Endometriosis Application for a Quicker Diagnosis

1. Endometriosis and the Long Road to Diagnosis

Endometriosis is a common whole-body condition that affects millions of patients worldwide. The most common symptoms experienced by patients with endometriosis are pelvic pain, infertility, and organ dysfunction. Some patients with severe endometriosis may be asymptomatic and suffer silent organ dysfunction. While highly prevalent, the myriad of symptoms and variety in presentation result in extensive issues diagnosing and treating this condition. The average time for a patient to obtain a diagnosis of endometriosis is estimated to be around 10-12 years (1). This results in prolonged suffering of symptoms, unexplained infertility, and decreased quality of life. Endometrial biopsy function testing for Bcl-6 and saliva sampling for salivary miRNAs via next generation sequencing and artificial intelligence (AI) are recently becoming promising options for more prompt diagnosis, but a non-invasive method is still needed.

2. The EndoApp – A Response to the delay

The technological capacity, availability, and increased smartphone ownership globally, including developing nations, promotes the smartphone as an attractive tool to deliver personalized healthcare solutions. It can empower patient self-management, encourage continuous symptoms and vital sign monitoring, and facilitate patient and physician communication. Smartphone technology, including mobile applications and app integrated wearable sensors have increasingly been applied to chronic disease management, and are being referred to as “mHealth” technology. Notably, mHealth applications for diabetes have been widely accepted as a tele-management service for Type 1 and Type 2 Diabetes Mellitus. mHealth applications are also being extensively used in the field of Women’s Health. Fertility tracking applications are used by both women and men for a variety of reasons including but not limited to: tracking fertility, following cycle, conceiving, and informing fertility treatment (2). These applications can also be utilized to spread awareness and obtain information regarding symptoms. There is excellent precedent for the use of mHealth technology to track, control, and diagnose clinical pathologies. It has proven to be a greatly beneficial resource across multiple health specialties, contributing to better patient outcomes, lower health costs, and higher levels of efficiency for health care providers. In the search for novel diagnostic measures of endometriosis, smartphone technology could provide a mechanism for detecting disease and a means of education for patients struggling to understand their symptoms thereby furthering patient autonomy. The Endometriosis Risk Advisor, or “EndoRA,” developed by Nezhat et. al. aims to streamline endometriosis diagnosis and treatment and empower individuals to seek care for their chronic pelvic pain and/or infertility (3). The app is designed to identify individuals with a high index of suspicion for endometriosis, allowing them and their physician team to seek expedited gold-standard diagnostic and therapeutic measures. The application was validated through a study that consisted of 293 patients who had chronic pelvic pain and/or unexplained infertility, owned smartphones, and had no prior diagnosis of endometriosis. The results demonstrated that the EndoRA score exhibited a high sensitivity of 93.1%. The positive predictive value was 94.1%, and the negative predictive value was 5.0%. The study found that EndoRA is most predictive of Stages III and IV endometriosis. While the application development team acknowledged some issues in the study design including potential selection bias and low specificity, they believe this application could serve as a valuable screening tool for high-risk individuals.

3. Steps Forward

Endometriosis is a difficult condition that often goes undiagnosed in women with chronic pelvic pain and infertility. Gold-standard diagnosis includes surgical measures that are delayed on average 10-12 years from the time of initial presentation. The EndoRA mobile application is a new screening measure for women who have chronic pelvic pain and/or infertility. While the validation of the application has some concerns regarding low specificity and sample size, the device is still a promising option to assist patients in educating themselves and advocating for further diagnostic steps and therapeutic management.

1. Leyland N, Casper R, Laberge P, Singh SS, Allen L, Arendas K, et al. Endometriosis: Diagnosis and Management. Journal of Endometriosis. 2010;2(3):107-34.

2. Earle S, Marston HR, Hadley R, Banks D. Use of menstruation and fertility app trackers: a scoping review of the evidence. BMJ Sexual & Reproductive Health. 2021;47(2):90-101.

3. Nezhat C, Armani E, Chen HC, Najmi Z, Lindheim SR, Nezhat C. Use of the Free Endometriosis Risk Advisor App as a Non-Invasive Screening Test for Endometriosis in Patients with Chronic Pelvic Pain and/or Unexplained Infertility. J Clin Med. 2023;12(16).

4. Bendifallah, S., Suisse, S., Puchar, A., Delbos, L., Poilblanc, M., Descamps, P., ... & Daraï, E. (2022). Salivary microRNA signature for diagnosis of endometriosis. Journal of clinical medicine, 11(3), 612.