Current Research on Endometriosis: An Interview with Dr. Courtney Munro

“We want work out where investing health resources is most efficient to help people.” 

Teresa Götz: Welcome, could you please introduce yourself to our readers briefly? 

Dr. Courtney Munro: My name is Courtney Munro, and I’m a Senior Research Officer at Murdoch Children’s Research Institute in Melbourne, Australia.

Teresa Götz: How did you come to research endometriosis?

Dr. Courtney Munro: I came to research first looking at cystic fibrosis where my PhD examined biomarkers of aminoglycoside toxicity. Throughout my career, I worked in acute care settings in tertiary hospitals, largely in cystic fibrosis, but also in transplant services. Then I did something completely different, working in advocacy and policy. I learned how to do advocacy and ground roots advocacy with non-for-profit organizations. When I returned to the research institute of my PhD, I moved into the field of gynecology – specifically paediatric and adolescent gynaecology, in which I had already gained some experience in my early career. I feel I benefit a lot from my different perspectives and that my current position combines all three aspects (clinical, research and advocacy).

About Dr. Courtney Munro

Dr. Courtney Munro is an endometriosis researcher with a background in pharmacy and policy. Her work focuses on interventions for period pain, pelvic pain and endometriosis in adolescents, and the diseases impact on their family. In the course of the 15th World Congress on Endometriosis, Dr. Munro was interviewed by the Endo Apps psychologist Teresa Götz about her project. 

Dr. Courtney Munro

Teresa Götz: Could you summarize your work projects for the patients and readers?

Dr. Courtney Munro:

The project I coordinate is called LongSTEPPP which is a longitudinal study for young people with period pain, pelvic pain and endometriosis. Our participants are aged 10 to 18. They have period pain, pelvic pain, and perhaps a diagnosis of endometriosis. My role is to follow them for up to five years, in which we are tracking their periods via online surveys.

We look at variables like their pain, their quality of life, and their mental health or emotional well-being. One question we try to answer is what comes first? Poor mental health may impact on pain perception, but equally, being in pain poses a risk of depression and anxiety.  

The other thing that we’re looking at in this project which makes it particularly unique, is health utilization. As a society, there’s a huge cost to pain and to endometriosis in terms of time off work, missed education, missed opportunity, and what they call presenteeism, where you’re at school or work but you’re not performing at your best because you’re in pain or unwell.  

We’re looking at the hidden costs of pain and endometriosis, and specifically at health utilization. Crudely, interventions can be separated into surgical and medical pathways. We want to examine who has better outcomes or where the outcomes may differ with different pathways because we don’t know what’s best for young people with period pain, pelvic pain, and endometriosis.

Literature exists on how to treat older patients and its common to see adults with deep infiltrating endometriosis and persistent pain with central sensitization. We are trying to look back before all of that happens and find out where we can intervene, and what interventions make a difference in an adolescent cohort.

For some adolescents the most appropriate plan of action seems to be cycle suppression, given that they’re only just coming into menarche. If we can intervene early, certainly the potential for benefit is huge.  

With additional funding, we might be able to run this study for longer and look at some of those other outcomes, commonly seen in adults like persistent pain and fertility. 

Teresa Götz: How will your findings contribute to improving the lives of women with endometriosis?

Dr. Courtney Munro:

We want work out where investing health resources is most efficient. We’re also hoping that by identifying disease at an early stage in young people, we can intervene sooner rather than later and prevent problems like persistent pelvic pain and infertility.  

Our goal is to recruit about 3000 young people in Australia. In doing so, we should be able to tease apart whether certain treatment modalities are associated with better outcomes or not. Through performing health economic analysis, we want to find out which interventions were related to which outcomes and at what cost.  

Besides looking at the patients, we also take into account the impact of endometriosis on families. We also recruit a family member over the age of 18 to ask them about the household status, the demographics of the family and factors such as whether they’ve got health insurance. What impact does the disease have on the family’s life?

Parents may have to take time off work to take their children to an appointment, or they could be suffering financially because they’ve spent money on a specialist, an ultrasound, or an MRI this week. We also ask the parent to rate their child’s pain and quality of life, and in the bigger picture, we’re looking at what’s happening in the family unit.

Lastly, we also look at the variable of intergenerational transmission of pain through heritability patterns between mothers and daughters. How does their pain relate to each other? Could it be that the tendency to catastrophize pain runs in the family? 

Teresa Götz: What do you think is the role of digital self-help?

Dr. Courtney Munro: This age group we are working with, adolescents, are very accepting of digital health strategies. In our focus groups that we ran back in 2021, they quite liked coming together in an online format in a digital space because they could be anonymous.

They could come when they were in pain. They could come in their pajamas, and they could come with their hot water bottle. In terms of education, group therapy, and meeting others who are going through a similar situation or condition they quite liked an online or a digital format.

Teresa Götz: What are your future research goals?

Dr. Courtney Munro: In terms of future research, we need to know what we’ve found out of this first study. I would like to bring in more co-design and co-creation, involving young people in advisory committees to make sure that the research about them is appropriate for them so that it doesn’t end up in the great wasteland of research findings, and that there isn’t this delay in implementing the research findings.  

There’s a huge amount of power in analytics and health utilization. I hope my future work will continue to involve young people, coming back to the principles of the James Lind Alliance, which is a UK initiative and priority setting partnerships. Therefore, making sure that the research we’re doing is research of interest to and conducted with the beneficiaries, be it the young people or their families. 

Teresa Götz: Is there anything else you would like to share with those affected? 

Dr. Courtney Munro:

We don’t have all the answers, but we’re working very hard to determine the treatment pathways that will help you the best.  

If you’re willing to share your lived experience, please consider taking part in a research study because your experience can change what it means for somebody else who has the same condition in years to come. 

Teresa Götz