The ELeMI Project

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Endometriosis, characterized by chronic inflammation, involves the presence of functional endometrial glands and stroma outside the uterine cavity. Ectopic endometrial implants typically occur in various locations such as the ovaries, fossa ovarica, uterosacral ligaments, and the posterior cul-de-sac. Similar to malignancies, endometriosis exhibit features like progressive and invasive growth, oestrogen-dependent proliferation, recurrence, and a potential for metastasis. The disease is classified into four stages (minimal, mild, moderate, and severe) based on the severity, amount, location, depth, and size of the growths. Deep endometriosis refers to infiltration beyond 5 mm under the peritoneum. However, this classification inadequately predicts clinical outcomes, including symptomatology and pain. Diagnosis, treatment, and follow-up of endometriosis pose challenges for medical professionals. Prevalent among premenopausal women, affecting 10–15% of reproductive-aged women, endometriosis significantly impacts social, occupational, and psychological functioning. It is particularly common in individuals with infertility (up to 30% prevalence) and chronic pelvic pain (up to 45% prevalence). Despite its prevalence, the aetiology and pathogenesis of endometriosis remain unclear. Endometriosis is initiated by genetic or epigenetic changes in endometrial, stem, or bone marrow cells. These defects, inherited at birth, contribute to endometriosis predisposition, infertility, and certain immunologic alterations. The likelihood of developing endometriosis is highest post-puberty due to hormonal influences, particularly oestrogen, associated with the onset of menstruation and sexual activity, and decreases progressively thereafter. Lesion growth is clonal, variable, and self-limiting, likely due to fibrosis. This challenges the notion of endometriosis as a progressive and recurrent disease. These concepts suggest potential avenues for prevention by reducing oxidative stress from retrograde menstruation and the upper genital tract and peritoneal microbiome. Continuous use of oral contraceptives, manipulation of the intestinal microbiome through diet and exercise, and antioxidant interventions are proposed preventive measures. Diagnosis relies on clinical experience, considering age, symptoms, clinical examination, imaging, and intraoperative recognition. Surgery remains the primary treatment, but a less radical approach is recommended when surrounding fibrosis is non-endometriotic. Microscopic endometriotic nests and the periphery of deep nodules may exhibit reversible metaplastic changes, returning to normal after excision. 

Given the complexity of Endometriosis, the mental health impact remains equally perplexed and managing this require a personalised and adaptable approach. Digital solutions have shown to provide cost-effective ways to provide support to both clinicians and patients. This concept is used within the multi-work stream ELeMI project exploring the disease sequalae of Endometriosis among multiple ethnicities, races, genders and ages. This project uses a data-connectivity approach to better understand the bi-directionality of Endometriosis and Mental Health.