Madrid, March 12, 2021.- Although it has been many years since endometriosis was recognized as a chronic disease, it continues to be an unknown condition for many women, to the point that many of those who suffer from the disease do not even know it. "It is estimated that 10-15% of the population may be affected, with an incidence of up to 40-50% in infertile patients," explains Dr. Javier de Santiago, head of the Gynecologic Oncology Service at MD Anderson Cancer Center Madrid – Hospiten.
Endometriosis is characterized by the presence of endometrial cells outside the uterine cavity (ovaries, tubes, peritoneum, etc.), which can survive and escape the natural defense mechanisms that should prevent their persistence in these unnatural places. In recent years, some immune and oxidative stress-related factors that appear to be related to endometriosis have been studied. Similarly, some genetic factors may contribute to the development of the disease.
Although the best-known form of endometriosis affects the ovaries in the form of the so-called “chocolate cysts”, the most symptomatic and difficult to treat form is deep endometriosis, which leads to the formation of tissue nodules of the disease, generally in the pelvis and causes adhesions that affect the tissue of the fallopian tubes and secondary sterility.
Surgical experience and knowledge of endometriosis
"If we consider that the ideal treatment for a disease is that which improves the patient’s condition, at low cost, with few side effects and is effective in the long term, then endometriosis does not have a perfect treatment in all cases," says Dr. Javier de Santiago. "Since we do not know the cause of the disease, we do not have a treatment that is effective at the onset of the disease or that can prevent it”. Depending on the symptoms and location of the affected tissue, basically there are three treatment options: medical, surgical and those applied in assisted reproduction.
Medical treatment is mainly aimed at treating the pain and preventing the progression of the disease and is based on administering analgesics and hormone therapy to suppress ovulation, decrease estrogen levels and shrink the size of endometrial tissue nodules. These drugs are mainly anovulatory contraceptives and progesterone derivatives. There are others, less commonly used and for refractory cases, which suppress the activity of the ovary inducing a pharmacological "menopause", but it is recommended to start with simple drugs, with few side effects and lower cost, and to use the more complex, expensive drugs in case of intolerance or when the others are ineffective.
Another strategy is surgery, preferably by means of laparoscopy. This aims to remove all visible endometriosis lesions and restore as much anatomy as possible. It is important that surgery be carried out by gynecologists with surgical experience and in-depth knowledge of endometriosis. "Inappropriate surgery will lead to future relapses of the disease and / or symptoms, which are very difficult to treat and give poor results", says Dr. de Santiago. Likewise, inadequate surgical treatment of ovarian cysts can affect the functioning of the ovaries and lead to fertility problems later on, both spontaneously and in the results of assisted reproductive techniques.
Assisted reproductive techniques to achieve pregnancy
When a woman suffers from endometriosis, it is often necessary to resort to assisted reproduction techniques to achieve a pregnancy, since the anatomical alterations caused by the disease are definitive and prevent natural pregnancy. However, the success rate of these techniques in patients with endometriosis will depend on the individual patient. "Success rates vary depending on the location and severity of the lesions," says Dr. de Santiago.
In recent years, new treatments have appeared that have shown some efficacy in relieving symptoms related to endometriosis, although the results are initial and not yet implemented in Spain. Treatment in these cases often resides in assisted reproductive techniques, mainly in vitro fertilization (IVF). There is no medical treatment that significantly improves pregnancy rates since, the hormonal treatments used actually prevent pregnancy by affecting the functioning of the ovaries or endometrium.
Uncertainty, anxiety and shared suffering
The pain associated with endometriosis produces a lot of uncertainty in women, as they are unable to anticipate when they will have pain and if the pain will prevent them from carrying out their daily activities. All that increases feelings of pessimism and fear, and of frustration and anger, since the pain associated with endometriosis is not fully understood by the patient's environment. Anxiety and depression are very common in patients who have chronic pain. In addition, shared suffering is common since neither partners or children understand the disease and pain and are not able to help as much as they would like. Furthermore, the difficulty to conceive children often affects the relationship, and problems in the sexual field are very common, since the condition can cause pain during sexual relations.
The pain caused by endometriosis may bring about a decrease in daily activities, such as work, social life or family relationships. “On many occasions it produces a feeling of dissatisfaction with the health system, since there are frequent misdiagnoses leading to delays in diagnosis and treatment, in addition to being a financial burden, due to the need for many consultations, diagnostic tests, sick leave and, sometimes, the loss of employment”, points out the head of Gynecologic Oncology at MD Anderson Madrid – Hospiten.