ESHRE2011: A new method to detect subtle endometriosis?

Stockholm, 4 July 2011

Researchers today presented the simple technique of using methylene blue staining to detect subtle or invisible endometriotic lesions in women with chronic pelvic pain.

With no apparent relationship between pain and extent of endometriosis a new model for understanding pain is needed to account for the temporal association between pain and menstrual bleeding.

Professor Bruce Lessey at the ESHRE meeting in Stockholm

Data was presented at the 27th Annual Meeting of ESHRE by professor Bruce Lessey (Greenville Hospital System, USA) on how methylene blue was used to paint the peritoneal surfaces in women with endometriosis.

His team demonstrated that the dye was taken up in discreet locations that correlated well to subjective localisation of pain.

Electron microscopy showed peritoneal cell-to-cell disruption at sites of dye update, suggesting an aberrant porosity in the mesothelial layer explained by the ability of the dye to stain underlying tissues.

“We hypothesised, based on these findings, that menstrual blood and associated peptides, such as substance P, glycodelin or TNF-∂, gain access to underlying nerves in women with mild endometriosis and thus accounts for the pain these women experience”, said professor Lessey, emphasising that “endometriosis may cause a field effect with the area of disruption being larger than the visible lesion”.

“This concept of localised peritoneal fluid leakage of inflammatory cytokines and chemokines might also have implications for immune responses and infertility associated with minimal or mild endometriosis”, concluded professor Lessey.

In the study presented at the meeting, endometriosis was found in 24 of 30 cases where the disease was surgically resected, restoring 22 out of 24 women to a pain free state. Following such surgery Professor Lessey recommends long term medical suppression of menstruation or – if fertility is desired – to get to it as soon as possible!

Further data from this study will be presented at the 11th World Congress on Endometriosis.