Shining a Light on Endometriosis: An Interview with Dr Dany Mercan, Unilabs Lab IVD

March marks Endometriosis Awareness Month. This chronic and systemic disease affects around 170 million women and girls worldwide (National Library of Medicine). Symptoms of this condition are debilitating pain, infertility, and various others that significantly disrupt daily life.

Despite its widespread occurrence and impact, diagnosis often faces considerable delays. There is currently no known cure for endometriosis, leaving those affected with the challenge of managing symptoms and exploring treatment options. Moreover, individuals with endometriosis and their families are at increased risk of various health disorders, including cancers and autoimmune diseases.

We interviewed Dr Dany Mercan, Clinical Pathologist and Head of Medical at Unilabs Switzerland to shed light on this condition.

Besides pain, what are the most common symptoms of endometriosis?

Aside from pain, the most common symptoms of endometriosis include infertility, systemic inflammation manifestations, cyclic dysuria (painful urination), painful intercourse, and mood disorders. Unfortunately, the variability in clinical presentations contributes to the delayed diagnostic issue.

Individuals with endometriosis and their families confront elevated risks of various health disorders, ranging from cancers to autoimmune diseases. Can you elaborate on this?

While there is an established link between endometriosis and a specific type of ovarian cancer, it's important to note that endometriosis isn't strongly associated with more common cancers, such as those affecting the cervix or breast.

Regarding autoimmune diseases, research suggests a potential connection with several of these conditions, although the relationship is not entirely understood.

In summary, the primary focus should be on accurately diagnosing endometriosis so that peripheral risks can be addressed through vigilant screening and appropriate medical management.

What is the role of diagnostics in the treatment of endometriosis?

The role of diagnostics in the treatment of endometriosis is crucial for accurately identifying and managing the condition. While laparoscopy, which involves searching for ectopic endometrial tissue or cyst formation, is often considered the gold standard, its performance may not always justify this classification. Additionally, it remains an invasive procedure that is not suitable for mass screening purposes.

Ultrasounds and MRIs are alternative diagnostic tools used to localise structures that are sufficiently large. However, there is a clear need for improved clinical stratification and the development of in vitro diagnostic tools to enhance the diagnostic process for endometriosis.

What are the latest research or advancements in the field?

In the field of endometriosis research, several advancements and ongoing studies are shaping our understanding and treatment of the condition.

Fundamentally, current research hypothesises that endometrial stem cells may be dispersed via retrograde menstruation, contributing to the development of endometriosis. However, alternative views, such as local metaplasia (transformation) of cells, also exist and are under investigation.

Clinically, there is a growing trend to expand the diagnostic process beyond the traditional pelvic area and to improve the identification of deep-infiltrating lesions, which are often associated with more severe symptoms.

In the realm of in vitro diagnostics (IVD), numerous clinical trials are underway to enhance the diagnostic process through the combined use of multiple biomarkers. While a simple and single test may not be available in the near future, current approaches hold promise for delivering improvements before the end of the decade.

Regarding therapy, the first-line approach typically involves the use of oral contraceptives and progestins. However, approximately one-third of patients do not respond to these treatments. Oral gonadotropin-releasing hormone (GnRH) antagonists have shown promise in helping these non-responsive patients. Advances in understanding the mechanisms of the disease are expected to lead to more efficient treatments in the future.

What advice or recommendation would you give to women who suspect they may have endometriosis but have not yet been diagnosed?

For women who suspect they may have endometriosis but have not yet been diagnosed, my recommendation is not to wait and to consult with a healthcare professional as soon as possible. It's crucial to openly discuss your symptoms with your doctor and provide detailed descriptions of what you're experiencing. Keeping track of your symptoms and noting any patterns or changes can be incredibly helpful.