Immunology, Menstrual Fluid, and Endometriosis, a Talk by Dr. Burns

The menstrual fluid is a vital component for the understanding of endometriosis.

The presence of menstrual clots is an indication of heavy periods and possibly endometriosis or adenomyosis.

Researchers now know that the menstrual fluid contains biomarkers that could open up avenues for the early, non-invasive detection of endometriosis.

Endometriosis has a significant immunological component. The menstrual fluid offers us deeper insights into the immunology and disease progression of endometriosis. 

Dr. Katherine Burns from the University of Cincinnati College of Medicine, and an Endo-Warrior herself, touched upon this topic at this year’s annual Patient Day organized by the Endometriosis Foundation of America (EndoFound).

The menstrual fluid in endometriosis

Dr. Burns said that menstruation is innately a highly inflammatory process. During menstruation, there is an increase in the number of macrophages, neutrophils, and uterine natural killer cells of the immune system. These cells allow the clearance of debris and promote the regeneration of tissues and blood supply to reform the endometrium.

During endometriosis, there is an increase in pro-inflammatory macrophages and neutrophils but a reduced natural killer cell count. This results in endometrial cells evading the immune system and lodging themselves as lesions and adhesions in the endometrium and other places, Dr. Burns explained.

She showed how they isolate white blood cells from the menstrual blood. She also talked about the various immune cells that constitute it.

The role of environmental toxicants in endometriosis progression

Dr. Burns also said that bisphenol A (BPA), a chemical commonly used in making polycarbonate plastics and resins, is abundant in the serum of women with endometriosis.

Nowadays, it is substituted with BPAF (fluorinated BPA). However, BPA has estrogenic effects and leads to endometriosis progression.

I don’t wear makeup unless I am giving a talk as there are a lot of chemicals absorbing through my skin, Dr. Burns said.

Dr. Burns’ research suggests that phthalates may contribute to the initiation of endometriosis by affecting the immune system. She said that more lesions occurred in animal models exposed to phthalates compared to controls. 

She is also studying the role of “forever chemicals” such as per- and polyfluoroalkyl substances (PFAS). These are common in cookware, fabric, pizza boxes, meat, and even drinking water.

PFAS are hard to avoid — most items that advertise themselves as water-resistant, stain-resistant, or non-sticky invariably include PFAS. PFAS are immunotoxic and hard to break down in our body and the environment. They cause hormone disruptions, reproductive harm, impaired fetal development, and even cancer.