Diagnosis
Research explores nervous system pathways that heighten endometriosis pain
Researchers have secured US$3m to study how brain pain pathways influence endometriosis treatment outcomes, potentially explaining why 25 to 40 per cent of patients do not respond.
The project will use neuroimaging to identify brain signatures that could predict which patients benefit from surgery or hormonal treatment.
USC researchers Jason Kutch and Neda Jahanshad received the National Institutes of Health grant to investigate pain processing patterns in the brain.
The study aims to understand why some patients get lasting relief while others undergo multiple surgeries with limited success.
There is often little correlation between the amount of endometrial tissue and pain levels.
Some patients with extensive lesions report minimal pain, while others with little visible disease experience severe symptoms.
Kutch is an associate professor in the USC Division of Biokinesiology and Physical Therapy
The researcher said: “About 25 to 40 per cent of patients don’t get sustained relief from those interventions.
“That leads many people to undergo multiple surgeries with only limited success.”
The research focuses on central sensitisation, where the nervous system becomes overactive and amplifies pain signals.
This involves complex interactions between biological pain drivers and how the nervous system detects and interprets those signals.
Kutch said: “There’s growing recognition that chronic pain involves a complex interplay between biological pain drivers and how the nervous system detects and interprets those signals.
“One key concept is central sensitisation, where the nervous system becomes overactive and amplifies pain.
“In this project, we’re trying to understand that component better: Can we predict who will respond to surgical or hormonal treatment, and who may not?”
The project builds on Kutch’s 14 years studying pelvic pain conditions, including bladder and prostate pain, where brain markers suggesting central sensitisation have been identified.
Jahanshad, associate professor of neurology and biomedical engineering at the Keck School of Medicine of USC, will harmonise independently collected datasets to explore different aspects of pelvic pain and treatment outcomes.
Jahanshad said: “My team specialises in merging different types of data that were collected independently and finding ways to harmonise them.
“The goal is to see whether there are brain signatures, before treatment, that can help predict who will respond successfully.
“We often see that some patients experience pain relapse after treatment or have coexisting conditions such as depression or anxiety that may influence their pain outcomes.
“We are looking to build a model that can help optimise treatment plans for women with endometriosis.” said
The researchers emphasised this is not about dismissing pain as psychological but understanding biological differences in brain pain processing.
Potential interventions could include non-invasive brain stimulation, which Kutch is currently trialling for interstitial cystitis, a related bladder pain condition.
Centrally acting medicines might also prove more effective if patients likely to benefit can be identified.
The FDA has delayed approval of camizestrant while it reviews new analyses submitted by AstraZeneca after advisers voted against the breast cancer drug.
The US regulator had been considering whether to approve the oral treatment after a phase 3 switching study in a specific group of breast cancer patients.
Camizestrant is an oral SERD, or selective oestrogen receptor degrader. These drugs are designed to block and break down oestrogen receptors that can help some breast cancers grow.
AstraZeneca filed for approval based on the phase 3 Serena-6 trial, which tested a treatment-switching approach.
Patients in the study received an aromatase inhibitor and a CDK4/6 inhibitor. Aromatase inhibitors lower oestrogen levels, while CDK4/6 inhibitors are targeted cancer drugs that help slow cancer cell growth.
After detecting an ESR1 mutation, investigators switched the aromatase inhibitor to camizestrant.
An ESR1 mutation is a change in a gene linked to the oestrogen receptor. It can make some breast cancers less responsive to standard hormone treatments.
AstraZeneca said switching to camizestrant was linked to a 56 per cent increase in progression-free survival.
Progression-free survival measures how long a patient lives without their disease getting worse.
However, the FDA raised questions about the study design.
An FDA advisory committee later voted six to three that AstraZeneca had failed to show camizestrant provides a clinically meaningful benefit.
The vote was a setback for the company’s hopes of approval, although the FDA can go against advisory committee recommendations.
After the setback, AstraZeneca submitted additional analyses requested by the FDA.
The company said the analyses include data on circulating tumour DNA clearance linked to longer-term efficacy outcomes.
Circulating tumour DNA refers to fragments of genetic material from cancer cells that can be found in the blood.
AstraZeneca is expected to share the data next week at the American Society of Clinical Oncology annual meeting.
The FDA has now delayed its ruling while it reviews the additional information. AstraZeneca did not provide a new decision date.
Three-month delays are typical and, during the second Trump administration, have been common.
After budget cuts reduced its workforce, the FDA delayed rulings on assets including Bayer’s Lynkuet, Biohaven’s troriluzole and Sanofi’s tolebrutinib. The FDA reportedly blamed a “heavy workload and limited resources” for one delay.
The agency has continued to delay rulings this year, with Biogen, Savara and Travere Therapeutics among the companies to say the FDA has extended reviews of their drugs.
Like AstraZeneca, those three companies faced delays after submitting additional information that the agency needed time to review.
If the additional analyses address the regulator’s concerns, AstraZeneca could still secure approval for a drug it has estimated could generate peak sales of more than US$5bn.
Guggenheim Securities analysts recently described the Serena-6 study as “a limited commercial opportunity in our and [AstraZeneca’s] view”.
AstraZeneca is also running two adjuvant studies and a trial in a first-line setting as it seeks to position camizestrant across different stages of breast cancer care.
Adjuvant treatment is given after primary treatment, such as surgery, to reduce the risk of cancer returning. First-line treatment is the first therapy given for a disease.
Roche reported the failure of its rival oral SERD in first-line breast cancer in March, but AstraZeneca executives have argued that their trial designs and drug candidate are different.
Last week, Europe’s Committee for Medicinal Products for Human Use issued a positive opinion on camizestrant.
The drug is expected to be marketed as Etcamah in Europe.
The NHS has been urged to update its website after PCOS was renamed PMOS, or polyendocrine metabolic ovarian syndrome.
Last week, the condition, thought to affect about one in eight women, was given a new name after a 14-year effort involving medical experts, charities and women with lived experience of the disorder.
However, the NHS website contains no mention of the new name or any change to the information provided about the condition.
Neelam Heera-Shergill, chief executive and founder of the charity Cysters, urged action.
She said: “As an organisation rooted in reproductive and health justice, we welcome conversations around language that better reflect the realities and experiences of those living with PMOS/PCOS. But any name change must go beyond symbolism.
“Communities deserve clear, accessible and timely information so people are not left confused, excluded or struggling to access support and diagnosis.
“We hope to see the NHS move quickly to update information and public-facing resources in a way that is inclusive, culturally competent and centred on the needs of the communities most impacted.
“For many people, especially those from marginalised backgrounds who already face barriers within healthcare, clarity and visibility can make a real difference in accessing the rightful care and support they need.”
However, Caroline Andrews, a trustee of the charity Verity, said the announcement of the new name came with a three-year transition period.
She added that the NHS is going through many changes, with a new health secretary recently announced after the resignation of Wes Streeting.
In addition, 2026 has seen the launch of the renewed Women’s Health Strategy for England, while the UK National Institute for Health and Care Excellence is expected to publish the first standalone guidelines for PMOS/PCOS later this year.
Andrews said: “We fully appreciate that they [the NHS] need transition time just like we do, just like many other organisations do.
“And we’d much rather the NHS do this carefully and thoughtfully, considering this in placement with all the lines of care, such as the fact the Nice guidelines are coming through, and how this is fitting with the delivery of care.”
Prof Channa Jayasena, an expert in reproductive endocrinology at Imperial College London, welcomed the name change.
He said: “I think it’s a tremendous initiative, and I think it’s a great step forward in trying to help women and clinicians understand the full breadth of the seriousness [of the] condition.”
But he added that the shift has only just occurred, with professional societies around the world meeting to inform their members about the change.
He said: “There’s a long history of many conditions sometimes still being called outdated things by clinicians because it takes a while for the workforce to be updated and upskilled.
“And I can guarantee you, not all doctors know about this at the moment, and therefore not all patients will.
“So I think it’s a great move in the right direction, which shows where we should be going.
“But professional societies which have webpages, obviously patient support groups, and the NHS will, I fully expect, over the next year or two, be updating all their websites.”
However, Dr Sophie Williams of the University of Derby and an expert on PCOS/PMOS and mental health said the three-year transition for the name change could cause confusion.
She said: “When you go on the NHS website and it’s still [saying] polycystic ovaries, PCOS… as a member of the public, that might make you question the legitimacy of the information you’re getting.
“[The NHS website] is one of the first places any person might think to go to for health care advice that is rigorous, that is reliable. So from my perspective, I do think that the sooner the better.”
Williams said one option would be to run two shadow webpages that link together, one for PCOS and one for PMOS, or to include text on the current page referring to the name change and noting that information is being reviewed.
An NHS spokesperson said: “We routinely review and update content on the NHS website to ensure it reflects the latest clinical advice and will carefully consider these recommendations.
“The NHS will also continue our work to improve women’s healthcare, including for this important group, which involves giving women more choice over their care, bringing down waiting times, and delivering more care in communities.”
Only one per cent of women can name all five gynaecological cancers, new research suggests, as 21 women in the UK die every day of the diseases.
The report also found that 31 per cent of women have put off or avoided seeking medical advice for gynaecological symptoms.
It also found that 43 per cent of women invited for cervical screening said barriers had put them off attending, while 18 per cent of respondents aged 25 to 34 who had been invited had never attended.
The five main gynaecological cancers are womb, also called uterine, ovarian, cervical, vulval and vaginal cancer.
The Lady Garden Foundation said that, while progress has been made since the UK government’s 2022 Women’s Health Strategy aimed to improve gynaecological cancer care, significant challenges remain.
John Butler, medical director and trustee at the Lady Garden Foundation, said: “The fact that only one per cent of the population can name the diseases that directly affect half of us underscores a significant awareness gap, impacting individuals’ ability to recognise vital signs and symptoms or seek timely medical help.
“Addressing this isn’t just about awareness; it’s a critical public health priority. Our collective efforts are essential to ensure the latest commitments announced by this government translate into tangible change that saves lives.”
The report said key reasons for delaying medical advice included difficulty making appointments, embarrassment and, for cervical screening, fear of pain or previous bad experiences.
Women also reported challenges within healthcare interactions, including feeling “not taken seriously”, “dismissed” or “not believed” when seeking gynaecological advice.
Jenny Halpern Prince, chief executive and charity co-founder, said: “We frequently hear reports of women feeling ‘not taken seriously,’ ‘dismissed,’ or ‘not believed’ when seeking gynaecological advice.
“These experiences highlight crucial areas where we can improve patient support and trust within our healthcare system, ensuring women receive the empathetic and effective care they need.”
The Lady Garden Foundation said it aims to increase awareness of both the charity and the five gynaecological cancers.
It also aims to serve as a primary entry point for reliable, stigma-free information, helping people understand their bodies, recognise symptoms and overcome barriers to accessing care.
Its Silent No More Garden was unveiled at the RHS Chelsea Flower Show 2026. Designed by Darren Hawkes, the garden serves as a national call to action, using five sculptures to spark conversations, break long-standing taboos and encourage open dialogue about symptoms and preventative care.
Butler said: “Continued focus and collaborative action are essential to progress.
“The ongoing commitment from the government, alongside societal efforts to break down taboos surrounding gynaecological health, are crucial.
“The Lady Garden Foundation is dedicated to being a beacon of information and support, empowering women with the knowledge they need. We urge everyone to learn the signs, speak up, and help us save lives.”
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