Summary: A new study suggests that changes in gut bacteria are common in endometriosis. It found that one gut chemical, 4HI, could help find the disease early and reliably. No surgery would be needed.
Some health problems, like endometriosis, are quite common, yet science does not fully know their causes. So chronic pain specialists guess at genes, changes in the menstrual cycle, hormone problems, and more.
But could this fairly common women’s health problem come from changes in gut bacteria?
New research suggests it quite likely could. That means the disease is much more tied to metabolic disorders and chronic inflammation than once thought.
Endometriosis is a common problem. It affects about 11% of women of reproductive age. So the numbers are huge. It causes chronic pelvic pain, period problems, and bowel and bladder issues. It also brings tiredness and mood swings. And it is a common cause of trouble getting pregnant.
In this condition, the tissue that lines the uterus starts growing in other body parts or nearby organs. This causes local inflammation and pain. And since this tissue reacts to hormones, the pain comes in cycles. It gets worse on certain days each month.
The condition is hard to manage without the help of chronic pain specialists. The same symptoms can come from other causes, like inflammatory bowel disease, ovarian cysts, and more. And since its causes are not fully known, it is hard to treat.
It is the second most common gynecologic problem (a problem of the female reproductive organs), yet it is very hard to diagnose. So it is no surprise that many women go years without a diagnosis. UK data shows that, on average, it takes more than eight years to confirm its diagnosis after symptoms begin!
When a diagnosis takes that long, the disease is poorly managed in most cases. Most women just keep getting symptom treatment, like painkillers, during flares.
But now, a new study in the journal Med offers hope to millions of women around the world. It suggests the diagnosis can be confirmed with great accuracy using a stool test.
Past studies suggested endometriosis might be tied to gut health. Many studies showed that dysbiosis is common in it. That means the balance of gut bacteria is upset.
This new study enrolled 18 women with confirmed endometriosis and 37 healthy women to compare with. Researchers measured 371 chemicals in their stool. Some were higher and some were lower in women with the disease.
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One chemical, 4HI (4-hydroxyindole), was significantly lower in women with endometriosis. Researchers say this can only happen when gut bacteria change significantly.
Endometriosis is not the first condition where they have seen this change in 4HI levels. They have also seen it in people with inflammatory bowel disease (IBD).
These findings matter, because researchers need to understand how endometriosis and IBD are linked. Treating endometriosis early may even help prevent IBD in many cases. IBD is a much more serious disease.
More research is needed, but researchers are excited. They say a stool test to find endometriosis early, with no surgery, might now be possible.
The researchers also tested giving 4HI to animals with endometriosis. They found that 4HI truly helped. This suggests that measuring 4HI in stool can help diagnose endometriosis early. It might even play a role in treating it.
These findings also fit the focus on prevention at clinics like Interventional Pain Management St. Louis, where early care is often stressed.
Frequently asked questions
What are the main signs of endometriosis?
Chronic pelvic pain is the main sign. It comes with period, bowel and bladder problems, tiredness and mood swings. The misplaced tissue reacts to hormones, so the pain comes in cycles and flares on certain days each month. Endometriosis is also a common cause of trouble getting pregnant. It affects about 11% of women of reproductive age.
What triggers endometriosis?
Endometriosis happens when tissue that lines the uterus grows in other body parts or nearby organs. That causes local inflammation and pain. Its causes are not fully known. Genes, changes in the menstrual cycle and hormone problems have long been suspected. New research points to changes in gut bacteria. That ties the disease more closely to metabolic disorders and chronic inflammation than once thought.
Can endometriosis be diagnosed without surgery?
A 2024 study in the journal Med points that way. Researchers measured 371 stool chemicals in 18 women with confirmed endometriosis and 37 healthy women. One chemical, 4-hydroxyindole (4HI), was significantly lower in the women with endometriosis. The researchers say a stool test for early diagnosis, with no surgery, now looks possible. But more research is needed before it reaches the clinic.
Why does endometriosis take so long to diagnose?
Its symptoms overlap with other problems, such as inflammatory bowel disease and ovarian cysts. And its causes are not fully known. UK data shows it takes more than eight years on average from the first symptoms to a confirmed diagnosis. In that time, most women get only symptom treatment, like painkillers during flares. So the condition is poorly managed.
Is endometriosis linked to gut health?
Yes. Earlier studies showed that dysbiosis, an upset balance of gut bacteria, is common in endometriosis. The new study found low 4HI levels. Researchers say that change only happens with significant shifts in gut bacteria. The same 4HI pattern shows up in inflammatory bowel disease. And giving 4HI to animals with endometriosis helped, which hints at a role in treatment too.
Source:
Talwar, C., Davuluri, G. V. N., Kamal, A. H. M., Coarfa, C., Han, S. J., Veeraragavan, S., Parsawar, K., Putluri, N., Hoffman, K., Jimenez, P., Biest, S., & Kommagani, R. (2024). Identification of distinct stool metabolites in women with endometriosis for non-invasive diagnosis and potential for microbiota-based therapies. Med, 0(0). https://doi.org/10.1016/j.medj.2024.09.006
Dr. Gurpreet Singh Padda, MD, MBA, MHP
