I wish to discuss at length a conclusion I have reached concerning the cause of endometriosis. I note with some concern that many patients in whom I diagnose endometriosis are drivers of motor cars. Women who remain in a seated position during menstruation will clearly have altered intra-abdominal pressure characteristics, which may lead to abnormal reflux of menses. Frequent use of the controls pedals of the motor car might further ‘pump’ menstrual fluid into the peritoneal cavity. I wish to propose this as a hypothesis for the aetiology of endometriosis. I cannot recall having ever seen a non-driving patient who had endometriosis, and of course the disease is very rare in women who are too young to take their driving test. Furthermore, the disease appears to be uncommon in parts of the world where women do not commonly drive, such as in Africa, since few reports concerning the prevalence of endometriosis in Africa have ever been published.
I look forward to this letter being published in the BJOG, with a view to achieving extensive media coverage and causing extreme disquiet amongst a large number of patients with endometriosis and the ‘worried well’. I am sure this will promote greater public understanding of the nature of the disease, and by discouraging women from driving cars, should reduce the burden of this illness in society.
I write this letter having just read your commentary (Vol 106, October 1999)1 which seems equally evidence based.