Caitlin Whyte (Host): This is Community Connect presented by TGH. I'm Caitlin Whyte. Joining me is Dr. Diana Encalada-Soto, an Assistant Professor at University of South Florida Tampa General Hospital. Thank you for being on the show.

What is endometriosis exactly and why is it often so challenging to diagnose? 

Diana Encalada-Soto, MD: Endometriosis is, you know, it's a chronic inflammatory condition that, kind of the, the main idea of it is tissue similar to the lining of the uterus that grows outside of the uterus, either in areas of the pelvis, like the ovaries, the bowel, around the ureters, but also can occur in distant spaces, like, for example, there can be endometriosis in the diaphragm or in pelvic nerves as well.

Can you tell us what drew you to specialize in complex, benign gynecologic conditions like this one? Yeah, I was drawn, to minimally invasive gynecologic surgery as a specialty, when I was in residency. And I saw my patients, like a lot of those patients that I was treating, were not able to access, like the exact treatment that they would need when they suffer from endometriosis or fibroids.

And a lot of those patients tried several providers, several practices, several hospitals, and, in some cases they were dismissed or told their symptoms were normal or received treatments that really didn't match their needs. And so that gave me that, that fire or that fuel, for the desire to do it.

So then I did my fellowship and while I was there, I realized how complex really is endometriosis, how surgically complex, but you know, it's also not only a reproductive disease, but a disease that is systemic. So, it really opened my eyes to, to how complex the disease is to treat.

Host: I love how you say that this disease is also systemic. That leads me to my next question. How has your practice evolved to meet the unique needs of patients with endometriosis?

Diana Encalada-Soto, MD: Yeah. I think, it's, you know, I'll, I'll keeping to be for me, a learning process as, as I, as I do this. The most important thing or why, what I try to put first in in the force center is, is the patient, patient centered care, trying to understand and recognize what are the specific needs of each of them, I think helps a lot because not all the patients will need surgery immediately.

Some of them may qualify for, you know, medical treatment or also ancillary treatments that not, do not only require surgery, but some people need physical therapy and other, you know, treatments at the same time. So I think that has changed for me. Instead of thinking this is only a surgical disease, it is much more complex than that.

Host: And what are some of the most common misconceptions about endometriosis that you encounter in your work? 

Diana Encalada-Soto, MD: Yeah, I think this is, this is a big one if I can get something, for patients to understand and also to feel validated, I think it's very important to, desmitify some of the things that they hear from providers or from other people. Some of them, have come and tell me, you know, they, they told me endometriosis is just a bad period pain.

And, for years I understood this was what I was supposed to feel. So I think that's the number one thing because definitely it's not just painful periods. Endometriosis that is not treated can cause irreparable damages to the reproductive system with infertility, bowel dysfunction, bladder dysfunction, and systemic inflammation.

So that's, that's one of the most common things that I hear. Another big one is that a pregnancy can cure endometriosis. Some patients have been told just become pregnant and, you know, that's it. So, what is important to know is that pregnancy can, in some cases, you know, mitigate the symptoms for some time because of the hormonal changes, but in no way is this a cure.

A lot of patients are not able to become pregnant with endometriosis that is untreated and they will actually benefit from having treatment first before attempting a pregnancy, but the most important thing is quality of life. So, if it's not treated it's never going to be a cure becoming pregnant.

Host: Well, how does endometriosis impact a person's physical, emotional, and reproductive health then?

Diana Encalada-Soto, MD: The main thing that I think about is the chronic pain impact in the lives of patients. This does not only, you know, affect them during menses, and women that have suffered from endometriosis for a long time, which is most of them, for many years even; pain can become pervasive, not only during the periods.

And this can affect their daily activities, work, and relationships. So that's a very big deal. The other thing is that there's not only symptoms related to pain, but as I mentioned, there's also the impact on reproductive function, which can lead to infertility without treatment.

The other thing would be symptoms that are related to fatigue, bloating, bowel dysfunction, urinary dysfunction that can be quite impactful. But also these patients carry a big emotional toll. These patients have been battling with gaslighting, dismissiveness in their symptoms, and a lot of them suffer anxiety and depression related to these issues.

As well as we know there's a big connection between the body and the mind, and people that live with chronic pelvic pain obviously tend to have a higher incidence of anxiety and depression and other mood disorders.

Host: And to wrap us up today, Doctor, can you explain the difference between superficial, deep, and ovarian endometriosis, and why accurate diagnosis is so important?

Diana Encalada-Soto, MD: So, I would say, you know, superficial endometriosis is one of the most common presentations that we have. And it is an endometriosis that is targeted towards the peritoneal layer which is a surround wrap that we have around our organs, in the pelvis and in the rest of the body.

So this one is, it's quite challenging because it's a type of endometriosis that is not able to be seen on our common diagnostic technologies like ultrasound or MRI, even if it's advanced modalities of imaging. But that doesn't mean the disease is not there. And the other important thing about superficial or peritoneal disease which is a kind of more of a proper name, is that the symptoms don't correlate with the amount of the disease. So that's the superficial one, or the peritoneal. Thinking about deep endometriosis, we have kind of an idea of endometriosis that is invading beyond the peritoneum 5 millimeters or more. It can be very varied in the, in the presentation, but in a way, this endometriosis is easier to diagnose with the correct methods. So, advanced ultrasound and MRI will be good ways to detect this disease. And we can plan and know in advance if we're going to need multidisciplinary care in the treatment of these patients since deep endometriosis can invade us, as we mentioned before, the ureters, the bladder, the bowel, and in these cases we plan the excision not only with GYN but with our colorectal surgery colleagues or with our urology colleagues as well. 

And then regarding ovarian endometriosis well, it's the invasion of endometriotic cysts the ovaries. And this is a big one in terms of reproductive function because when you have an endometrioma, they're usually pretty large, and what this disease does is kind of thinking about the ovary as a room, a space in a small room.

And then an elephant comes in, which is the endometrioma, and pushes out the eggs or the ovarian reserve in the ovary, which can cause already a big impact in the reproductive capability. So in these cases, not only excision is important, but a plan for patients, because in some cases they will need reproductive assisted technology to conceive or a plan to do egg freezing or embryo retrieval before they undergo excision surgery. 

Host: This has been Dr. Diana Encalada-Soto. For more information, please visit TGH.org. If you enjoyed this episode, please be sure to like, subscribe, and follow Community Connect, presented by TGH, on your favorite podcast platform. I'm Caitlin Whyte, and this is Community Connect, presented by TGH. Thanks for listening.