Why you should care

Startup founder Heather Bowerman plans to launch the first noninvasive test for endometriosis.

Heather Bowerman is on the verge of a breakthrough. Her company is poised to release the first noninvasive test for endometriosis — the agonizing uterus condition that affects tens of millions worldwide and renders many infertile. For the first time, she believes, these women can dare to hope for better than a decade-long wait and expensive surgery before finally getting a diagnosis.

Yet still Bowerman is fighting for respect. Being a young female tech founder is tough. Being a young female founder of a women’s health tech startup is even tougher. “Women’s health is viewed as a niche area,” she says, “but we’re half the population. That doesn’t make sense.”

At 33, she is the CEO and founder of DotLab, a personalized medicine company for women headquartered in San Francisco. “We’re working on something that affects so many,” Bowerman says — 176 million, in fact. That’s the number of women worldwide who are estimated to suffer from endometriosis, where the lining of the uterus spreads to other organs, causing symptoms that include excruciating pelvic pain during menstruation, sex, urination or bowel movements, as well as infertility. (Lena Dunham of Girls, Padma Lakshmi of Top Chef and Daisy Ridley of the Star Wars franchise are among the household names who have battled it. Many other women tell no one.) Later this year, DotLab plans to release DotEndo, the first noninvasive test for endometriosis that would let doctors ship samples of their patients’ blood or saliva to the company for analysis. In two weeks or less, DotLab would email doctors a link to their patients’ results.

Preliminary data on DotEndo’s accuracy “looks really impressive,” says Xin Huang, an assistant professor of obstetrics, gynecology and reproductive sciences at the University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center. Women wait as long as 10 years after seeing a doctor before a conclusive diagnosis is made. That’s partly because pelvic pain can result from a plethora of conditions, such as irritable bowel syndrome, uterine fibroids or menstrual cramps, all of which doctors must rule out before resorting to expensive laparoscopic surgery, the only way to definitively diagnose endometriosis today.

Bowerman hopes [to] temper the tendency to dismiss [females’] discomfort as part and parcel of womanhood.

A noninvasive test “offers a great opportunity to diagnose endometriosis early,” says Linda Giudice, a reproductive endocrinologist and professor of obstetrics, gynecology and reproductive sciences at the University of California, San Francisco. Doctors could order DotEndo for a patient at the first sign of pelvic pain; if she tests positive, she could start therapy for endometriosis, Bowerman says. Huang adds that a test like DotEndo could also allow patients who test positive to undergo surgery early on to remove the spreading tissue. “That essentially cures them,” says Huang, sparing them from years of discomfort, multiple doctor visits, lost work and the infertility that can occur in advanced stages of the condition.

To date, DotLab scientists have published studies about DotEndo’s ability to diagnose endometriosis based on biomarkers detected in blood serum samples only; they have yet to show data evaluating its ability to diagnose endometriosis from saliva. And, as the researchers themselves acknowledge, they “probably need to increase the sample size,” Huang says.

Sunny yet driven, Bowerman has an earnest demeanor and a broad smile. Growing up in Clovis, California, she felt equally drawn to the sciences and humanities. She earned a bachelor’s degree from the University of California, Berkeley College of Engineering, and a master’s from Harvard. In 2010, she worked at the White House Office of Science and Technology Policy before landing a health care consultant job at McKinsey. “I really love the idea of moving discoveries from lab to market,” she says.

With years of insight under her belt, she thought about which problems to apply it to. She studied how diseases develop in men versus women — and how they respond differently to treatment. Although Congress required that clinical trials include women as far back as 1993, most preclinical studies still use mostly male animals or study subjects, meaning there’s scant evidence to inform drug development and treatment options for women. Also, investors seem less willing to fund women’s health ventures, Bowerman says, since “most investors are male, and people often want to fund what they relate to or deeply understand.” She wondered: “What’s the best point of entry to eliminate this systemic bias?”

Heather bowerman in san francisco, ca

Heather Bowerman

Meanwhile, she’d become interested in technology that could leverage saliva samples, as well as snippets of genomic material called microRNAs (miRNAs), which had attracted attention as molecular fingerprints, or biomarkers, of several diseases and are present in saliva. She stumbled on a 2015 study led by Hugh Taylor of the Yale School of Medicine that suggested the levels of miRNAs that play a role in endometriosis differ in the blood serum of women with the disease versus those without it, indicating they could be used for diagnosis. After being introduced to Taylor, Bowerman founded DotLab in 2016 to develop the miRNA technology into DotEndo.

Suddenly, she went from cushy consulting job to crashing with friends while meeting investors in New York and Boston. “Heather marches to the beat of her own drum,” says Margaux Currie, Bowerman’s college classmate. “She tackles problems she believes in. She doesn’t need all the VC community saying, ‘Yes, this is what we want you to solve.’” Indeed, Bowerman says (mostly male) investors tend to ask for “more evidence of the market opportunities” — some utterly unaware of endometriosis.

In a study published shortly after DotLab’s launch, the team identified a panel of miRNAs that showed altered levels in the blood serum of women with endometriosis and ran a statistical model to measure how accurately they could discern endometriosis from other conditions. They then assessed the accuracy of this panel using blood serum samples from 100 women suspected to have endometriosis prior to undergoing laparoscopies. Sure enough, a combination of the miRNAs could confirm active endometriosis disease with near-perfect accuracy.

Bowerman is excited that the timing of DotEndo’s release will align with the emergence of a class of endometriosis drugs with minimal side effects, called GnRH antagonists, offering nonsurgical treatment options to women with positive DotEndo results. Having known women who suffer from debilitating pelvic pain, she hopes DotEndo will temper the tendency to dismiss their discomfort as part and parcel of womanhood, and allow for early intervention before the condition threatens their fertility. “It’s like this hidden drain on quality of life,” Bowerman says. “This test could make a difference.”

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