico.it) that interpretation of research data should be done carefully and that conclusions by researchers often are overstretched and/or biased.
The observation of higher incidences of nerve fibers in the endometrium of women with endometriosis is nice research. To suggest this as a non invasive diagnostic test however is way premature.
1. First, an association does not permit to conclude about cause and effect. We know ( more than 50 articles) since 20 years that the endometrium of women with endometriosis is slightly different from the endometrium of women without endometriosis. It is unclear whether these differences are a consequence of the endometriosis or whether these differences merely signal an ‘endometrioitic’ constitution (as suggested in the endometriotic disease theory). Knowing what happens after surgical excision of endometriosis could give a hint. We previously demonstrated that the decrease in natural killer cells in endometriosis women is not affected by surgical excision of endometriosis whereas CA125 decreases tremendously therafter.
2. Second the article knowingly and willingly disregard subtle endometriosis which is present intermittently in many women and which -I and others think- should not be considered a disease, as discussed in the literature since more than 10 years.
My guess considering the pain symptoms, is that the increased nerve endings is a sign besides many others, that a women will have more retrograde menstruation and also more frequently subtle endometriosis etc, something I am considering since many years as irrelevant findings at laparoscopy since subtle endometriosis does not cause pain or infertility.
The key problem of not recognising or not referring severe endometriosis or doing an incomplete excision or doing unnecessary bowel resections will remain.

The key problem for women with endometriosis will remain the same : not recognising or not referring severe endometriosis or doing an incomplete excision or doing unnecessary bowel resections. The risk is that this observation will be used before proper validation and that it will result in a lot of unnecessary laparoscopies and surgery.

Also the comment by David Healy, who I do regard highly as a scientist,  on www.gynsurgery.org areanother example of this.  The conclusion that “Therefore, whereas this research is promising towards the development of a less invasive diagnostic test for endometriosis, it is important to emphasise that such a test is not yet validated, and therefore not yet available . is preceded by  speculation feeding confusion and false expectations.

“If other researchers can confirm this test, this might become the standard way of diagnosing endometriosis. This would mean that the condition could be identified earlier, which could give real benefits for women, who may later become infertile due to endometriosis” and “In other words: early detection may preserve fertility if correct treatment is commenced promptly” First in a woman without complaints, I do not see why it should be important to make a diagnosis ; on the contrary this could lead to unnecessary interventions to confirm.  Secondly the indication for laparoscopy which is pain or infertility will not be changed by a non invasive diagnosis. And finally there is no evidence whatsoever that an early diagnosis will have any effect in preserving fertility : this is pure speculation.

Prof P. R. Koninckx and Dr A. Ussia