Research attempts to find a cure for abnormal growth of uterine tissue, the origin of which is unknown
ENDOMETRIAL EXPERT. Gynaecologist Elena Suarez, from the Gynaecology Service of the Vall d’Hebron Hospital, where 150 ovarian endometriosis surgeries are performed each year.
Painful and abundant menstruation, tiredness, asthenia, fatigue, abdominal or pelvic pain outside the menstrual period, and during or after sexual relations, as well as reproductive problems, are some of the symptoms of women with endometriosis.
It is estimated that between 6% and 10% of women of childbearing age suffer from this disease without a cure, one of the most studied and yet with the most obscure areas of gynecology. Its exact origin is unknown,” says Elena Suarez, a gynecologist at the Vall d’Hebron University Hospital in Barcelona. “Up to 30% of women under study for sterility are affected by endometriosis. This is one of the diseases that is currently attracting the most interest in research”, points out Suárez. Scientific studies on this pathology range from diagnostic and therapeutic strategies to the role of stem cells in the disease”, summarises the gynaecologist.
“Endometriosis is a benign and chronic disease, which cures with outbreaks. It consists of the existence of endometrial tissue -the inner layer of the womb- outside its usual location”, explains Suárez. “The most frequent affectation is in the ovaries -endometrioma- but it can also appear in the myometrium, the intermediate muscular layer of the womb -adenomyosis- and, less frequently, in other non-gynaecological organs such as the bladder or the intestine, among others”, says the endometrium expert. In order to reach a diagnosis of endometriosis, “a transvaginal ultrasound scan is normally performed, and in some more complex cases, a magnetic resonance imaging scan”, indicates Elena Carreras, head of Obstetrics and Reproductive Medicine at the Vall d’Hebron University Hospital and president of the Catalan Society of Obstetrics and Gynecology.
INFERTILITY / “Endometriosis does not always cause sterility”, points out Dr. Elena Suárez. “There are patients with preserved fertility whose main symptom is pain, and we act on it”, she says. “And there are a significant proportion of patients who are diagnosed with endometriosis during the study of their infertility and are asymptomatic. The spectrum is variable,” adds Suarez.
Recognizing the initial symptoms that end up leading to a diagnosis of endometriosis is difficult because, “although there are some guiding symptoms, the clinic overlaps with other entities and the spectrum of involvement is very broad. From asymptomatic patients to others with a significant limitation to their daily life”, Suárez specifies. The time that elapses between the onset of symptoms and diagnosis can exceed four years on average and, as described in international studies, even reach seven years. The complexity of these patients led the Vall d’Hebron Hospital to create in 2012 a practice dedicated exclusively to endometriosis for severe cases of the disease. “This year we will reach 350 patients evaluated,” says Suárez.
TREATMENT / According to the gynecologist at Vall d’Hebron Hospital, “there are two types of treatment for endometriosis: medical and surgical”. In medical treatment, “combined hormonal contraceptives, progesterone, gonadotropin-releasing hormone analogues, levonorgestrel devices and oral progestogens are used,” explains Suárez.
Surgery improves pain parameters and spontaneous fertility rates. “In the case of patients with reproductive desire, we must bear in mind that surgical action on ovarian lesions, especially repeated surgeries, leads to a loss of ovarian reserve,” warns the doctor.
“It is usually the appearance of pain that makes us look, through imaging techniques, for the presence of endometriosis foci. Normally, an ultrasound scan is performed first, and in some more complex cases, an MRI”, states Elena Carreras. Between severe and mild cases, at the
Vall d’Hebron, where Carreras is head of gynecology, around 1,500 cases of endometriosis are seen each year and around 150 operations are performed.
“The cases are evaluated together with a multidisciplinary team that includes gynecologists who specialize in assisted reproduction, gynecologists who specialize in surgery and radiologists, the imaging specialists,” Carreras says. “When the disease affects the ovaries and there are few follicles left, it is advisable to preserve the oocytes for when you want to gestate,” says the head of Obstetrics at Vall d’Hebron Hospital.