Doom and gloom - endometriosis edition

    Much of my pessimism surrounding the healthcare system stems from my experience with women’s health as both a researcher and a patient. I chose to do my master’s thesis on endometriosis because I was so frustrated with the lack of knowledge my providers had about the condition, despite its prevalence of 10% of reproductive-aged women worldwide. It shares a similar prevalence with type 2 diabetes and rheumatoid arthritis in the US. Again, despite its prevalence, the cause of endometriosis is unknown, it can only be diagnosed surgically, and there is no cure.

    A friend recently sent me an article about new research surrounding the pathophysiology of endometriosis and the involvement of macrophages in the development of lesions. This research is incredibly exciting because it is starting to provide the foundation for work towards non-hormonal treatment options. Building off this, another team of researchers found endometriosis lesions in mice contain nerve fibers with CGRP and its receptors. I thought this was very interesting because migraines are a common comorbid condition with endometriosis. This team of researchers tested four drugs that inhibit CGRP signaling (rimegepant, ubrogepant, fremanezumab, and galcanezumab) and found these agents to reduce pain and lesion size. The research team is looking to advance this work on mouse models intro trials with humans. 

    This is super exciting research, and my first thought was that this is a huge step towards a non-hormonal option for managing endometriosis. However, my next thought was about the accessibility of these medications. These drugs are FDA-approved for migraines and many insurance companies require patients with migraines to trial and fail several less expensive medications before they will consider a CGRP agent. Assuming these drugs do get FDA-approved, how accessible will they be for people with endo? A 5 mg tablet of norethindrone acetate costs $2.65 per tab where as Nurtec costs $154.35 per tab and Emgality costs $890.03 for one syringe. How many hoops will patients have to jump through to successfully fill a prescription for Nurtec after already waiting an average of 7-10 years to get a diagnosis? It’s an interesting place to be in to be excited about scientific advancements as a researcher but also cynical as a patient. Research on endometriosis is finally starting to make progress but I’m not sure the healthcare system is equipped to best support patients in its current state.

Sources:

MSU Today

Harvard Medical School

Lexicomp