Menstrual Effluent Provides a Novel Diagnostic Window on the Pathogenesis of Endometriosis

Nayyar A; Saleem MI; Yilmaz M; DeFranco M; Klein G; Elmaliki KM; Kowalsky E; Chatterjee PK; Xue X; Viswanathan R; Shih AJ; Gregersen PK; Metz CN

doi:10.3389/frph.2020.00003

The fieldEndometriosis

Menstrual Effluent Provides a Novel Diagnostic Window on the Pathogenesis of Endometriosis

Nayyar A, Saleem MI, Yilmaz M, et al.Frontiers in Reproductive Health · 2020DOI 10.3389/frph.2020.00003

In plain language

Stromal cells grown from the menstrual effluent of 24 women with surgically confirmed endometriosis and 23 controls were tested for decidualization, the change the uterine lining makes to prepare for pregnancy. Cells from women with endometriosis decidualized less, a test built on this separated cases from controls with an area under the curve of 0.92 (87.5% sensitivity, 91.7% specificity), and exposing control cells to the inflammatory cytokines TNF and IL-1β produced similar changes.

Key numbers

24 vs 23: Women with confirmed endometriosis versus controls
AUC 0.92: Decidualization assay, cases versus controls
87.5% / 91.7%: Sensitivity / specificity at the optimal cut-off

What it means

Live cells shed in menstrual effluent carry a measurable difference in endometriosis, and the same difference can be induced in healthy cells by inflammation. It supports the idea that menstrual effluent could one day help flag endometriosis without surgery.

What it does not show

Controls were self-reported, not surgically checked, and the cut-off was set and tested in the same small case-control group. The assay needs fresh, live cells cultured in a lab, which a dried sample cannot provide.

Figures

Figure 1 from Menstrual stromal cells in endometriosis: Stromal cells grown from the menstrual effluent of people with endometriosis, or with symptoms but no diagnosis, produced much less of the marker IGFBP1 when prompted to decidualize (left), and this measure separated endometriosis cases from controls with an area under the ROC curve of 0.92 (right). — **Figure 1.** Stromal cells grown from the menstrual effluent of people with endometriosis, or with symptoms but no diagnosis, produced much less of the marker IGFBP1 when prompted to decidualize (left), and this measure separated endometriosis cases from controls with an area under the ROC curve of 0.92 (right).Figure 1 from Nayyar et al., Frontiers in Reproductive Health (2020), CC BY 4.0.

Figures reproduced unchanged from Nayyar A et al., Frontiers in Reproductive Health, 2020, under CC BY 4.0. Captions written by Qvin.

How to cite

Nayyar A, Saleem MI, Yilmaz M, DeFranco M, Klein G, Elmaliki KM, et al. Menstrual Effluent Provides a Novel Diagnostic Window on the Pathogenesis of Endometriosis. Frontiers in Reproductive Health. 2020;2:3. doi:10.3389/frph.2020.00003