There is now considerable evidence that endometriosis is likely to be a complex multifactorial trait, such as diabetes or asthma, in which a number of susceptibility loci interact with each other, and the environment, to produce the disease phenotype. This thesis presents studies on the genetic and environmental basis of endometriosis in both a non-human primate model and in women. The study of the autopsy records of 399 female rhesus monkeys identified 81 (20%) with spontaneous endometriosis. Age, exposure to ≥ 3 oestradiol implants (relative risk 9.7, P < 0.001) or ≥ 1 hysterotomy (relative risk 5.8, P = 0.006) were significant risk factors as determined by conditional logistic regression. Living descendants of the affected animals had MRI scans which suggested that 8/113 (7%) had at least one endometriotic lesion >1 cm in diameter. Segregation analysis was conducted on the resulting 12 pedigrees, which contained 64 half sib-pairs, 2 full sibpairs and 11 mother-daughter pairs. Human, affected sib-pairs and families were recruited for the OXEGENE study to conduct sib-pair analysis using microsatellite markers at 10cM resolution across the entire genome. MRI studies of the first-degree relatives of women with rAFS stage III-IV disease estimated that the relative risk (λ_R) may be as high as 14 (95% Cl 4.8 - 30.3). Candidate gene studies, comparing the frequency of the GALT N314D polymorphism, the CYP1A1 MspI polymorphism and the GSTM1 and T1 null mutations in two case groups, with either sporadic disease or a family history of endometriosis, and two control groups, did not show evidence of association. Linkage analysis using three microsatellite markers and 50 affected sib-pairs in the region to which GSTM1 maps (1p13) did not show evidence of linkage to this region. However, there was an apparent relationship between the presence of both the GSTM1 null mutation and the CYP1A1 MspI polymorphism and an increased risk of endometriosis. The initial findings of a sib-pair analysis, using 29 microsatellite markers across chromosome one in 128 affected sib-pairs, did not reveal evidence of linkage. These findings provide some insight into the aetiology of endometriosis in women.

Thesis (M.S.)--University of Hawaii at Manoa, 2005. / Includes bibliographical references. / vii, 23 leaves, bound ill. 29 cm

Senior Honors Thesis (Nursing)--Ohio State University, 2004. / Title from first page of PDF file. Document formatted into pages; contains 26 p. Includes bibliographical references (p. 23-24). Available online via Ohio State University's Knowledge Bank.

Thesis (M.S.)--Rutgers University, 2008. / "Graduate Program in Nutritional Sciences." Includes bibliographical references (p. 56-59).

The entire thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file; a non-technical public abstract appears in the public.pdf file. Title from PDF of title page (University of Missouri--Columbia, viewed on October 7, 2009) Thesis advisor: Dr. Kathy L. Sharpe-Timms. Includes bibliographical references.

Thesis (Ph.D) - University of Queensland, 2006. / Includes bibliography.

M.Tech. / The study was aimed at determining the efficacy of the homoeopathic simillimum in the treatment of endometriosis. Endometriosis may be defined as the presence of endometrial tissue outside the uterine cavity and is often associated with severe pain and infertility. The homoeopathic simillimum is the single remedy prescribed that most closely matches the symptoms presented by the participant. Symptoms from the physical, mental and emotional plane are taken into account when prescribing the simillimum remedy. The ten participants taking part in the study were evaluated at monthly intervals over a period of four months. The participants were assessed on different levels including mental, physical and emotional and the homoeopathic remedies were individually prescribed for each participant. Participants were required to record all symptoms experienced on a daily basis and report back at the monthly evaluation. The results of the daily evaluation and the observations, made by the researcher at each monthly visit, enabled the researcher to determine the efficacy of the homoeopathic treatment. The results of the daily evaluations were statistically analysed using the Analysis of Variance technique and the Chi-squared statistic to test for associations. The study showed a statistically significant improvement in the amount of bleeding, constipation, depression, diarrhoea, nausea and pelvic pain experienced by the participants and a not statistically significant improvement was shown for well-being, vomiting, dysmenorrhoea and dyspareunia. The women taking part in the study felt there was an improvement in the majority of symptoms associated with endometriosis. Therefore, the homoeopathic simillimum has proved benefit

The aim of this study was to determine the efficacy of the combination of Nigersan® 4X, Citrokehl® 10X/30X/200X and Recarcin® 4X in the treatment of symptoms experienced with endometriosis. Endometriosis is a gynaecological disorder, where functioning endometrial tissue is present outside the uterine cavity. Symptoms are often associated with severe pain and/or infertility. The aetiology is unknown and there is no cure for endometriosis. This was a double blind study in which a placebo group was compared to an experimental group. Twenty five females with pre-diagnosed endometriosis were analysed over a twelve week period. The participants were randomly divided into two groups, one receiving Nigersan® 4X, Citrokehl® 10X/30X/200X and Recarcin® 4X and the other placebo. This was a subjective study with reference to the participant’s perception of their condition before, during and at the end of the study. Participants were asked to record the following on a daily basis: menstruation, pelvic pain, backache, nausea, vomiting and diarrhoea. The participants were then also asked to rate the following on a monthly basis: energy levels, general wellbeing, dysmenorrhea, pelvic pain, menstrual clotting, menstrual flow, menstrual colour and dyspareunia. All forms and questionairres were then collected at four week intervals and analysed for comparison. The data was statistically analysed using the Analysis of Variance technique and Chi-squared statistics. Results revealed a significant decrease in the average number of days of backache and pelvic pain within the placebo group while the experimental group indicated a significant improvement in energy levels and general wellbeing. Therefore it is concluded that Nigersan® 4X, Citrokehl® 10X/30X/200X and Recarcin® 4X did not significantly alleviate symptoms associated with endometriosis. / Dr. N. Wolf Dr. S. Sarawan

Endometriosis is a chronic estrogen-dependent gynecological disease where endometrial cells implant at inappropriate sites causing significant pelvic pain, decreased quality of life, and often infertility. It affects 10% of women of reproductive age, and there is no minimally invasive diagnostic test. Consequently the time to diagnosis, which occurs during laparoscopic surgery followed by pathological confirmation of disease, is prolonged and exceeds 11 years. During this time, the disease often worsens and women thus experience avoidable morbidity. Additionally, endometriosis is a financial burden on the healthcare system; its annual cost was $69.4 billion (U.S.) and $1.8 billion (Canada) in 2009. For these reasons, identifying a clinical marker remains a top priority. Although multiple putative markers have been identified and reviewed, emerging evidence suggests a relationship between neurotrophins and endometriosis. The neurotrophins are growth factors recognized for promoting neuronal differentiation, growth, and maintenance. Recently, they have been shown to induce pathways central to endometriosis including proliferation, adhesion, angiogenesis and resistance to apoptosis, in cultured neurons, epithelial cells, fibroblasts, and cancer cell lines. Although two studies have suggested elevated concentrations of brain-derived neurotrophic factor (BDNF) in the plasma and eutopic endometrium of women with endometriosis, relatively little is known about uterine BDNF. Herein, we demonstrate the conservation of BDNF and its high affinity receptor in the mammalian uterus, and show the upregulation of BDNF and its low affinity receptor by estradiol in the mouse uterus. Encouraged by our results, we assessed circulating BDNF for its ability to differentiate between women with and without endometriosis, as excess estradiol in endometriotic lesions might increase BDNF in women with disease. Our results revealed that circulating BDNF concentrations were significantly higher in women with endometriosis, particularly those with Stage I and II disease compared to controls. Furthermore, women with endometriosis undergoing ovarian suppression had significantly lower circulating BDNF than women not undergoing treatment, suggesting that BDNF may provide an opportunity to monitor patient response to treatment. Taken together, the data herein advances our limited knowledge of uterine neurotrophins, and supports a link between BDNF and endometriosis. I therefore strongly suggest that BDNF is a useful clinical marker of endometriosis, and encourage additional research to determine its role in the pathophysiology of disease. / Thesis / Doctor of Philosophy (PhD) / Endometriosis is a chronic condition that affects over 10% of women of reproductive age. Women with endometriosis suffer from debilitating pelvic pain and it takes approximately 12 years before they are diagnosed during surgery. This is in part because there is no blood test to diagnose disease. We are interested in using a protein called brain-derived neurotrophic factor (BDNF) that is linked to several of the pathways that are disturbed in women with endometriosis as a means of determining whether or not a woman has endometriosis. The key goals of this thesis are to show that BDNF is a protein which is found in the uterus of many species, that it is controlled by estrogen, and that it might be useful in diagnosing endometriosis and monitoring how well a patient is responding to endometriosis treatment.

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