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Melanie Cole: Welcome. This is the podcast series from Deacons, The Women's Hospital, a place for all your life. I'm Melanie Cole and today we're discussing endometriosis. Joining me is Dr. Daniel Griffin. He's a Reproductive Endocrinologist at Boston IVF, at The Women's Hospital. Dr. Griffin, it's a pleasure to have you join us today for the listeners. Why don't you start by telling us what is endometriosis?

Dr. Griffin: Endometriosis is a condition in which the lining of the uterus, which is called the endometrium, it's a glandular type of tissue, for whatever reason, and there are several different theories as to why this happens, but part of that glandular tissue, it gets outside of the uterus. And it can implant really anywhere in the pelvis and has been associated with painful periods and pelvic pain.

Host: And we don't know why this happens cause knowing why would help us to know who's at risk. Right?

Dr. Griffin: Absolutely. There, there are several different theories as to why it occurs. Many women will have retrograde ministration where part of the blood, in those glandular tissues go out of the fallopian tubes. And there are different theories which have shown that a change in their immune response allows this glandular tissue to then implant and proliferate in the pelvis, which then of course contributes to the symptoms of the disease.

Host: Well then let's talk about the symptoms of the disease and, when it's diagnosed, is it difficult to diagnose?

Dr. Griffin: Endometriosis can be very tricky thing to diagnose. The most common symptoms of endometriosis are pain with periods, pelvic pain in general, as well as pain with intercourse. And endometriosis can also lead to scarring that can develop in the pelvis, which can cause infertility. As many as 50% of patients who have infertility will have some evidence of endometriosis. And again, the problem with diagnosing endometriosis is it is difficult to do noninvasively. Most imaging modalities would not show evidence of endometriosis. Sometimes women will form cysts on their ovaries that you might be able to see on an ultrasound, but you typically can't detect it on ultrasound or a cat scans, MRIs those types of tests. The only way you can definitively diagnose endometriosis is with a surgical procedure called a laparoscopy.

Host: So as you were talking about symptoms, Doctor, and you were saying painful intercourse or painful periods, at what age would this typically show up? Because sometimes those kinds of things can just be part of a normal woman's cycle. We all go through these things.

Dr. Griffin: Sure. They can show up fairly early on. You know, after a patient has started menstruating, I've seen patients within endometriosis who are teenagers and it can continue throughout a woman's reproductive life. Most symptoms of endometriosis will improve as patients hit menopause and sometimes endometriosis can regress on its own. But there are many treatments that have been useful in patients in terms of pain symptoms, as well as patients who may have had difficulties getting pregnant. I would encourage patients who have had symptoms which have effected their quality of life to certainly seek out a medical opinion in care, in regards to these symptoms so that they don't worsen.

Host: Well, then let's talk about treatments. What treatments by you try before considering any surgical procedures? And what's the main goal of this type of treatment? If you're doing medicational intervention or you know, something like that. What's the main goal? What are you doing?

Dr. Griffin: Ideally you're trying to help a patient's symptoms so that she can resume, you know, normal activity in her life. There are many medical treatments for endometriosis. The usual first line treatment is used like a nonsteroidal anti inflammatory drugs like ibuprofen or Naproxen, birth control pills have also been used for many years to treat the symptoms of endometriosis. It can help with both, you know, pain with periods as well as other types of pelvic pain. There are many secondary lines of endometriosis treatment. Both can be given as, you know, oral medications as well as intrauterine devices, progestin implants. But ideally you're trying to stop a patient from menstruating, and lower their estrogen production because estrogen is what seems to fuel the growth of the glandular tissue and can, you know, make someone's symptoms worse.

Host: Hmm. So what have you seen in your practice that's really working well? Tell us about some of your outcomes and what women have told you about how it's changed their lives.

Dr. Griffin: I personally, you know, for an initial treatment, we'll still use birth pills, but beyond the medication which is relatively new, it's been out just for a couple of years now, is called Elegiacs, which is a medicine that actually lowers a woman's estrogen level, and works quite quickly and has been shown to improve symptoms in patients with moderate to severe endometriosis. And Mirena IUD is another, or progestin IUD is another treatment which I've had a lot of success with. The strongest medication that we use is a drug called a Looperlied, which is given as an injection, which essentially puts a woman into a temporary menopause. And that can also be very effective with pain symptoms. One of the things I always tell patients is that medical treatment, while it's good for treating pain symptoms, it does prevent pregnancy. So you have to look at a patient's goals in terms of what the best treatment may be. If a woman is trying to get pregnant, then we may not always use medical treatment right off the bat. We might start with either a surgical treatment or some other type of fertility treatment to see if we can help them to achieve a pregnancy. But here in my practice, we've had many good outcomes and we've been able to help patients with their symptoms. And again, get back to a better quality of life.

Host: Is there anything you'd like a woman to be doing on her own? Are there any lifestyle or behaviors, diet, exercise, anything that she can do that might have an effect on this or help her with her symptom management?

Dr. Griffin: There is not a lot of things that somebody can do just on their own to treat endometriosis symptoms. It doesn't appear to be affected by, you know, weight or even, you know, smoking, you know, different things like that. I would say from my standpoint, the key thing is to, if you're having bothersome symptoms, to seek out treatment sooner rather than later, because these symptoms can get progressively worse. And the earlier that we're able to intervene, the less problems patients will have further down the road.

Host: That's really great advice. Doctor, thank you so much for joining us today and sharing your expertise to explain to women about endometriosis. We've heard so much about it in the media, but you explained it so well for us today. Thank you, Dr. Griffin for joining us. And that concludes this episode of the podcast series from Deaconess, The Women's Hospital, A Place For All Your Life. For more information, please visit deaconess.com.BIVF or you can call (812) 842-4530, to schedule an appointment and to get connected with one of our providers. Please remember to subscribe, rate, and review this podcast and all the other Deaconess Women's Hospital podcasts. Until next time, I'm Melanie Cole.