We sat down with Doctor Ashlee Berryman (PhD, BSc(Hons)), a postdoctoral research fellow at University of Otago, to discuss her current work with endometriosis. Berryman’s research focuses on understanding cognition and brain activity in biological women with endometriosis. 

Berryman’s research was inspired by a close friend’s experience living with endometriosis. “The impact endo had on her life was immense. It was not an unusual occurrence for her to be unable to attend university due to her pain – this often looked like her being doubled over in pain, nauseous, and faint, among a myriad of other symptoms.”  A deep dive into what was known about endometriosis and cognitive symptoms (like brain fog and difficulty concentrating) left Berryman “grossly concerned at just how under researched and poorly understood certain aspects of the condition remained. I therefore decided to dedicate my doctoral studies to endometriosis, hoping to fix that very issue.” 

Measuring what patients have long reported

Berryman' s research explores the relationship between endometriosis, chronic pelvic pain and cognitive function. In her review article, she highlighted that “more than 60% of patients with endometriosis-associated pain reported some level of cognitive disruption. This presented as difficulty concentrating, brain fog, and loss of productivity at work or school.” 

Across her doctoral programme, she ran several studies measuring the cognitive abilities of people with endometriosis – both with and without chronic pelvic pain – and endometriosis-free controls to finally develop a picture of cognition in this population. “From these studies, I found evidence of objective, or measurable cognitive difficulties for those with endometriosis, validating their longstanding lived experiences and complaints. I also found that the degree of difficulties, or how hard the tasks felt, depended on how much pain people were experiencing when they were taking the cognitive tests. This is actually good news, because it suggests that managing people’s pain may help improve thinking abilities.”

It’s not just in your head

Those with endometriosis will likely understand just how draining and frustrating these symptoms linked with endometriosis can be, and Berryman reassured that “these symptoms are not just in your head. Interestingly, some endometriosis cells (or lesions) have been found capable of developing their own nerve supply to the central nervous system. In other words, these cells can have a one-way superhighway sending pain and inflammatory signals directly to the brain. It is because of these complexities in endometriosis that we are no longer thinking of the condition as merely a menstrual health disorder, but instead, a system-wide chronic inflammatory condition with complex pain presentations.” 

A condition that deserves attention

According to research 1 in 10 New Zealanders have endometriosis, this is a higher prevalence rate than breast cancer  (~11%), melanoma (~10.2%), diabetes (~6.6%), heart disease (~4.35%), and stroke (~2.1%), to name a few. “This is a serious chronic condition that deserves the same recognition, research investment, and clinical attention as other major diseases.” Berryman states. 

Nutrition and supplementation

We asked Berryman what the current evidence tells us about the potential role of nutrition and supplementation (e.g Magnesium bisglycinate & Fish Oil) in supporting cognitive health and inflammation for women living with endometriosis. 

“Nutrition is particularly important for brain health. Omega-3 fatty acids, such as those found in fish oil supplements, are an area of growing interest in endometriosis research. Given the inflammatory processes associated with endo, omega-3s may help modulate the inflammation linked to endo flare-ups (although the research is still ongoing). Overall, a balanced diet and adequate nutrient intake are important foundations for health and wellbeing, but especially for those living with chronic conditions.” 

Get involved

People living with endometriosis can take part in Berryman’s research to help advance what is known about the condition. She’s been blown away by the community’s enthusiasm so far. “My ultimate goal is to ensure that the lived experiences of people with endometriosis are heard, understood, and validated, and to help bridge the gap between lived experience and scientific evidence. I want to identify effective ways to manage pain, improve cognitive functioning, and ultimately help people with endometriosis feel better, live better, and thrive in their everyday lives. 
I’m hopeful for a future where endometriosis is better understood and better managed.” 

You can learn more about Berryman's work and take part in her impressive research via the below QR code, or reach out to Ashlee herself via  ashlee.berryman@otago.ac.nz with any questions. 

REFERENCES:

Endometriosis
Now reported to affect 1 in 7 in Australia. Reference: https://www.aihw.gov.au/reports/chronic-disease/endometriosis/contents/summary

Prevalence of 10-15% in New Zealand (e.g., 1 in 10 to 1 in ~7 in NZ). Reference: Tewhaiti-Smith, J., et al. (2022). An Aotearoa New Zealand 
survey of the impact and diagnostic delay for endometriosis and chronic pelvic pain. Scientific Reports, 12, 4425
Reference: https://bpac.org.nz/2021/endometriosis.aspx

Breast Cancer
Affects 1 in 9 in New Zealand, or ~11% Reference: MeharrySBorotkanicsRRamsaroopRMerienF. Risk factors at five-year survival in grade 3 breast cancer: a retrospective observational study of the New Zealand population. BMC Public Health. (2021) 21:2020. 10.1186/s12889-021-12122-8

Melanoma
Affects 10.2% in New Zealand (lifetime risk). Reference: Rice, S., Zhou, L., & Martin, R. (2018). Epidemiology of melanoma in situ in New Zealand: 2008–2012. The New Zealand Medical Journal (Online), 131(1482), 73-79.

Diabetes
Prevalence of 6.6% in New Zealand. Reference: https://www.healthnz.govt.nz/assets/Publications/Diabetes-baseline-review-summary.pdf

Heart Disease
Affects 1 in 23 New Zealanders, or ~4.35%.Reference: Listed on https://www.heartfoundation.org.nz/

Stroke
Approximately 2.1% in New Zealand living with stroke effects today (lifetime risk is however much higher at 1 in 4 in those aged over 25). Reference: https://www.stroke.org.nz/understanding-stroke/statistics-data/