New research suggests that girls who are tall and lean are more at risk for developing endometriosis, but some experts argue itâ€™s not that simple.
The researchers found that girls who had a higher body mass index (BMI) in childhood had a lower risk of endometriosis compared with girls who were lean and tall.
â€œOur findings suggest that indicators of risk can be picked up at an earlier age, which might help speed up diagnosis so treatment can be started to slow the growth of endometrial tissue,â€ Julie Aarestrup, PhD, lead researcher of the study from Denmarkâ€™s Center for Clinical Research and Prevention, said in a press release.
In undertaking the research, Dr. Aarestrup and colleagues analyzed the height, weight, and birth weight of girls born in Denmark between 1930 and 1996.
Follow up began in 1977 or when the girls reached age 15, whichever occurred later.
The researchers said they found that thinner and taller girls were more likely to be at risk for endometriosis.
A 2.3 kilogram difference between two 7-year-old girls in the study was associated with an 8 percent increased risk of endometriosis in the girl who weighed less.
A girl who was 5.2 centimeters taller was associated with an increased endometriosis risk of roughly 9 percent.
A different theory
Dr. Valerie A. Flores, an assistant professor in the department of obstetrics, gynecology, and reproductive sciences at the Yale School of Medicine in Connecticut, argues the relationship between height, weight, and endometriosis is more complex than the new research indicates.
â€œThe study has it a bit backward. This is actually a very common misconception,â€ Flores told ishonest. â€œItâ€™s not that if youâ€™re lean or skinny or tall that that predisposes you to developing endometriosis. Itâ€™s that the endometriosis in and of itself by being a systemic disease tends to lead to a lean phenotype.â€
â€œItâ€™s been very well described in the literature that women with endometriosis tend to be thinner,â€ she added. â€œBut most people have said it the way this paper has said it, which is that if youâ€™re thin, that predisposes you to endometriosis.â€
â€œBut itâ€™s the reverse,â€ she continued. â€œIf you have endometriosis you are more likely to be thin because endometriosis is acting in a systemic natureâ€¦ itâ€™s acting at sites distant to the pelvis like the liver, which is involved with metabolism and that, in turn, is leading to changes in genes that are involved in weight loss or weight gain.â€
What is endometriosis?
About 1 in 10 women in the United States and 200 million women worldwide are estimated to live with endometriosis.
The condition occurs when tissue called endometrium, similar to that found in the lining of the uterus, grows outside the uterus.
While similar cells that build up in the uterus break down and exit the body, endometrial cells that grow elsewhere in the body have no way of escaping.
Resulting symptoms can include severe cramps, lengthy or heavy periods, nausea or vomiting, chronic fatigue, painful intercourse, and problems with the bowel and bladder.
Thereâ€™s no known cause and no known cure for endometriosis. Women can spend years waiting for a diagnosis.
â€œThere are huge diagnostic delays in endometriosis. Women go 7 to 10 years and see 3 to 5 doctors before they ultimately get diagnosed with the disease,â€ Flores said.
Treatment and diagnosis
Dr. Anna Reinert, an obstetrician and gynecologist at Keck Medicine of USC, said current approaches to treatment of endometriosis are problematic.
â€œWe have started describing the state of endometriosis treatment in America as a â€˜care crisis,â€™ which is appropriate,â€ Reinert told ishonest. â€œIn part because of inadequate research from which to issue practice guidelines, the majority of obstetrician-gynecologists have a poor understanding of endometriosis and chronic pelvic pain.â€
â€œFurthermore, very few gynecologists are trained in appropriate surgical treatment of endometriosis,â€ she continued. â€œThis leads to many patients having diagnostic surgery delayed for years, or undergoing surgery that does not effectively treat their disease.â€
She argues it would be helpful to have an indicator that identifies woman at risk for endometriosis.
â€œWhat will be most helpful is studies identifying a biomarker â€” a blood test, for example, that helps identify patients at risk for the disease. Unfortunately, height or low BMI isnâ€™t specific enough to be very helpful clinically,â€ she said.
Experts say the treatments available arenâ€™t ideal either.
â€œTreatments include surgical removal of endometriosis implants or lesions, medications that decrease or inhibit estrogen production, and the closest we have to a cure is hysterectomy and removal of the ovaries. However, none of these options are great options,â€ Dr. Clara Paik, clinic medical director of obstetrics and gynecology at the University of California Davis, told ishonest.
â€œThe medications cannot be used long term due to risks of bone loss, and obviously a hysterectomy and removal of ovaries are not good options for women who want to preserve their fertility,â€ Paik said.
â€œAlso, removing ovaries in young women can lead to earlier onset of cardiovascular disease and osteoporosis,â€ she said. â€œMultiple surgeries for removal of endometriosis implants can be associated with risks such as adhesions and bowel injury.â€
Pay attention to menstrual pain
Flores said women have been conditioned to believe painful periods are normal. She argues women should be mindful of warning signs that the pain they experience when menstruating might be more than standard period pain.
â€œEndometriosis tends to be progressively worse menstrual cycles, usually does not respond to nonsteroidal anti-inflammatory agents, and tends to also have other cyclical symptoms whether they be bowel or bladder symptoms,â€ she said.
Dr. Kathleen M. Brennan, associate clinical professor in the department of obstetrics and gynecology at the David Geffen School of Medicine at the University of California Los Angeles, said women shouldnâ€™t hesitate to discuss painful periods with their doctor.
â€œWe canâ€™t predict who will have endometriosis, other than knowing that daughters or sisters of women that have endometriosis are at risk,â€ Brennan told ishonest.
â€œI think itâ€™s important for adolescents and young women to discuss painful periods with their doctor,â€ she said. â€œGynecologists see many women with endometriosis and itâ€™s always in the list of possible diagnoses when girls or women describe painful periods.â€
Experts agree that endometriosis is a disease that warrants more research, but Reinert notes endometriosis doesnâ€™t receive the same level of funding as other diseases.
â€œIn the United States, endometriosis receives some of the lowest funding of any disease. Itâ€™s number 276 on the National Institutes of Healthâ€™s budget for 288 diseases, receiving about 1 dollar per patient,â€ she said. â€œItâ€™s hard to make progress toward a cure in this environment.â€