Poster No:
1723
Submission Type:
Abstract Submission
Authors:
Allesandra Iadipaolo1, Elle Murata1, Hannah Grotzinger1, Sanjay Agarwal2, Andrea Gabay2, Gabriella Natividad2, Matthew Panizzon2, Emily Jacobs1
Institutions:
1University of California, Santa Barbara, Santa Barbara, CA, 2University of California, San Diego, San Diego, CA
First Author:
Co-Author(s):
Elle Murata
University of California, Santa Barbara
Santa Barbara, CA
Introduction:
Endometriosis is an estrogen-dependent disorder which impacts approximately 1 in 10 women, yet it remains one of the least funded conditions per NIH dollars (Smith, 2023). The disease is characterized by lesions of endometrial-like tissue which grow outside of the uterus and is a leading cause of infertility and chronic pelvic pain. Although endometriosis is primarily considered a disorder of the reproductive tract, it may also confer effects within the central nervous system. Women with endometriosis experience exacerbated rates of depression and anxiety, and central sensitization is a key mechanism of endometriosis pain (Maddern, 2020). However, the extent to which endometriosis and its symptoms impact brain morphology is virtually unknown. Relative to healthy controls, women with endometriosis-related pain may have altered functional connectivity (As-Sanie, 2016) and gray matter volume [GMV] (As-Sanie, 2012; Maulitz, 2024) of brain regions involved in pain perception. While providing valuable insights into potential impacts of endometriosis on brain structure, these findings come from limited sample sizes and analyses employing voxel-based morphometry. Expanding analyses in larger samples using robust methods of brain volume estimation are warranted.
Methods:
Here, we examine brain morphology in women with endometriosis compared to healthy women (N=91, aged 18-48). Participants underwent whole-brain structural MRI scanning on 3T Siemens MAGNETOM Prisma scanner at the University of California. Measures of cortical and subcortical GMV were calculated by running T1w images through the recon-all pipeline from FreeSurfer (Fischl, 2012). Participants completed self-reported assessments of medical and reproductive history, psychiatric symptoms, and pain. The Biberoglou & Behrman Scale (1981) was used to assess pelvic pain, and endometriosis-related pain was assessed using the Endometriosis Health Profile Questionnaire (Jones, 2001). Independent samples t-tests were used to compare demographic, mood, and MRI measures between women with endometriosis and controls. Pearson's correlations were computed to assess the relationships among mood and pain, and linear regression was used to examine the effects of pelvic and endometriosis-related pain on GMV.
Results:
Women with endometriosis (n=44; age, M=29.91, SD=7.13) were on average older than controls (n=47; age, M=27.00, SD=4.21), p=0.022. They endorsed more symptoms of depression (p<0.001), anxiety (p=0.013), and pelvic pain (p<0.001), compared to controls. Group comparisons on regional GMV revealed no differences detected with Bonferroni correction, suggesting no discernable difference between women with endometriosis and controls. However, at an exploratory uncorrected threshold and adjusting for age, women with endometriosis exhibit greater GMV in the right pericalcarine cortex, relative to controls (ps < 0.05). Among women with endometriosis, more severe pelvic pain was associated with lower GMV of the right precentral gyrus and precuneus and left superior parietal sulcus and posterior cingulate cortex (ps < 0.05). Despite a strong correlation with depressive symptoms, r=0.54, p<0.001, endometriosis-related pain was a significant predictor of lower GMVs above and beyond the effects of depression in the right/left inferior temporal gyrus and left banks of the superior temporal sulcus, medial orbitofrontal cortex, postcentral gyrus, and posterior cingulate cortex (ps < 0.05).
Conclusions:
Endometriosis is a complex, systemic condition associated with a high degree of disability and psychosocial burden. However, its effects beyond the reproductive tract are poorly understood. Here, we provide preliminary evidence that the experience of chronic, endometriosis-related pain may be associated with structural brain differences in regions critically involved in integrating sensory, cognitive, and emotional aspects of pain.
Neuroanatomy, Physiology, Metabolism and Neurotransmission:
Cortical Anatomy and Brain Mapping 1
Neuroanatomy Other 2
Keywords:
ADULTS
Cortex
DISORDERS
NORMAL HUMAN
Pain
STRUCTURAL MRI
1|2Indicates the priority used for review
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Healthy subjects only or patients (note that patient studies may also involve healthy subjects):
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Was this research conducted in the United States?
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Were any human subjects research approved by the relevant Institutional Review Board or ethics panel?
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Please indicate which methods were used in your research:
Structural MRI
For human MRI, what field strength scanner do you use?
3.0T
Which processing packages did you use for your study?
Free Surfer
Provide references using APA citation style.
As-Sanie, S., (2012). Changes in regional gray matter volume in women with chronic pelvic pain: a voxel-based morphometry study. Pain, 153(5), 1006–1014.
As-Sanie, S., (2016). Functional Connectivity is Associated With Altered Brain Chemistry in Women With Endometriosis-Associated Chronic Pelvic Pain. The journal of pain, 17(1), 1–13.
Biberoglu, K. O., & Behrman, S. J. (1981). Dosage aspects of danazol therapy in endometriosis: short-term and long-term effectiveness. American journal of obstetrics and gynecology, 139(6), 645–654.
Fischl, B. (2012). FreeSurfer. NeuroImage, 62(2), 774–781.
Jones, G., (2001). Development of an endometriosis quality-of-life instrument: The Endometriosis Health Profile-30. Obstetrics and gynecology, 98(2), 258–264.
Maddern, J., (2020). Pain in Endometriosis. Frontiers in cellular neuroscience, 14, 590823.
Maulitz, L., (2024). Psychological characteristics and structural brain changes in women with endometriosis and endometriosis-independent chronic pelvic pain. Human reproduction, 39(11), 2473–2484.
Smith, K. (2023). Women's health research lacks funding - in a series of charts. Nature, 617(7959), 28–29.
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