Yes, endometriosis is inflammatory – but what does that really mean for you, your diagnosis & your fertility journey?

If you’ve been looking into endometriosis, whether you’re on a fertility journey or not, you’ve probably come across the word “inflammation” a whole lot. 

It’s something we see across the TRB community too –  so many of us have heard that endometriosis is an inflammatory condition, but what does this actually mean? Does endometriosis cause inflammation? And can this inflammation even help confirm a diagnosis?

ReceptivaDx™ is the team behind the cutting-edge BCL6 test, which looks for hidden inflammation associated with endometriosis and can help shorten the time to diagnosis and treatment, particularly for people experiencing unexplained infertility, pelvic pain, or both.

They’re our absolute go-to for all things endo and fertility. So today, tapping into their expert perspective, we’re checking off all of these key questions, and digging into the connection between endometriosis and inflammation, with a view to empowering you with a new way to move your journey forward.

First off, is endometriosis an inflammatory disease?

Yes. Endometriosis is widely described as a chronic inflammatory disease or disorder. 

Endometriosis involves interactions between lesions, hormones and the immune system, creating an inflammatory environment around the affected tissue. It is driven by estrogen which is why pain can come and go for women with endometriosis.

Does endometriosis cause inflammation?

So, does this mean that endometriosis cause inflammation? Yes. Endometriosis lesions can trigger an immune response in the surrounding area, causing the body to release inflammatory substances.

Diving a little deeper, endometriosis lesions outside the uterus provoke an immune response involving macrophages and other inflammatory cells. These produce cytokines (small chemical messenger proteins) and mediators including IL-1β, IL-6, IL-8, TNF-α and prostaglandins, particularly within the pelvis and peritoneal fluid which may contribute to pain, irritation and changes to the surrounding tissue.

This inflammation can:

• Cause pelvic pain and painful periods
• Irritate nearby nerves and organs
• Promote scar tissue and adhesions
• Help lesions grow and form new blood vessels
• Potentially impair ovulation, fertilization and implantation

Another key takeaway here too, is that all of this is self-enforcing. Lesions cause inflammation, while inflammation can support lesion survival and progression.

How can endometriosis-related inflammation affect fertility?

Inflammatory substances released by endometriosis lesions can irritate nearby tissue and contribute to scar tissue and adhesions on the fallopian tubes, ovaries and other reproductive organs.

Endometriosis-related inflammation can also affect your endometrium, the lining of the uterus where an embryo implants. Changes in immune activity and inflammation in this lining may affect the uterine environment and make embryo implantation more difficult.

Pelvic inflammatory disease vs endometriosis: what’s the difference?

The names can make pelvic inflammatory disease vs endometriosis sound like two versions of the same condition. They are different, though both can impact fertility.

Pelvic inflammatory disease (PID) is an infection of the female reproductive organs. It is often caused by sexually transmitted infections such as chlamydia or gonorrhea, and without treatment, PID might cause inflammation and scarring within the reproductive tract.

Endometriosis, meanwhile, is a chronic inflammatory disease involving endometriosis-like tissue growing outside the uterus. It is not an infection and is not treated with antibiotics in the way PID is.

Another ‘false friend’ here is endometritis, inflammation of the uterine lining caused by infection. This is different from endometriosis, too, and we’ve covered off the specifics here.

Do anti inflammatories help endometriosis?

Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen are commonly used to manage endometriosis-related pain, and current American College of Obstetricians & Gynecologists (ACOG) guidelines do recommend NSAIDs as a first line option.

Importantly, though, there’s a difference between managing inflammation-related symptoms and treating the underlying disease. 

An anti-inflammatory painkiller may make pain symptoms easier to manage, but it won’t treat or remove the endometriosis itself, or improve fertility.

Can endometriosis cause inflammation in the body outside of the pelvis?

This is where things can get a little more complicated. Endometriosis creates a strong inflammatory environment, particularly around the lesions and within the pelvic cavity. 

Some research has also found differences in inflammatory markers in the blood of people with endometriosis, but this does not mean everyone with endometriosis will have obvious signs of systemic inflammation on a routine blood test.

Can endometriosis cause elevated inflammatory markers?

Yes, though it’s important to understand how testing works. As we’ve mentioned above, some studies have identified changes in certain inflammatory markers in the blood.

However, routine inflammatory blood tests are not a reliable way to diagnose endometriosis. Many factors can influence inflammatory markers, and a normal result does not rule out endometriosis.

This is one reason researchers have been interested in finding markers that can identify inflammation closer to the uterine lining.

How can inflammation help identify endometriosis?

Recently updated guidance from ACOG does emphasize recognizing symptoms and using imaging and specialist assessment as part of diagnosis. However, the same goes for imaging as it does for inflammatory blood tests – a normal result does not rule out the condition. You can read up on that here.

Inflammation in the uterine lining specifically can provide another avenue for investigation though. Leading the charge here is the ReceptivaDx™ BCL6 test, an endometrial biopsy that looks for BCL6, a protein biomarker associated with inflammation of the uterine lining. 

Elevated levels of BCL6 are highly suggestive of inflammation most commonly associated with endometriosis. Multiple studies show a high association between a positive BCL6 result and confirmed endometriosis by surgical laparoscopy – the current gold standard for a diagnosis.

How the ReceptivaDx™ test works

The test works by taking a small endometrial biopsy from your uterine lining, and then analyzing the tissue for BCL6.

A positive BCL6 result indicates increased expression of this inflammatory marker, which is most often associated with endometriosis, including cases where the condition has not previously been diagnosed or where symptoms may be minimal or non-existent.

Head here for the ReceptivaDx™ test results explainer, and their team’s expert perspective.

What does this all mean if you’re looking for answers?

The link between endometriosis and inflammation is really important in understanding how the condition develops, can affect your reproductive health, and ultimately in getting a diagnosis. Or, if you’re going through IVF, having a successful pregnancy by treating the underlying condition.

So if you’re dealing with unexplained infertility or persistent pelvic pain paired with ‘normal’ blood tests or imaging that have not yet given you a clear diagnosis, push your provider for the ReceptivaDx™ text.

It could help you confirm or rule out endometriosis, and support you in making more informed decisions on your fertility journey.

Hop over to their website to find a testing partner near you, or start with a free 20 minute consultation to learn more. When you’re ready, you can grab $75 off your test with code TRB26 – just pop it on your test request form.

Want to hear more from the ReceptivaDx™ team? Read this next: Can you see endometriosis on an ultrasound​? What imaging can (& can’t) tell you