Comorbidity of Endometriosis and Autoimmune Disorders

Some of you may have heard of there being a link between endometriosis and autoimmune disorders. Or maybe you even heard that endometriosis is an autoimmune disorder? Is this true? If so how does it apply to you?

Well, according to some more recent studies it does appear that there is a link between endometriosis and immune dysfunctions. It has been found that women with endometriosis tend to have increased, polyclonal B-cells and T-cells1. These are types of phagocytic white blood cells, meaning they devour other foreign material and cells (such as bacteria from an infection). Also “natural killer cells” in women with endometriosis seem to have a decreased cytotoxicity (cell damaging effect) on endometrial cells when compared to NK cells of women without endometriosis.2

As I was looking into the research I asked myself… Wait? wouldn’t more phagocytic cells help endo, not make it worse? After all their job is to clear out cellular tissue that doesn’t belong in the body… Well, that is what you would think, but research in apes and mice indicate quite the opposite. These immune cells release growth factors, and cytosine that increase rate of ectopic endometrial tissue development and trigger more blood cells to grow into the area allowing for further inflammation and spreading of the disease3. Not only can an increase in some immune cells have a negative effect on endometriosis they can also increase risk to other autoimmune disorders. You see, autoimmune disorders arise when an immune cell perceives normal or healthy cells in the body as foreign and starts to attack them, one mechanism of doing so is by producing autoantibodies. Immune cells are vital for survival but in cases of low grade chronic elevation there is an increased risk that these immune cells will react to the wrong thing4. Don’t be fooled either, just because your overall cell count is normal does not mean your B and T cells are normal.

Interestingly enough GNrH agonists such as lupron or orllisa suppress auto antibodies and increase NK cells. This may be why some women experience symptom relief not directly associated to lower estrogen levels while on these medications5.

Statistically women with endometriosis are about 7 times more likely to have autoimmune related underactive thyroid (hashimoto’s), 20 times more likely to develop Sjögren’s syndrome or Systemic lupus erythematosus and about twice as likely to develop rheumatoid arthritis then the average population.6

According to Pamela Stratton, MD a researcher at The Eunice Kennedy Shriver National Institute of Child Health and Human Development –

To summarize, it is important to look at the whole body picture when it comes to endometriosis. It isn’t as simple as endometrial tissue outside of the uterus. It is a multifaceted disease process requiring a holistic approach. Endometriosis itself is not an autoimmune disorder but it is associated with changes in immune cells and therefore has a high likelihood of  comorbidity (the simultaneous presence of two chronic diseases).  If you have endometriosis it is likely worth pursuing a few extra blood tests to make sure you don’t have of immune mediated diseases. This is something you could discuss with a primary care physician, your endometriosis specialist, or a rheumatologist well versed in autoimmune conditions as rheumatology and autoimmune conditions often come hand in hand.

References
1Badawy, S.Z., Cuenca, V., Stitzel, A. and Tice, D. (1987) Immune rosettes of T and B lymphocytes in infertile women with endometriosis. J. Reprod. Med. , 32, 194–197.
2Oosterlynck, D.J., Cornillie, F.J., Waer, M., Vandeputte, M. and Koninckx, P.R. (1991) Women with endometriosis show a defect in natural killer activity resulting in a decreased cytotoxicity to autologous endometrium. Fertil. Steril., 56, 45–51.
3Tulandi, T., & Redwine, D. B. (2004). Endometriosis: Advances and controversies. New York: Marcel Dekker. page 92
4Sinaii, N. (2002). High rates of autoimmune and endocrine disorders, fibromyalgia, chronic fatigue syndrome and atopic diseases among women with endometriosis: A survey analysis. Human Reproduction, 17(10), 2715-2724. doi:10.1093/humrep/17.10.2715
5Gioelegarzetti, G., Ciavattini, A., Provinciali, M., Muzzioli, M., Stefano, G., & Fabris, N. (1996). Natural cytotoxicity and gnrh agonist administration in advanced endometriosis: Positive modulation on natural killer activity. Obstetrics & Gynecology, 88(2), 234-240. doi:10.1016/0029-7844(96)00146-9
6Sinaii, N. (2002). High rates of autoimmune and endocrine disorders, fibromyalgia, chronic fatigue syndrome and atopic diseases among women with endometriosis: A survey analysis. Human Reproduction, 17(10), 2715-2724. doi:10.1093/humrep/17.10.2715

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