For Immediate Release
March 3, 2024 - Dr. Roberta Kline (former OBGYN and Functional Genomics Specialist) delivered a field-based presentation about Genetics and Endometriosis at the 15th Annual Patient Symposium of the Endometriosis Foundation of America (also known as EndoFound). Her clinical review titled "Unlocking the Mystery of Your Genes: The Role of Genomics and Epigenetics in Endometriosis" offered a special and unique insight in the role of functional genetic expression testing for patients and clinicians alike.
WOMEN’S HEALTH ADVOCATE DR. ROBERTA KLINE EARNS ACCOLADES FOR PRESENTING EPIGENETICS ROLE IN ENDOMETRIOSIS SYMPOSIUM
As this year's appointed director of clinical education of the WOMEN'S HEALTH COLLABORATIVE (an educational branch of the AngioFoundation 501c3), Dr. Kline's professional work in the study of women's disorders continues beyond her tenure as an OBGYN - pursuing a profound career as a medical educator on the national stage. “I believe the future of diagnostics lies in genomics and epigenetics, not just for endometriosis, but for many diseases we don’t have simple tests for,” Dr. Kline starts. “Through the WHC, we’ve been getting more into the community and conventional medical system to educate people. They don’t need to be experts in all these different modalities, but they need to be aware of it and come to it with an open mind. I’ve been in both worlds and understand the mindset, training, and realities of conventional practice, and I can tell you this science is not experimental anymore. It’s real, and it is changing how we approach health and disease. And healthcare needs to change, too.”
"For a decade and a half, EndoFound's annual patient symposium has consistently stood as a cornerstone for educating patients and the public about endometriosis. As one of the pioneering organizations to initiate such an event, the patient symposium brings together individuals impacted by endometriosis, offering them crucial tools, information, and a sense of community to improve their lives," said Carolyn Mayer, EndoFound's Senior Program Manager. "This year, we've arranged over 50 speakers and organized a vibrant networking reception to conclude day one, fostering a sense of community." Mayer added that, as part of EndoFound's ongoing mission to educate the public and patients, there are plans to reach out to schools regarding the expanded ENPOWR™ Project (Endometriosis: Promoting Outreach and Wide Recognition). This initiative introduces a series of videos and an e-course tailored for nationwide education in grades 9-12 about endometriosis and menstrual health.
In March of 2023, Dr. Kline confirmed her research partnership with Dr. Robert Bard and the IHRC (the Integrative Health Research Center on 60th Street in NYC) where she helps to blueprint a series of pilot studies on some of the most critical health issues including Dense Breast Tissue, endometrial inflammation, Urinary Incontinence and other Pelvic Disorders. They are scheduled to conduct pilot studies to monitor the efficacy of non-invasive therapies including pulsed bioenergy frequency and photobiomodulation technology. "We are extremely proud to have our own Dr. Kline be chosen to present at this year's Endometriosis Foundation annual conference," states Dr. Bard. "Her expertise in the complex science of gene expression and her extensive knowledge in women's health sciences has added so much to our educational and exploratory research initiatives... and having her present her findings to the medical and patient communities will significantly add new dimension to this educational event."
The 15th Annual Endometriosis Foundation of America Patient Symposium, "Understand Your Endo, Take Control of Your Life!" is a 2-day event from March 2-3 at the 4W43 Building - 4 West 43rd St. in New York City. This public event brings together a community of strength, resilience, and shared knowledge at its Patient Symposium. This weekend-long event will feature more than 30 speakers—doctors, surgeons, researchers, therapists, and activists, among many others— who will provide the tools and information that individuals with endometriosis need to lead their best lives while managing this challenging condition.
I believe it's time to collectively acknowledge the existence of different endometriosis types that demand specific attention in terms of terminology. Understanding that we may need different imaging techniques and surgical approaches to detect and treat them is crucial. Reconsidering, and more importantly, redefining the classification/terminology we use, steering away from the generic endo I-IV or deep/superficial endo, could contribute to a more accurate and nuanced discourse. Embracing a more detailed and tailored classification system would not only better reflect the diverse nature of the condition but also pave the way for more precise diagnosis and effective treatment strategies. This shift in terminology could enhance communication among healthcare professionals, researchers, and patients, fostering a deeper understanding of the complex manifestations of endometriosis, a multisystem disease. (see full feature)
UNVEILING THE MENTAL HEALTH DIMENSIONS OF ENDOMETRIOSIS: A CASE VIGNETTE by Joyce Gregory, MD
Endometriosis is a chronic inflammatory disease in which tissue like the inner lining of the uterus grows outside the uterus and affects roughly 10% (190 million) of reproductive age women and girls globally. It is associated with severe, life-impacting pain during periods, sexual intercourse, bowel movements and/or urination, abdominal bloating, nausea, fatigue, infertility, and even psychiatric vulnerability such as depression and anxiety. With no cure currently, treatment is aimed at controlling symptoms and thus strongly suggests a multidisciplinary approach.
Endometriosis has been increasingly recognized for its profound impact on mental health, especially in patients like Michelle who face challenges in accessing consistent healthcare due to gaps in insurance coverage. The psychiatric aspects of endometriosis encompass a wide array of challenges, from depression and anxiety to impaired quality of life and intimate relationships. This case vignette aims to shed light on the interplay between endometriosis and psychiatric health, drawing attention to the need for a holistic approach to patient care.
Understanding the Psychological Burden of Pain
Endometriosis presents a significant burden of pain, with 60% of affected women experiencing it as a predominant symptom, while 40% grapple with infertility. This pain isn't just physical; it inflicts a profound psychological toll, often leading to a susceptibility to various psychiatric disorders. Women enduring pelvic pain from endometriosis are particularly vulnerable to developing affective or anxiety disorders, alongside a heightened risk of substance use disorders. Consequently, the combination of pelvic pain, infertility, and the increased propensity for psychiatric conditions commonly results in disability and a markedly diminished quality of life for women of reproductive age.
With a significant family history of endometriosis, including her mother, maternal aunt, and sister, Michelle's genetic predisposition compounded her struggles. Her work history bore the brunt of her condition's impact, with an inability to maintain employment for more than two years due to chronic pelvic pain frequently hindering her attendance. Despite her desire to start a family with her partner of six years, Michelle faced disappointment on that front as well, unable to conceive. However, recent access to consistent healthcare under her husband's insurance has provided a glimmer of hope amidst her challenges.
The psychiatric ramifications of endometriosis are multifaceted. Chronic pain, a defining characteristic of the condition, can precipitate the onset of mood disorders such as depression and anxiety. Research underscores that individuals grappling with endometriosis are at an elevated risk of experiencing psychological distress, resulting in diminished quality of life and impaired social functioning. The unpredictable nature of the disease, compounded by diagnostic and treatment challenges, exacerbates feelings of disempowerment and emotional upheaval in patients like Michelle.
Pain associated with endometriosis manifests in various forms, encompassing dysuria (pain during urination), dysmenorrhea (pelvic pain during menstrual flow), and dyspareunia (pain during sexual intercourse). Chronic pelvic pain (CPP), lasting at least six months, is a hallmark symptom and may coincide with lower pain thresholds. Individual pain perception is influenced by a myriad of factors, including personality traits, coping mechanisms, stress levels, and past traumas. Consequently, endometriosis profoundly impacts self-esteem, emotional stability, and overall quality of life, with pain serving as a pivotal driver of distress and psychiatric symptoms.
Michelle was started on medication regimen for her anxiety and depression from her psychiatrist. She also became engaged in individual therapy and involved with an endometriosis online community. She continues to have regular follow-up with her gynecologist who specializes in endometriosis.
Neurobiological Mechanisms and Psychological Distress
Despite its profound potential implications, the relationship between endometriosis and neuropsychiatric symptoms has received relatively limited research attention. However, existing literature indicates a significant association between endometriosis and various psychiatric symptoms, encompassing affective disorders, anxiety disorders, substance use disorders, and other psychiatric conditions. From a neurobiological standpoint, the intricate interplay of pain signaling and hormonal dysregulation in endometriosis can have extensive repercussions on mental health. The chronic inflammatory state linked to endometrial lesions can instigate neuroimmune responses that disrupt brain function and emotional well-being. Additionally, the dysregulation of sex hormones, particularly estrogen, has been implicated in mood disturbances, cognitive alterations, and changes in stress responsiveness.
These neurobiological underpinnings emphasize the imperative of adopting a comprehensive approach to patient care in addressing endometriosis-related psychiatric issues. Integrating psychiatric and psychosocial interventions alongside medical and surgical management may prove essential for catering to the multifaceted needs of individuals grappling with the complexities of endometriosis. By acknowledging the neurobiological mechanisms contributing to psychological distress in endometriosis, healthcare providers can devise treatment strategies that encompass both the physical and emotional dimensions of the condition, fostering improved outcomes and enhanced patient well-being.
Michelle's case serves as a poignant illustration of the necessity for such an integrative approach. As she battles the dual burdens of physical pain and psychological distress.
References:
1. World Health Organization. (2023, March 24). Fact sheet. Retrieved from [www.who.int/news-room/fact-sheets/detail/endometriosis].
2. Carbone, M. G., Campo, G., Papaleo, E., Marazziti, D., & Maremmani, I. (2021). The Importance of a Multi-Disciplinary Approach to the Endometriotic Patients: The Relationship between Endometriosis and Psychic Vulnerability. Journal of Clinical Medicine, 10(8), 1616.
3. Goodwin, E., et al. (2023). The Association Between Endometriosis Treatments and Depression and/or Anxiety in a Population-Based Pathologically Confirmed Cohort of People with Endometriosis. Women's Health Reports, 4(1), 551-561. https://doi.org/10.1089/whr.2023.0068
4. Wang, T. M., et al. (2023). Association Between Endometriosis and Mental Disorders Including Psychiatric Disorders, Suicide, and All-Cause Mortality -A Nationwide Population-Based Cohort Study in Taiwan. International Journal of Women's Health, 15, 1865-1882. https://doi.org/10.2147/IJWH.S430252
5. Gao, M., Koupil, I., Sjöqvist, H., et al. (2020). Psychiatric Comorbidity Among Women with Endometriosis: Nationwide Cohort Study in Sweden. American Journal of Obstetrics and Gynecology, 223(415.e1-16).
6. D'Arrigo, T. (2020, April 28). Endometriosis, Psychiatric Disorders May Raise the Risk of One Another. Psychiatric News. https://doi.org/10.1176/appi.pn.2020.4b10.
7. Carbone, M. G., et al. (2021). The Importance of a Multi-Disciplinary Approach to the Endometriotic Patients: The Relationship between Endometriosis and Psychic Vulnerability. Journal of Clinical Medicine, 10(8), 1616. https://doi.org/10.3390/jcm10081616
8. Laganà, A. S., et al. (2017). Anxiety and Depression in Patients with Endometriosis: Impact and Management Challenges. International Journal of Women's Health, 9, 323-330. https://doi.org/10.2147/IJWH.S119729
9. Vercellini, P., et al. (2017). Endometriosis: A Disease That Remains Enigmatic. Fertility and Sterility.
10. Facchin, F., et al. (2015). Impact of Endometriosis on Quality of Life and Mental Health: Pelvic Pain Makes the Difference. Journal of Psychosomatic Obstetrics & Gynecology.
AUTHOR:
THE 15th ANNUAL ENDOFOUND PATIENT SYMPOSIUM: A REVIEW
By: Robert Bard, MD
This weekend (2/3-2/4 2024), I had the pleasure of attending the 2-day ENDOFOUND PATIENT SUMMIT- an impressive educational event produced by the Endometriosis Foundation of America. Over 50 speakers and panelists gifted the audience (of several hundred as well as the web-based viewers worldwide) with significant insight from a variety of perspectives on this chronic illness plaguing over 6 million women in this country. Presentations by some of the top clinical experts and national patient advocates imparted priceless information to sufferers and survivors alike.
We observed the design of this event to encourage optimal engagement wherever possible- giving patients complete access to clinical experts and supportive resources. We witnessed and experienced highly recognized clinicians like Dr. TAMER SECKIN (founder and leading endo surgeon) and Dr. DAN MARTIN (Scientific and Medical Director) generously present the latest updates about the disease on stage, while staying available throughout the event for anyone to approach them on a one-on-one discussion. It is this level of public engagement that makes a patient symposium a truly effective resource for a most emotionally charged disorder, and offering profound benefits to a most underserved community. In addition, this is what makes EndoFound a true role model for other women's health organizations who carry the flag of advocacy.
A COMPASSIONATE APPROACH TO ADVOCACY
As a cancer imaging radiologist and diagnostic researcher, I am no stranger to fundraising events or patient outreach activities. But what was most unique about the EndoFound educational framework was their complete attention to the patient’s needs and a most dedicated approach to educational programming. The sentiment of a loving community-minded support was most apparent throughout the 2-day event - with a careful message to collaborate and explore available options while address the prevalent concerns of anyone 'suffering in silence'. More than about the impression of benevolence, producing a voice that’s 100% about the patient is key to what foundations were meant to providing- and every segment of this organization’s work clearly showed the fulfilment of that promise.
As a proud supporter and donor to women’s advocacy groups (as well as a member of the medical community), I applaud the Endometriosis Foundation for their compassionate and most generous approach to uniting the world of a most challenging disease. Hat's off to Drs. Martin and Seckin and their entire team of producers whose work truly adds so much to the battlefield against Endometriosis. Public outreach initiatives like EndoFound's work makes finding the answer (and expanding patient relief) an imminent reality with resonating confidence.
CONTRIBUTOR
DR. ROBERT L. BARD has paved the way for the diagnostic study of various cancers both clinically and academically. He runs an active NYC practice (Bard Diagnostic Imaging) using the latest in digital Imaging technology which has been also used to help guide biopsies and, even replicate much of the same reports of a clinical invasive biopsy. Imaging solutions such as high-powered Sonograms, Spectral Doppler, sonofluoroscopy, 3D/4D Image Reconstruction and the Spectral Doppler are safe, noninvasive, and does not use ionizing radiation. His commitment to lead the community of cancer imaging and diagnostic experts has led to the establishment of the "Get Checked Now!" campaign.
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