The Developmental Origins of Endometriosis (ENDOHaD)

Introduction:

Endometriosis is a common pathology affecting one in 10 women, characterized by the ectopic development of endometrium, which can cause pain and/or infertility. This pathology is primarily determined by hereditary factors, but it is also susceptible to environmental influences, such as the age of the onset of menstruation or exposure to chemical substances that modify the endocrine system. Recent studies have highlighted that endometriosis is more common in women with relatively short ano-genital distances (AGD), and that sensitivity to pain is closely linked to adult levels of testosterone (T) or oxytocin (OT).

Aim:

The main objective is to compare the anogenital distance (AGD) between two groups of women: one with stage III or IV endometriosis (ENDO +) and another group without endometriosis confirmed by laparoscopy (ENDO -).

The secondary objectives are to compare various factors between the 2 groups :

• Basal testosterone levels in blood.
• Variations in blood testosterone levels before and after a video stimulating empathy.
• Basal oxytocin levels in saliva.
• Variations in oxytocin levels in saliva before and after an empathy-stimulating video.
• Pelvic pain, between D2 and D5 after the start of the menstrual cycle.

For the ENDO + group only:

• Evaluate patients' quality of life, between D2 and D5 after the start of the menstrual cycle.
• Correlate pain experienced over the last 4 weeks with hormonal markers (AGD, T, OT).

Methods:

Participants in the ENDO+ group will fill in a questionnaire assessing the impact of pain experienced over the past 4 weeks on their quality of life. D0 is defined as the day when participants experience a menstrual bleed before 10 am. All participants will return for project-specific hospital appointment between D2 and D5 after the start of their menstrual cycle to measure T, Sex Hormone-Binding Globulin (SHBG) and OT.

During this consultation, the following samples will be taken:

• 10mL blood sample
• 2mL saliva sample

Both samples will be taken at t0 (before watching the video) and t1 (20 minutes after watching the video).

Study Overview

• Status: Recruiting
• Conditions: Endometriosis
• Intervention / Treatment: Other: Blood samples for testosterone and SHBG measurements; Other: Saliva samples for oxytocin measurements

• Study Type: Observational
• Enrollment (Estimated): 40

Contacts and Locations

• Study Contact: Name: Alexandra ALVERGNE, PhD; Phone Number: +334.67.14.46.15; Email: alexandra.alvergne@umontpellier.fr
• Study Contact Backup: Name: Noémie RANISAVLJEVIC, MD; Phone Number: +334.67.33.64.81; Email: n-ranisavjlevic@chu-montpellier.fr

Study Locations

• France
  • Montpellier, France, 34295
    • Recruiting
    • CHU de Montpellier
    • Principal Investigator: Noémie RANISAVLJEVIC, MD
    • Sub-Investigator: Martha DURAES, MD
    • Contact: Noémie RANISAVLJEVIC, MD; Email: n-ranisavljevic@chu-montpellier.fr

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: N/A

• Sampling Method: Non-Probability Sample

Study Population

Women with or without endometriosis

Description

Inclusion Criteria:

• Nulliparous woman
• No hormonal contraception for at least 3 months
• Regular menstrual cycles (between 26 and 32 days) or proven ovulation (positive urine ovulation test ovulation test or progesterone level >3 ng/ml in the luteal phase)
• Normal BMI (≥ 18,5 and < 30 kg/m²)

Specific criteria (ENDO+ group) :

• Stage III or IV endometriosis confirmed by laparoscopy or by laparotomy or MRI
• Painful symptoms

Specific criteria (ENDO- group) :

• Patient without endometriosis confirmed by laparoscopy

Exclusion Criteria:

• Ovarian stimulation planned within 3 months
• Adenomyosis
• Use of a copper coil
• Polycystic ovary syndrome
• Pudendal neuralgia
• Episiotomy or lesion of the posterior perineum that may modify AGD
• Diabetes or thyroid disease
• Chronic liver failure, chronic renal failure, cardiac pathology, autoimmune disease
• Autism
• Diagnosis and/or treatment for psychiatric illness
• Chronic exposure to cocaine, methamphetamine, morphine or ecstasy within 30 days before the inclusion visit
• Chronic exposure to Tetrahydrocannabinol (THC) within 7 days prior to inclusion.
• Patient on treatment(s) that vary oxytocin (e.g. atosiban), testosterone or GnRH
• Pregnant or breast-feeding patient
• Patients who have given birth or breastfed within 6 weeks before the inclusion visit
• Patient unable to read French
• Failure to obtain informed consent
• Patient not affiliated with or not benefiting from a national health insurance scheme
• Person under legal protection, guardianship or curatorship
• Patient participating in other research involving the human person

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
ENDO +; Patients with endometriosis diagnosed by Magnetic Resonance Imaging (MRI) or laparoscopy	Other: Blood samples for testosterone and SHBG measurements; Several measurements of the testosterone concentration will be performed on serum from 10 mL of blood collected at: t0 corresponding to the start of the hospital appointment and before watching the video; t1 which corresponds to 20 minutes after watching a 2 minutes empathy-inducing video; Other: Saliva samples for oxytocin measurements; Several measurements of the oxytocin concentration will be performed on 2 ml saliva samples: t0 corresponding to 20 minutes after the start of the hospital appointment and before watching the video; t1 which corresponds to 20 minutes after watching a 2 minutes empathy-inducing video
ENDO -; Patients without endometriosis diagnosed by laparoscopy	Other: Blood samples for testosterone and SHBG measurements; Several measurements of the testosterone concentration will be performed on serum from 10 mL of blood collected at: t0 corresponding to the start of the hospital appointment and before watching the video; t1 which corresponds to 20 minutes after watching a 2 minutes empathy-inducing video; Other: Saliva samples for oxytocin measurements; Several measurements of the oxytocin concentration will be performed on 2 ml saliva samples: t0 corresponding to 20 minutes after the start of the hospital appointment and before watching the video; t1 which corresponds to 20 minutes after watching a 2 minutes empathy-inducing video

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Measure of the anogenital distance (AGD)	AGD is measured at enrollment for patients already diagnosed by Magnetic resonance imaging (MRI), and it is measured during the laparoscopy once the diagnosis has been confirmed. AGD is measured by 2 different operators with a millimetric precision ruler according 2 validated methods : measure of the distance from the clitoral surface to the anus (AGD-AC), and; measure of the distance from the posterior fourchette to the anus (AGD-AF). The method is described here: https://www.jove.com/v/57912/ Each operator will measure the AGD-AC and the AGD-AF 3 times. For each type of AGD, the final value will correspond to the mean of the 6 values.	At diagnosis or at inclusion

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Basal total testosterone	The basal total testosterone (Ttotal(t0)) level is measured in blood	t0 : Between the second and the fifth day of the menstrual cycle, before wathching an empathy-inducing video
Basal bio-available testosterone	The basal bio-available testosterone (Tbio-available(t0)) level is measured in blood	t0 : Between the second and the fifth day of the menstrual cycle, before wathching an empathy-inducing video
Basal sex hormone-binding globulin	Basal sex hormone-binding globulin (SHBG(t0)) level is mesured in blood	t0 : Between the second and the fifth day of the menstrual cycle, before watching an empathy-inducing video
Basal Free Androgen Index	Basal Free Androgen Index (FAI(t0)) = (Ttotal(t0)/SHBG(t0))*100	t0 : Between the second and the fifth day of the menstrual cycle, before watching an empathy-inducing video
Total testosterone after empathy induction	The total testosterone level after empathy induction (Ttotal(t1)) is measured in blood	t1 : Between the second and the fifth day of the menstrual cycle, after wathching an empathy-inducing video
Bio-available testosterone after empathy induction	The bio-available testosterone level after empathy induction (Tbio-available(t1)) is measured in blood	t1 : Between the second and the fifth day of the menstrual cycle, after wathching an empathy-inducing video
Sex hormone-binding globulin after empathy induction	Sex hormone-binding globulin after empathy induction (SHBG(t1)) is mesured in blood	t1 : Between the second and the fifth day of the menstrual cycle, after wathching an empathy-inducing video
Free Androgen Index after empathy induction	Free Androgen Index after empathy induction (FAI(t1)) = (Ttotal(t1)/SHBG(t1))*100	t1 : Between the second and the fifth day of the menstrual cycle, after wathching an empathy-inducing video
Variation in total testosterone levels before and after an empathy-inducing video	The level of variation in total testosterone before (t0) and after watching empathy-inducing video (t1) is assessed according to: Ttotal(t1)-Ttotal(t0)	t1 : Between the second and the fifth day of the menstrual cycle, after wathching an empathy-inducing video
Variation in bio-available testosterone levels before and after an empathy-inducing video	The level of variation in bio-available testosterone before (t0) and after watching empathy-inducing video (t1) is assessed according to: Tbio-available(t1)-Tbio-available(t0)	t1 : Between the second and the fifth day of the menstrual cycle, after wathching an empathy-inducing video
Variation in Sex hormone-binding globulin levels before and after an empathy-inducing video	The level of variation in Sex hormone-binding globulin before (t0) and after watching empathy-inducing video (t1) is assessed according to: SHBG(t1)-SHBG(t0)	t1 : Between the second and the fifth day of the menstrual cycle, after wathching an empathy-inducing video
% of variation in Free Androgen Index before and after an empathy-inducing video	% of variation in Free Androgen Index before (t0) and after watching empathy-inducing video (t1) is assessed according to: [[FAI(t1)-FAI(t0)]/FAI(t0)] × 100	t1 : Between the second and the fifth day of the menstrual cycle, after wathching an empathy-inducing video
Basal oxytocin (OT) level	The basal OT level is measured by the dosage in the saliva of : Total OT (OTtotal(t0))	t0 : Between the second and the fifth day of the menstrual cycle, before wathching an empathy-inducing video
Oxytocin (OT) level after empathy induction	The basal OT level is measured by the dosage in the saliva of : Total OT (OTtotal(t1))	t1 : Between the second and the fifth day of the menstrual cycle, after wathching an empathy-inducing video
Variation in oxytocin (OT) level before and after an empathy-inducing video	Variation in OT level before (t0) and after watching an empathy-inducing video (t1) is assessed in the saliva according to: - OTtotal(t1)-OTtotal(t0) -% of variation of OT = [[OT(t1)-OT(t0)]/OT(t0)] × 100	t1 : Between the second and the fifth day of the menstrual cycle, after wathching empathy-inducing video
Area under the Receiving Operator Characteristic (ROC) curve for AGD	The ROC curve is a graphical representation that illustrates the performance of a binary classification model. It plots the true positive rate (sensitivity) against the false positive rate (1 - specificity) at various classification thresholds. In other words, the model's sensitivity corresponds to the model's ability to detect patients (ENDO+) while the model's specificity corresponds to the model's ability to detect a non-patient (ENDO-). The ROC curve helps assess the model's ability to correctly identify true positives while minimizing false positives. The area under the ROC curve (AUC) can be interpreted as the probability that, among two randomly chosen subjects, a patient and a non-patient, the value of the marker is higher for the patient than for the non-sick. An AUC of 0.5 (50%) indicates that the marker is non-informative. An increase in AUC indicates an improvement in discriminatory abilities, with a maximum of 1.0 (100%).	At diagnosis (ENDO+) or at enrollment (ENDO-)
Pelvic pain intensity	Pelvic pain will be assessed using a Visual Analogue Scale (VAS). The visual analog scale (VAS) is a validated, unidimensional subjective measure for acute and chronic pain. Scores are recorded by making a handwritten mark on a 10-cm line that represents a continuum between "no pain" and "worst pain."	t0 : Between the second and the fifth day of the menstrual cycle, before watching an empathy-inducing video

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Quality of life (for the ENDO+ group only)	The quality of life of patients with endometriosis is assessed with the Endometriosis Health Profile questionnaire (EHP-30©) EHP-30 is a self-administered questionnaire validated in French to assess the effects that endometriosis can have on the quality of life of women. This questionnaire consists of 30 domains grouped into 5 areas: Pain (11 items: n° 1 to 11), Control and helplessness (6 items: n°12 to 17), Emotional well-being (6 items: n°18 to 23), Social support (4 items: n°24 to 27), Self-image (3 items: n°28 to 30). Each item is rated on a Likert scale (Never=0, Rarely=1, Sometimes=2, Often=3, Always=4). Each domain is then represented by a score calculated on a scale from 0 (indicating the best possible state of health) to 100 (indicating the worst possible state of health): Domain score = [sum of responses to each item in the domain] / [4 (= maximum item response) × number domain items] × 100	t0 : Between the second and the fifth day of the menstrual cycle, before wathching an empathy-inducing video
Score of pain (for the ENDO+ group only)	The score of pain of patients with endometriosis is assessed with the French version of the Endometriosis Health Profile questionnaire (EHP-30©). The score of the first domain Pain consists of 11 items. Each item is rated on a Likert scale (Never=0, Rarely=1, Sometimes=2, Often=3, Always=4).	t0 : Between the second and the fifth day of the menstrual cycle, before wathching empathy-inducing video

Collaborators and Investigators

• Sponsor: University Hospital, Montpellier
• Collaborators: Université Montpellier; Centre National de la Recherche Scientifique, France; Fondation pour la Recherche Médicale; Fondation pour la Recherche sur l'Endométriose
• Investigators: Study Chair: Alexandra ALVERGNE, PhD, Centre National de la Recherche Scientifique, France

Study record dates

Study Major Dates

• Study Start (Actual): January 8, 2024
• Primary Completion (Estimated): August 8, 2026
• Study Completion (Estimated): October 8, 2026

Study Registration Dates

• First Submitted: June 29, 2023
• First Submitted That Met QC Criteria: July 10, 2023
• First Posted (Actual): July 19, 2023

Study Record Updates

• Last Update Posted (Actual): February 25, 2026
• Last Update Submitted That Met QC Criteria: February 23, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Keywords: Oxytocin; Endometriosis; Testosterone; DOHaD
• Additional Relevant MeSH Terms: Urogenital Diseases; Genital Diseases; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Pregnancy Complications; Genital Diseases, Female; Prenatal Injuries; Prenatal Exposure Delayed Effects; Endometriosis; Developmental Origins of Health and Disease; Hormones; Hormones, Hormone Substitutes, and Hormone Antagonists; Investigative Techniques; Specimen Handling; Clinical Laboratory Techniques; Diagnostic Techniques and Procedures; Diagnosis; Punctures; Surgical Procedures, Operative; Polycyclic Compounds; Steroids; Fused-Ring Compounds; Gonadal Steroid Hormones; Gonadal Hormones; Androstenes; Androstanes; Androstenols; Testosterone Congeners; Testosterone; Blood Specimen Collection
• Other Study ID Numbers: RECHMPL23_0057

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No