What is endometriosis and how does it affect women's health?

“One of the fascinating things about endometriosis is that it's so multifactorial. There's a lot about the disease itself that we don't understand, and it deserves a lot more attention," says Sawsan As-Sanie, MD, director of the Endometriosis and Pelvic Pain Consultative Clinic, USA. Endometriosis is easy to misdiagnose because its symptoms can be associated with other illnesses, she adds. Despite symptoms, the diagnosis often comes painfully late.

Though extremely painful periods are the most common symptom, there is much more to endometriosis. In light of World Endometriosis Awareness Month, Dr. Charles Nagy, consultant obstetrician & gynaecologist and master surgeon of endometriosis at Medcare Women & Children Hospital, sheds light on the condition, and why we need to increase our awareness.

According to Dr Nagy, one of the primary reasons why the genuine number of women suffering from endometriosis is larger than the world-wide reported prevalence of only 1.5 per cent is that many women are forced to face the disease without receiving an accurate diagnosis. "Every year, we treat about 500 cases of complex endometriosis, and our pregnancy success rate after surgical procedures for patients with Deep Infiltrating Endometriosis, the most severe type of endometriosis, is over 65 per cent," he adds.

Excerpts from an interview:

What is endometriosis and how does it affect women's health?

Endometriosis is a disorder in which tissues similar to the uterine lining develop outside the uterus. It can cause severe pelvic pain, making it difficult to conceive. Endometriosis can begin with a woman's first menstrual period and continue until menopause. Women can suffer from endometriosis in silence for years. The usual diagnosis takes approximately ten years. Endometriosis causes surrounding tissues to become irritated and potentially develop scars and sticky fibres that bind tissues together. In some cases, endometriosis can cause cysts on the ovaries. These are called endometriomas. Endometriosis has serious social, public health, and economic consequences. It can have a negative impact on quality of life by causing extreme pain, exhaustion, depression, anxiety, and infertility. Some endometriosis patients endure unbearable discomfort that keeps them from going to work or school.

What are some common misconceptions about endometriosis, and how do you address them?

Endometriosis may masquerade as other disorders such as: Appendicitis, Ovarian cysts, Bowel obstruction. Endometriosis is particularly challenging to detect due to its wide range of clinical manifestations. Furthermore, some women may not even feel pain (asymptomatic). Endometriosis presents a paradox: people with the most endometrial implants experience the least discomfort. Endometriosis is sometimes dismissed by patients as a "bad period." One fallacy that women need to dispel is that painful periods are natural. It is not typical to have painful periods, and endometriosis can induce pain in between periods, making the diagnosis much more challenging. To minimise stigma and offer timely diagnosis and treatment, we need measures to improve illness management, education, and awareness that involve all key stakeholders. Patients' lives can be considerably improved with effective management choices such as pain control, hormone therapy, or surgery.

Dr Nagy, in your experience, what are the most effective treatment options for managing endometriosis symptoms?

Endometriosis can be treated medically or surgically. Sometimes both medicine and surgery are necessary. Alternative remedies are beneficial to some women as well. The medications range from pain relievers (such as anti-inflammatories) to hormone medicines that suppress ovulation and periods. Laparoscopy (keyhole surgery) is the most prevalent surgical method for endometriosis. Endometriosis cysts on the ovaries (endometriomas) are unlikely to resolve on their own and cannot be treated medically. They can be surgically removed if they cause symptoms or are huge. Small endometriomas that do not cause symptoms can be detected with regular ultrasounds.

How important is early detection and diagnosis of endometriosis, and what steps can women take to ensure their health is in their hands?

Although there is no known way to prevent endometriosis, increased awareness, followed by early diagnosis and therapy, may slow down or stop the disease's natural progression and decrease the long-term impact of its symptoms. Endometriosis symptoms can appear as early as the start of the menstrual cycle. However, most people do not acquire a diagnosis until they are between the ages of 30 and 40 years.

How does Medcare Women & Children Hospital address the management of endometriosis?

Medcare Women & Children Hospital is one of the first gold seal accredited centres of excellence for endometriosis multidisciplinary care, and our goal is to provide endometriosis patients in the UAE with fresh hope for fertility and pain management. Our approach to treating patients with endometriosis is comprehensive, addressing the condition's impact on multiple organs. We have assembled a multidisciplinary team consisting of colorectal surgeons, fertility specialists, urologists, radiologists, pain management experts, and gynaecologists like myself. As a Master Surgeon for Endometriosis Care, my priority is to enhance the patient's quality of life, particularly if we choose laparoscopic surgery as a treatment option. At Medcare Women & Children Hospital we place great emphasis on accurate and early diagnosis of endometriosis through detailed ultrasound mapping and MRI so that we can precisely diagnose the disease and draw an individualised plan according to the patient's symptoms and fertility requirements.

Are there any home remedies for dealing with the pain?

Taking a warm bath or using a heating pad or hot water bottle to the lower abdomen might help relax cramping pelvic muscles and relieve pain. Natural remedies such as regular exercise, nutritional supplements, probiotics and prebiotics, Chinese herbs and foods high in isoflavones or resveratrol can all help manage endometriosis at home.

What message would you like to share with women who may be struggling with symptoms of endometriosis or who have recently been diagnosed?

Consult your gynaecologist for a physical examination as well as imaging testing such as ultrasound so that clinicians can diagnose the disease early and treat it effectively.

wknd@khaleejtimes.com

"One of the fascinating things about endometriosis is that it's so multifactorial. There's a lot about the disease itself that we don't understand, and it deserves a lot more attention," says Sawsan As-Sanie, MD, Director of the Endometriosis and Pelvic Pain Consultative Clinic, USA. Endometriosis is easy to misdiagnose because its symptoms can be associated with other illnesses, she adds. Despite symptoms, the diagnosis often comes painfully late.

Though extremely painful periods are the most common symptom, there is much more to endometriosis. In light of World Endometriosis Awareness Month, Dr. Charles Nagy, Consultant Obstetrician & Gynaecologist and Master Surgeon of Endometriosis at Medcare Women & Children Hospital, sheds light on the condition, and why we need to increase our awareness.

According to Dr Nagy, one of the primary reasons why the genuine number of women suffering from endometriosis is larger than the world-wide reported prevalence of only 1.5 percent is that many women are forced to face the disease without receiving an accurate diagnosis. "Every year, we treat about 500 cases of complex endometriosis, and our pregnancy success rate after surgical procedures for patients with Deep Infiltrating Endometriosis, the most severe type of endometriosis, is over 65%" he adds.