Endometriosis Treatment- In need of a paradigm shift
Endometriosis affects an estimated 1 in 10 women during their reproductive years (i.e., usually between the ages of 15 to 49), which is approximately 176 million women in the world. Women with endometriosis suffer from chronic pain, extreme PMS, heavy bleeding, fatigue and infertility.
I really believe that the health care system is failing these patients. Women with Endometriosis are often being turned away with crippling, debilitating symptoms and responses such as ‘it’s normal’ or ‘it’s unexplained’. How can women be expected to live with this and for their quality of life to be unaffected. They can’t.
Endometriosis is a very complex condition and psychological factors have an important role in determining the severity of symptoms and the effectiveness of the treatments. According to recent data, women with endometriosis are at risk for anxiety, depressive symptoms and other psychiatric disorders.
A recent study comparing the prevalence of depression in women with surgically diagnosed endometriosis found that depression was detected in 86% of women with pelvic pain and and 38% of the women without pelvic pain. That’s astonishingly high.
Various studies have reported that physical illness or uncontrollable physical pain are major factors in up to 70%
of suicides.
According to studies in the New England Journal of Medicine, endometriosis is one of the top three causes of female infertility.
While it is one of the most treatable, it remains the least treated.
What can we do?
“As per Dr. Matthew Leonardi, ‘Endometriosis should be treated as if it were cancer. We believe that recognition of complex benign gynaecology as a subspecialty is necessary. ”
He believes that complex gynaecological cases like endometriosis should receive care under a dedicated subspecialty. Since the establishment of gynaecological oncology, ovarian cancer patient outcomes have improved. This is as a result of the care they receive, delivered in a multidisciplinary approach, with specialised teams and units. “Integrating pain specialists, psychologists, physiotherapists and other surgical specialities (e.g. urology, colorectal, and thoracic surgery).” It allows allows for further research in the specific field.
Universal staging, standardised training programs, and specific diagnostic and treatment guidelines have yielded relative uniformity in how people are treated. Dr. Matthew believes that a paradigm shift is needed in the care of people with endometriosis to ‘mirror’ that of the care given to cancer patients.
These two conditions are different of course. The treatment goal with ovarian cancer is survival and for endometriosis, improved quality of life and/or fertility. Despite these differences, they do share similar diagnosis and treatment difficulties.
The World Endometriosis Society and Research Foundation agree that a multidisciplinary, evidence based approach is in the best interest of all patients suffering with endometriosis.
“Evidence based medicine is the skill – perhaps even the art – of being able to integrate the best available scientific evidence and to apply it to each patient’s individual situation. The World Endometriosis Society consensus on current management of endometriosis is a unique collaboration between clinicians of all disciplines involved in treating women endometriosis along with representatives of women suffering from the disease that has sought to achieve this integration.
What we have achieved is more than ‘recommendations’ or ‘a guideline’; it is a concentrate of immense clinical experience, research efforts, and cooperation together with women with endometriosis.”
Researchers are searching for a simple test that would be used as a biomarker, detecting and diagnosis endometriosis more efficiently. This would mean that a simple blood, saliva, urine or uterine lining sample could indicate if endometriosis is present, removing the need for such invasive means to fully diagnose the disease.
For patients experiencing endometriosis and looking to understand more, there are many great resources dedicated specifically to endometriosis.