Play PodcastPlay Download PodcastDownload

Transcription:

Maggie McKay (Host): Endometriosis, it can be painful, make it harder to get pregnant, and you can have it and not even know it. So to fill us in on all we need to know about endometriosis is Dr. Rohan Hattiangadi, physician at Evergreen Health Women's Specialty Care Gynecology.

Host: This is Check-Up Chat with EvergreenHealth. I'm Maggie McKay. Thank you so much for joining us, Dr. Hattiangadi. First of all, what is endometriosis?

Rohan Hattiangadi, MD (Guest): Thank you so much for having me. I'm very happy to talk about this topic, which is very near and dear to my heart. So, endometriosis is a chronic inflammatory condition in which cells that resemble those that are found in the endometrium, which is the lining of the uterus, are found elsewhere. And these cells can be implanted anywhere in the ovary, the fallopian tube, the bladder, the rectum and in the inner lining of the pelvis, or really anywhere else in the body. And wherever they implant, they can cause inflammation and pain in that organ. Endometriosis impacts about one in 10 women or an estimated 200 million women worldwide.

Host: And speaking from personal experience, I know you can have it and not even know it. So, is that something that can be found during a yearly gynecology checkup, or what are the symptoms?

Guest: Good question. So, research shows that about 20 to 25% of patients with endometriosis may be asymptomatic, that they don't have any symptoms at all. The other thing is that endometriosis is a wide spectrum disease. Some patients have very, very minimal symptoms and some patients have very severe symptoms. And the degree of pathology within the abdomen and the pelvis, the degree of endometriosis that is found within the abdomen and pelvis doesn't necessarily have to correlate with the degree of symptoms. And so, it makes it very challenging to be able to diagnose.

Now, the typical presentation of endometriosis is with painful periods. And so, patients will oftentimes report their periods have always been painful or they've been painful as long as they can remember. Patients with endometriosis also have pain with penetrative intercourse when they go to their bathroom, especially during their period and will have lower back pain. They can also have bloating, fatigue, nausea and vomiting, constipation and diarrhea. They can have difficulty with getting pregnant and they can have significant anxiety and depression. And these aren't the typical symptoms that you hear about in the media when it comes to endometriosis. And so, a lot of people go around thinking that they're asymptomatic or they don't have endometriosis when they just don't know the symptoms to look out for.

So, how does endometriosis cause all these symptoms, right? So, endometriosis is primarily a hormone-sensitive inflammatory disease. So, what does that mean? It means that with menstrual cycles, ovarian hormones go up and they go down, right? And so when the hormones fluctuate, they respond by creating an environment of inflammation, then activates nerve fibers. Those nerve fibers then send pain signals to the brain. It can create scar tissue that can distort the normal anatomy, making organs that would otherwise not be connected to one another start to stick to one another. And so then over time, chronic exposure to endometriosis and the resulting inflammation leads to chronic pain on intimacy careers, and mental health.

Host: And what if you leave it untreated?

Guest: So, the symptoms, especially the downstream impacts, can progressively get worse. And so, you can go from having cyclical pain with each menstrual cycle to persistent pain. And we see a lot of that in our patients who oftentimes these patients go on to develop crippling pain that is persistent and unrelenting.

Host: So, let's say you've had a hysterectomy, can you still get endometriosis?

Guest: Absolutely. And that is one of the big misconceptions about endometriosis. Hysterectomies do not cure endometriosis. Now, hysterectomies are very useful in patients who have endometriosis and heavy bleeding. Another feature of endometriosis are a similar pathology called adenomyosis, and it can certainly help reduce the recurrence risk of endometriosis. But it is important that if you are to have a hysterectomy, that at the same time you have what is called as an excision of endometriosis, where in addition to removing the uterus, the surgeon does a very thorough inspection of the pelvis to make sure that one, if there is any endometriosis, it is completely excised.

Host: Dr. Hattiangadi, who's most likely to get endometriosis or is it an equal opportunity disease?

Guest: That's a good question. Any woman of reproductive age is at risk for endometriosis. We find that family history is actually one of the biggest risk factors. So if a first-degree relative has endometriosis, so for example, mom, sister, daughter, there's about a seven to 10-fold increased risk that the patient herself may also have endometriosis.

You know, I can't tell you how many times I have cared for a patient with endometriosis. And in that same visit in my clinic, her mother will be there and she'll share stories that she too suffered for years with painful periods and that no one had listened. And so, it oftentimes runs in the families. And if you have a family member who has suffered from the symptoms of endometriosis, there's a pretty high chance that you yourself may also have endometriosis.

Host: Wow. So after menopause, you're not likely to get it?

Guest: That's a very good point. And so, what happens is new endometriosis is unlikely to form after menopause simply by the reason that endometriosis is stimulated by estrogen. And so once the ovaries stop producing estrogen, then endometriosis often does not come back.

Host: That's good news. How is it treated? Surgery, hormones?

Guest: Actually, a combination of both. The important thing to remember is that endometriosis has no cure. So once a diagnosis is made, treatment is continuous. It's a continuous process. So because endometriosis is hormonally sensitive, it grows under the influence of estrogen. We know that if we suppress ovarian production of estrogen, we can also suppress endometriosis. And when endometriosis is suppressed and it's inactive, then the pain related to endometriosis also improves. So, this can be done through things like birth control pills, progestin-only pills, the IUD, the implant, vaginal rings. These are all hormones designed to suppress the ovary. And so, the total amount of hormone reduces and endometriosis does not get stimulated.

Other medications like NSAIDs, so ibuprofen, Advil, heating pads, meditation, yoga, mindfulness, and even acupuncture are all good adjuncts to helping reducing pain related to endometriosis. Now, that's in terms of more conservative management options. In terms of surgery, there's a variety of different surgical approaches that can be helpful, and this includes laparoscopic excision of endometriosis, hysterectomy, and then if necessary, removal of the ovaries. Then, an interesting fact is that after a thorough laparoscopic excision of endometriosis, and if you go with a trained specialist who deals with endometriosis on a regular basis, there can be about a 60-80% improvement in pain symptoms for at least a couple of years.

Host: Wow, years. That brings me to what is recovery like? What can you expect recovery-wise?

Guest: So ultimately, it depends on the aggressiveness, with which you do the surgery, right? And so whenever I meet somebody in my clinic who has endometriosis and we're planning a surgery for endometriosis, I always ask them, "What is your goal at the end of the day?" Because depending on how aggressive we are, this may be a very simple recovery which lasts for a couple of weeks, and it may be a more complicated recovery. And the consequence of that directly impacts the quality of life and the normal function. So for example, if there's endometriosis that is invading into the colon or the rectum, and that is going to require a complex enough surgery that the rectum will have to be reconfigured through something like an ostomy that has a direct impact on the quality of the life of the patient, but it also has an impact on the recovery timeframe. So, we have these discussions at the end of the day before we go to the operating room to make sure that what we come out with after the operating room is exactly what the patient expects.

Host: And what does the future look like for research regarding endometriosis? Are there any breakthroughs coming down the road?

Guest: Yeah, there are constantly scientists throughout the world, not just in America, throughout the world, who are more brilliant than I am working on this every single day, and we are slowly moving from just hormone-based suppressive treatments that don't cure endometriosis to possibly looking at even things like genetic therapy, right? We know that endometriosis, there's a genetic predisposition to it. It runs in families. And we don't quite understand yet how to turn that off, right? There's a lot of research being done. And what are the best methods of being able to achieve things like fertility goals and pain relief in patients with endometriosis. This is a very, very booming field. There are hundreds of scientists and surgeons and endometriosis specialists throughout the world who meet to try to put together the best ways to be able to give patients a better quality of life.

Host: How did you decide on this specialty?

Guest: Oh man, absolutely. Good question. It is something that I have been passionate about for a very long time. I think that women's health in general in this nation is undervalued and underappreciated. And I think that we really need to improve the quality of care that we give our patients. There are women who live their whole lives thinking painful and heavy periods are normal and that they should just deal with it. And it's not a thought that they came across on their own, but that they've been conditioned to live this way and believe this way because of the way that society has regarded them and women's reproductive care. And so, this is something that I'm very passionate about and trying to be able to help to the best of my ability.

Host: That's awesome. Do you have daughters?

Guest: I do actually. I have a daughter who's just about to turn two years old.

Host: exciting. Congratulations.

Guest: Thank you.

Host: I'm sure when she grows up, she'll be so proud of you that, being a man, you get it. So, in closing, is there anything else you'd like to add or share that we didn't cover?

Guest: Yeah. You know, I think that, especially for a woman, it's really important to be self-advocates. There is a lot of misinformation on social media, in social groups. And it can be very demeaning to people and discouraging, especially if you have endometriosis. There are a lot of myths that need to be debunked. One such myth is that patients with endometriosis can't have children, and that's simply not true. Now, endometriosis can cause challenges with pregnancy and conception due to inflammation and anatomic distortion, but there are ways to help someone with endometriosis conceive, whether that's through surgery or assisted reproductive technology like IVF and IUI. And so, it's very important to not get discouraged and think that endometriosis won't let you have children. Another big myth that I hear a lot is pregnancy is the cure for endometriosis. And that's just simply not true. I can't tell you how many times a patient has come to me and said that their OB doctor told them, "Well, you have endometriosis. The best thing to do is get pregnant and that will cure your endometriosis."

at the end of the day, there really is no cure for endometriosis. No medication, no surgery. But just like any chronic condition, like high blood pressure, diabetes, thyroid, endometriosis requires management with specialists who are well trained and passionate about this disease to improve the overall health and quality of life.

Host: This has been so educational and hopeful, I'm sure, for a lot of patients who have it, who, like you said, some doctors actually tell their patients to get pregnant to cure it, which is a myth. So, it's good to know the straight story and the latest updates on endometriosis, and we so appreciate your time.

Guest: Thank you so much. I will say I really am hopeful, like you said, that this gives people hope that there is something that you can do about endometriosis, because there's a lot. Hopelessness is not a symptom of endometriosis. Hopelessness is a consequence of the way that our society has treated endometriosis and patients with endometriosis for far too long. And if you have endometriosis or suspect that you do, EvergreenHealth and the Women's Specialty Care Clinic is here for you.

Host: That's so great. EvergreenHealth's Women's Specialty Care Gynecology provides comprehensive care to patients with complex diagnosis. And for more information, please visit evergreenhealth.com/gynecology or call 425-899-6400 to schedule your appointment. And that wraps up this episode of Check-Up Chat With EvergreenHealth. Head on over to our website at evergreenhealth.com for more information and to get connected with one of our providers. Please remember to subscribe, rate, and review this podcast and all the other EvergreenHealth Podcasts. For more health tips and updates, follow us on your social channels. This is Check-Up Chat, presented by EvergreenHealth. I'm Maggie McKay. Thanks for listening.