Women’s Health
Peritoneal fluid brain-derived neurotrophic factor and endometriosis characteristics, symptoms and comorbidities Amy Shafrir* Amy Shafrir Ashley Laliberte Allison F. Vitonis Kathryn L. Terry Christine B. Sieberg Stacey A. Missmer
One-third of people with endometriosis experience persistent chronic pelvic pain, potentially via nociplastic pain – a process of increased sensitivity of the central nervous system (i.e., central sensitization [CS]). Brain-derived neurotrophic factor (BDNF) is a marker of CS development, but no research has assessed localized BDNF levels and pain symptoms among people with endometriosis. Using BDNF levels measured in peritoneal fluid (PF) and self-report questionnaires, we investigated the association of endometriosis characteristics, symptoms, and comorbidities with localized BDNF levels among 290 surgically-diagnosed endometriosis participants from the Women’s Health Study: from Adolescence to Adulthood (A2A) cohort. BDNF was measured using an enzyme-linked immunosorbent assay and natural-log transformed. Linear regression was used to calculate geometric means (GM) with 95% CI of BDNF for each endometriosis characteristic adjusting for age, physical activity, body mass index, physician-diagnosed depression, and hormone and anti-depressant use. At surgery, median age was 17 years (interquartile range:15-20y) and 97% had rASRM stage I/II endometriosis. BDNF levels were higher with greater time between endometriosis-associated symptom onset and diagnosis (GM for <1 year:10.32 [CI:9.09-11.73] pg/ml vs. GM for >3 years:13.84 [CI:12.37-15.49] pg/ml; p-trend=0.002). Participants with physician-diagnosed migraines had higher BDNF levels (GM:14.78 [CI:12.86-17.00] pg/ml) compared to those without migraines (GM:11.53 [CI:10.62-12.53] pg/ml; p=0.004). No significant associations were observed between BDNF levels and current pelvic pain type or severity. These results suggest that BDNF levels in the peritoneal cavity may increase with longer duration of undiagnosed endometriosis but may not be associated with endometriosis-associated pain experience – particularly among those with pain types and severity that warranted surgical intervention.
