NICHD Endometriosis Research Information

Promoting reproductive health is an important element of NICHD’s mission. Gaining a better understanding of endometriosis—its diagnosis, treatment, causes, and symptoms—is a key aim of the institute’s research on this and other reproductive health problems that cause pain and contribute to infertility.

NICHD research goals related to endometriosis include (but are not limited to) the following:

• Better ways to diagnose the disease. Currently, surgery is the only way to diagnose endometriosis definitively. NICHD researchers are seeking less invasive ways to determine whether a woman has this condition.
• Better treatments for the disease and its symptoms. There is currently no cure for endometriosis, and even the most invasive surgical treatments don’t provide definite relief. NICHD research focuses on the two most common symptoms, pain and infertility.
  • Although painkillers can treat milder pain, many women find relief from severe pain only with hormone treatments or surgery, and sometimes that relief is only temporary. A better understanding of how the disease is related to pain is crucial to developing more effective pain treatments.
  • Even though endometriosis may be common among women with fertility problems, researchers still do not know how endometriosis causes infertility. Understanding the underlying mechanisms by which endometriosis decreases fertility will help in developing ways to improve fertility in women who have endometriosis.
• The causes of endometriosis. The exact cause or causes of endometriosis remain unknown, making development of better treatments for and ways to prevent the disease more difficult. NICHD research examines inflammation, epigenetics, genetics, hormonally active environmental contaminants, and other mechanisms as possible causes.

NICHD conducts and supports a range of research activities to learn more about causes, risk factors, and treatments for endometriosis. The Endometriosis and Women’s Health fact sheet describes the institute’s support of research on this common gynecologic condition and highlights some recent findings and advances from NICHD-funded projects. Also learn more about NICHD’s Infertility and Women’s Health, including some recent advances in understanding, diagnosing, and treating this common condition in males and females.

Institute Activities and Advances

The institute supports research on endometriosis mostly through its Fertility and Infertility Branch (FIB) and Gynecologic Health and Disease Branch (GHDB), both within the Division of Extramural Research (DER), but also through other extramural organizational units. GHDB’s Scientific Vision (PDF 1.6 MB) outlines several goals and directions for endometriosis research.

Researchers in NICHD’s Division of Population Health Research (DiPHR) and Division of Intramural Research (DIR) also conduct research on different aspects of endometriosis. DiPHR led the Endometriosis: Natural History, Diagnosis, and Outcomes (ENDO) Study to better understand the role that endocrine-disrupting chemicals play in endometriosis. Visit the ENDO Study website for a listing of published findings. The DIR Reproductive Endocrinology and Gynecology Group and several intramural training programs also study issues related to endometriosis, including clinical efforts.

Findings on endometriosis from NICHD researchers and researchers funded by NICHD include the following:

• Spotlight: What to Know About Endometriosis provides a Q/A about endometriosis with NICHD scientist Lisa Halvorson, M.D., former chief of GHDB. It also notes some recent findings from NICHD-funded research on endometriosis.
• Foundational NICHD research on the drug elagolix that helped support the drug’s approval as a treatment option for endometriosis-associated pain was supported by NICHD through its Small Business Innovation Research program (PMID: 19033369).
• NICHD-funded researchers found several inflammatory proteins in blood that were linked with a higher risk of later endometriosis diagnosis. This study provided evidence that inflammation may contribute to the development of endometriosis.
• Researchers funded by NICHD screened uterine tissue to detect gene activity patterns as a way to diagnose the presence and severity of endometriosis.
• In an NICHD-funded study, researchers were able to turn adult stem cells from bone marrow into endometrial cells. The finding opens the possibility of replacing an endometrial lining with healthy endometrial tissue created from a woman’s own cells. Visit Science Update: NIH-funded researchers produce uterine cells from adult stem cells for more information.
• NICHD-funded researchers studying endometriosis reported that antibiotic therapy reduces endometriosis progression in mice, possibly by reducing specific gut bacteria.
• Research by NICHD and the National Cancer Institute (NCI) found that women with certain levels of inflammatory biomarkers had a higher risk for endometriosis.
• NICHD-funded research has been studying ways to screen uterine tissue to detect gene activity patterns as a way to diagnose the presence and severity of endometriosis.
• Researchers discovered the source of a cell type that is central to endometriosis, endometrial stromal fibroblasts (eSF). In endometriosis, eSF are unable to respond to progesterone and do not function properly, producing inflammation and pain. The research helps explain how eSF develop and how they become prone to inflammation. See NIH-Funded Study Uses Lab Cultures to Trace Problem Cells Back to Their Source for more information.
• An NICHD-supported study found that eating more than two servings of red meat a day was linked to a higher risk of endometriosis compared to eating one serving or fewer a week.
• A study funded in part by NICHD found that a drug, bufalin, effectively suppressed the growth of endometriosis lesions in mice and in human endometrial cells in the lab.
• An NICHD-supported study found that women who consumed more than four servings per day of dairy foods during adolescence had a 32% lower risk of surgically confirmed endometriosis in adulthood than women who’d had one or fewer servings per day.
• An NICHD-supported study analyzed insurance data of women with endometriosis in Puerto Rico and learned that women with public-sector insurance were less likely to use obstetric or gynecological services and more likely to have a laparoscopy and be prescribed opioids for pain than women with private-sector insurance.
• Research funded in part by NICHD used machine learning to analyze genetic data to find better ways to classify endometriosis. The study identified several biomarkers that may be useful in diagnosing endometriosis.
• NICHD and NCI funded a study that found that women with endometriosis had an increased risk of heart disease. Women who had a hysterectomy and had their ovaries removed were at even higher risk. See Endometriosis Linked to Increased Risk for Heart Disease for more information.

Other Activities and Advances

• In 2013, the World Endometriosis Society Montpellier Consortium published the first-ever worldwide consensus statement on the management of endometriosis. The statement, published in the journal Human Reproduction, addresses 69 issues related to the management of endometriosis. NICHD scientists and grantees were among those in the Consortium. Visit Global Consortium Identifies Best Management of Endometriosis for more information.
• The National Centers for Translational Research in Reproduction and Infertility (formerly the Specialized Cooperative Centers Program in Reproduction and Infertility Research) is a national network of research-based centers, supported by FIB, that aims to promote interactions between basic and clinical scientists with the goal of improving reproductive health.
• Human Endometrial Tissue and DNA Bank
  This biobank, a national resource on genes associated with the uterus, provides de-identified specimens of donated human endometrial tissue and matching blood samples to approved researchers.
• The FIB-supported Reproductive Medicine Network (RMN) studies issues related to infertility and reproductive health in women. Several RMN studies are examining the effectiveness of assisted reproductive technology, such as IVF, in promoting pregnancy among women who are infertile, including those who have endometriosis-related infertility.