Immune-mediated conditions and endometriosis in adolescents and adults

Autoimmune and/or inflammatory diseases could be encountered in endometriosis patients based on the underlying common etiopathogenetic mechanisms.

Key Points

Highlights:

• Endometriosis patients should be carefully evaluated for immunologic diseases in order to provide appropriate management.

Importance:

• Patients having endometriosis should be informed about potential comorbidity with immunological dysfunctions.

What’s done here?

• This cross-sectional study was conducted to investigate potential comorbidity between endometriosis and immunologic disorders.
• Women diagnosed with endometriosis were compared with an age-matched control group having no diagnosis of endometriosis.
• A baseline questionnaire was used to evaluate the lifestyle, reproductive factors, pain levels, medication use; along with self-reported autoimmune and/or inflammatory diseases [systemic lupus erythematosus, multiple sclerosis, rheumatoid arthritis, celiac disease, inflammatory bowel disease, Sjogren's syndrome, psoriasis, endocrine disorders, chronic pain-fatigue syndromes, and atopic diseases].
• Previous mononucleosis infection, family history of endometriosis, and demographic characteristics [age, BMI, race, smoking, parity, menarche, oral contraceptives, and analgesic medications] were also recorded.

Key results:

• A total of 1203 patients (n=551 having a diagnosis of endometriosis - the study group compared to n=652 in the control group) were included.
• Women in the study group more commonly reported "endometriosis" in a first‐degree relative (33.2% vs. 4.8%, respectively), and oral contraceptives were more commonly used by endometriosis patients.
• Any autoimmune and/or inflammatory disease, chronic pain and/or fatigue disorder (3.3% vs. 1.1%), allergies (40.8% vs. 26.4%), asthma (27.6% vs. 17.6%), and previous mononucleosis infection (14.2% vs. 9.4%) encountered more frequently in the endometriosis patients.
• The co-occurrence of endocrine disorders and eczema are not common in endometriosis patients.
• Under the age of 30, the possibility for the association of endometriosis and autoimmune/inflammatory conditions diminished, but the associations for CFS/fibromyalgia, allergies, asthma, eczema, and previous mononucleosis infection were either similar or strengthened.
• As the number of immune-mediated conditions increased, the risk of having endometriosis also increased.

Lay Summary

The most common presenting complaints of endometriosis are mainly pelvic pain and infertility, commonly in relation to the menstrual period. Affected women demand therapy for these symptoms.

Immunologic diseases such as autoimmune and/or inflammatory diseases, allergies, asthma, previous mononucleosis infection, and chronic fatigue and/or fibromyalgia could be encountered in endometriosis patients due to underlying common etiopathogenetic mechanisms. 

Shafrir et al, from the Brigham and Women’s Hospital and Boston Children’s Hospital, USA, published a prospective study titled “Co-occurrence of immune-mediated conditions and endometriosis among adolescents and adult women” in the journal "American Journal of Reproductive Immunology".

The authors aimed to investigate potential comorbidity between endometriosis and immunologic disorders. They found that any autoimmune and/or inflammatory disease, chronic pain and/or fatigue disorder, allergies, asthma, and previous mononucleosis infection were encountered more frequently in the patients with endometriosis. On the contrary, these patients had a diminished risk for having endocrine disorders and eczema.

Participants having an autoimmune and/or inflammatory disease, fibromyalgia and/or chronic fatigue syndrome, and allergies had an increased likelihood of coexistent endometriosis. The association with chronic fatigue syndrome /fibromyalgia, allergies, asthma, eczema, and previous mononucleosis infection was found to be more pronounced under the age of 30. The number of immune-mediated conditions also increased the coexistence of endometriosis.

“There may be pathophysiologic pathways in common between endometriosis and immune-mediated conditions. Our results highlight the need to consider endometriosis as potential comorbidity for adolescents and women with immune-mediated conditions” the authors concluded.    

Research Source: https://pubmed.ncbi.nlm.nih.gov/33583078/