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Missmer coauthors NEJM article to highlight pelvic pain issues

Endometriosis is an often painful ailment afflicting an estimated 10 percent of reproductive-age women, about 190 million women worldwide, yet it doesn’t get nearly the attention or research funding it deserves.

Michigan State University Prof. Stacey Missmer, ScD, hopes that an article she co-authored in the New England Journal of Medicine will help change that.

For too long, many women have suffered in silence with the pelvic pain and other symptoms associated with endometriosis, either due to stigma or the false assumption that it’s a normal part of being a woman.

When women do talk to their family or physicians about the pain, “often it has not been met with a supportive response,” Missmer said. “The take-home message is, when women are expressing that they’re suffering, take them seriously.”

Missmer and co-authors Christian M. Becker, MD, and Krina T. Zondervan, D.Phil, both at the University of Oxford, were invited to write the article for the New England Journal of Medicine, a rare opportunity, since endometriosis does not receive much attention in the major scientific journals.

“Despite being very prevalent and having a great deal of life impact, it’s very poorly understood among the general public and in clinical care,” Missmer said.

Endometriosis is an often painful condition in which tissue similar to what normally lines the uterus grows elsewhere – most often in the pelvic cavity. Besides menstrual cramping and chronic pelvic pain, its symptoms can include bowel and bladder pain, fatigue, and infertility.

Most primary care physicians do not routinely ask their female patients if they suffer pelvic pain, Becker noted, adding that women report an average of seven years to diagnose.

“We’ll sometimes hear the comment, ‘Well, you don’t die from it,’” Missmer said.

But women who suffer endometriosis not only experience considerable impact of their symptoms on their daily lives, but are also at a higher risk of other morbidities, such as ovarian cancer and cardiovascular disease, as well as autoimmune diseases.

Endometriosis can be debilitating for many women during what should be their most productive years, causing some to become socially isolated, miss work and forego job opportunities and income, Zondervan said, yet it receives little funding for research compared with other diseases.

The National Institutes of Health spends about $9 million on endometriosis research annually, Missmer added, a fraction of that spent for many other less prevalent diseases.

She sees a glimmer of hope that it will begin to attract more attention in the clinic and in the laboratory. In recent years, some celebrities have talked openly about their struggles with endometriosis, and some members of Congress have begun to show interest. Missmer testified about the need for more funding at a Congressional hearing in April 2019, and an endometriosis caucus was launched in the House of Representatives on March 5, 2020.

As endometriosis draws more attention, “I believe we will see an incredible leap forward,” Missmer said. “With attention and funding, all of the scientific, technologic, and clinical elements are in place to get there for girls and women with endometriosis.”