Endometriosis: a riddle of nature or an example of failure of science?

• Snezhana V. Volkova
• Marina B. Khamoshina
• Mekan R. Orazov
• Mukhammednazar A. Soyunov

Abstract

Background. Endometriosis is a chronic gynecological disease, the etiology and pathogenesis of which are not fully known. The disease and its consequences are the greatest burden on health care and society, for each individual patient and her family. Unlike, for example, diabetes mellitus (DM) and cardiovascular diseases (CVD), endometriosis, which causes no less harm to the state and society, primarily due to its association with infertility, is not recognized as a socially significant disease, which determines the corresponding state policy and investment in research.

The key question: why is endometriosis, known to science for more than 300 years, is still "a disease of riddles and assumptions"?

Short answer: perhaps, due to underestimation of its social significance by government agencies and the lack of the required volume of investments in science, which indirectly reflects the publication activity in refereed databases.

Aim of the study - to compare the worldwide publication activity in relation to endometriosis and such socially significant diseases as diabetes mellitus and diseases of the cardiovascular system.

Material and methods. The material for the study was articles on endometriosis, diabetes mellitus, and CVD, published in the period 2009-2020 and posted in the search engine Pubmed.gov. Using the methods of descriptive and comparative statistics, an analysis of the frequency of publication of articles and their annual growth over the past 12 years was carried out.

Results. The analysis showed a significantly lower publication activity in relation to endometriosis compared with diabetes and CVD (p<0.001).

Conclusion. Endometriosis is a "disease of mystery and speculation," but it is partly an example of the failure of modern science. Gaps in the modern paradigm of its etiology and pathogenesis today, in the era of globalization, are undoubtedly interconnected with a significantly lower publication activity in comparison with such socially significant diseases as diabetes and CVD. It is possible that with a change in the attitude of government agencies and the emergence of national programs to combat endometriosis, which will inevitably lead to an increase in the number of publications in refereed databases, scientists will be able to find out the true causes and mechanisms of this disease, and clinicians and healthcare organizers - to develop effective management of endometriosis and stop calling it "the disease of riddles and assumptions."

Keywords:endometriosis; diabetes mellitus; cardiovascular disease

REFERENCES

1. Khamoshina M.B., Orazov M.R., Abitova M.Z., Volkova S.V., Aryutin D.G., Aleev I.A., Bayramova A.A. Infertility associated with ovarian endometriosis: a modern view to the problem. Voprosy ginekologii, akusherstva i perinatologii [Problems of Gynecology, Obstetrics and Perinatology]. 2021; 20 (1): 98-104. DOI: https://doi.org/10.20953/1726-1678-2021-1-98-104 (in Russian)

2. Orazov M.R., Radzinskiy V.E., Khamoshina M.B., Mikhaleva L.M., Dukhin А.О., Volkova S.V., Shustova V.B., Abitova M.Z. Endometriosisassociated infertility: options of combined therapy. Voprosy ginekologii, akusherstva i perinatologii [Problems of Gynecology, Obstetrics and Perinatology]. 2020; 19 (2): 27-34. DOI: https://doi.org/10.20953/1726-1678-2020-2-27-34 (in Russian)

3. Nezhat C., Nezhat F., Nezhat C. Endometriosis: ancient disease, ancient treatments. Fertil Steril. 2012; 98 (6 suppl): S1-62. DOI: https://doi.org/10.1016/j.fertn-stert.2012.08.001

4. Leeners B., Damaso F., Ochsenbein-Kolble N., Farquhar C. The effect of pregnancy on endometriosis-facts or fiction? Hum Reprod Update. 2018; 24 (3): 290-9. DOI: https://doi.org/10.1093/humupd/dmy004

5. Maggiore U.L.R., Ferrero S., Mangili G., et al. A systematic review on endometriosis during pregnancy: diagnosis, misdiagnosis, complications and outcomes. Hum Reprod Update. 2016; 22: 70-103. DOI: https://doi.org/10.1093/humupd/dmv045

6. United Nations. World Population Prospects 2019: Highlights. New York: Department of Economic and Social Affairs, 2019: 46 p.

7. Rosstat. Demographic forecast until 2036. URL: https://rosstat.gov.ru/folder/313/document/72529 (in Russian)

8. Orazov M.R., Khamoshina M.B., Mikhaleva L.M., Volkova S.V., Abitova M.Z., Shustova V.B., Khovanskaya T.N. Molecular Genetic Features of the State of Endom-etry in Endometriosis-Associated Infertility. Trudniy patsient [Difficult Patient]. 2020; 18 (1-2): 23-32. DOI: https://doi.org/10.24411/2074-1995-2020-10005 (in Russian)

9. Nnoaham K.E., Hummelshoj L., Webster P., et al. Reprint of: Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries. Fertil Steril. 2019; 112 (4): e137-52. DOI: https://doi.org/10.1016Zi.fertn-stert.2019.08.082

10. Soliman A.M., Yang H., Du E.X., et al. The direct and indirect costs associated with endometriosis: a systematic literature review. Hum Reprod. 2016; 31 (4): 712-22. DOI: https://doi.org/10.1093/humrep/dev335

11. Hudson N. The missed disease? Endometriosis as an example of «undone science». Reprod Biomed Soc Online. 2021; 14: 20-7. DOI: https://doi.org/10.1016/j.rbms.2021.07.003

12. Orazov M.R., Volkova S.V., Khamoshina M.B., Soyunov M.A. Pathogenetic mechanisms causing abnormal inflammation in the eutopic endometrium of women with endometriosis-associated infertility and methods of its management. Voprosy ginekologii, akusherstva i perinatologii [Problems of Gynecology, Obstetrics and Perinatology]. 2021; 20 (1): 138-45. DOI: https://doi.org/10.20953/1726-1678-2021-1-138-145 (in Russian)

13. International Working Group of AAGL, ESGE, ESHRE and WES; Vermeulen N., Abrao M.S., Einarsson J.I., Horne A.W., et al. Endometriosis classification, staging and reporting systems: a review on the road to a universally accepted endometriosis classification. Hum Reprod Open. 2021; 2021 (4): hoab025. DOI: https://doi.org/10.1093/hropen/hoab025

14. International Working Group of AAGL, ESGE, ESHRE and WES; Tomas-setti C., Johnson N.P., Petrozza J., et al. An international terminology for endometriosis, 2021. Hum Reprod Open. 2021; 2021 (4): hoab029. DOI: https://doi.org/10.1093/hropen/hoab029

15. Gross M., McGoey L. The Routledge International Handbook of Ignorance Studies. In: M. Gross, L. McGoey (eds). Oxon: Routledge, 2015: 1-14.

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