Transcription:
What is Endometriosis

Announcer: Another informational resource from UK Healthcare. This is UK HealthCast featuring conversations with our physicians and other healthcare providers.

Caitlin Whyte (Host): Welcome to UK HealthCast, the podcast from the University of Kentucky Healthcare. I'm your host, Caitlin Whyte. Joining us today is Dr. Peter Movilla, an OB GYN at UK Healthcare. He's talking to us today about endometriosis. So, doctor let's start off with the basics here. What is endometriosis?

Peter Movilla, MD, FACOG (Guest): Well endometriosis is a complex gynecologic disease where the cells that normally reside solely within the lining of the uterus migrate and find their ways into the areas of a patient's body, where they're not supposed to be. These cells can end up in a patient's abdomen, around the colon and rectum. They can end up in a patient's pelvis near their cervix, bladder, vagina, and they can even migrate deep within the wall of the uterus where they don't belong. And since these cells still behave similarly to the cells that are inside the lining of the uterus, they still respond to estrogen that a patient makes during their monthly menstrual cycle and thus, they can grow, bleed and cause a lot of inflammation and scarring that leads to a patient's pain in their abdomen and pelvis.

Host: Now, what are some typical symptoms of this condition?

Dr. Movilla: Well, this can be a little bit of a tricky answer, but the classic symptoms of endometriosis are dysmenorrhea, which means painful periods, dyspareunia, which means pain during sexual intercourse. And additionally, a patient can even have painful urination and pain with bowel movements that we call dysuria and dyschezia respectively during their periods. The trickiest part of endometriosis is that some patients have no symptoms at all. And the endometriosis is only found during a workup for infertility or during surgery for another reason. While other patients with endometriosis may actually have minimal disease when we go in for surgery, but they have the most significant symptoms.

And we as clinicians and scientists, don't exactly know what causes this phenomenon with endometriosis, but we hypothesize it has something to do with the nerve innervation to the endometriosis lesions. Which means maybe some patients have more nerve fibers than others that leads to their more significant pain. It's not also uncommon for patients with endometriosis and pain for so long that it no longer just occurs during the period, which means that they're in a constant state of pain in their abdomen and pelvis. And we call this chronic pelvic pain. Some patients with endometriosis and chronic pelvic pain have some additional medical syndromes and can be diagnosed with interstitial cystitis, irritable bowel syndrome, pelvic floor dysfunction and even fibromyalgia. And again, we believe this may be due to the chronic nerve stimulation from the endometriosis that lead to the inappropriate nerve stimulation of these adjacent organs and muscles.

Host: Is there any age or predispositions that might put a woman at more of a risk for contracting this?

Dr. Movilla: No, that's a question and definitely an area of research. We definitely see, you know, women with their first periods beginning to endure painful like symptoms that occur during their menstrual cycle. That often is just the experience of their first menstrual cycle. So we call that primary dysmenorrhea.

We usually treat it just medically with medications like Motrin or ibuprofen. But there is some theory that the patients who are going to get endometriosis may begin to initiate that after their first period and the disease progresses as they get older. We see a lot of this data actually from places in Italy and Brazil, where they study this disease a little bit more than where we are here in America.

And the only kind of risk factors that have been associated a little bit is a little bit of our family history of endometriosis. But, other than that, it's a little bit difficult because it can affect up to 10% of the female population here in the United States is predicted.

Host: Wow. And is there any link between endometriosis and infertility?

Dr. Movilla: There is an association with patients who are infertile having endometriosis. And we think we know why. We think endometriosis is a pro-inflammatory state and because it can cause scarring, it can cause distortion of the reproductive anatomy. So, the fallopian tubes next to the ovaries, it can cause cysts within the ovaries and the inflammation as well as the scarring can sometimes make it difficult for the sperm and the egg to meet or for an embryo to implant inside the uterus. So, it can be associated with infertility, but patients with endometriosis still can get pregnant. And those who have difficulty often seek the assistance from reproductive endocrinologist and fertility specialist, as well as sometimes gynecologic surgeons.

Host: Going off that, what are some other issues that endometriosis can cause for women?

Dr. Movilla: Well, the pain associated with endometriosis, unfortunately, it can cause several issues. The first is that many times, as individuals is a surgically diagnosed disease, meaning that without surgery and a biopsy, it's actually really hard to definitively say someone has endometriosis. You know, the imaging can be helpful in advanced stage diseases. It's often not sensitive enough to find smaller endometriosis lesions. And there is actually no-good blood test to detect that as all. So, the ability to definitively diagnose endometriosis without surgery often leads to patients seeking answers for why they have abdominal pain. Why they have pelvic pain for several years before they get a clear-cut answer as why click, it ends up they actually have endometriosis and then probably the most important issue my patients face is that they have significant decrease in their quality of life. You know, when they're suffering on a sometimes daily basis from chronic pelvic pain, painful periods. They aren't able to go to work, routinely socialize with friends and family, or even enjoy the simple day-to-day joys that we all hope to have in our lives.

Patients who experience pain during sex often express to me with their visits, that they have some stress in their relationship because of these symptoms and patients with endometriosis that are deep within the uterine wall that we call adenomyosis, can also have painful periods with heavy menstrual bleeding that makes living with their periods, even that much more difficult.

Host: So, what are some treatment options available?

Peter Movilla, MD, FACOG (Guest): Well, there's some good news. Although every treatment plan for a patient with endometriosis needs to be individualized. We do have many options to try and many of them are effective. So, in my clinic, I always tell my patients that although surgery is the only definitive means to diagnose endometriosis, if they have the classic symptoms and they do not seem to have any other likely cause of their symptoms, then we can treat them medically without getting a surgery and if they feel better, then that's great. We can presume that they have endometriosis and continue treating them as such. And we call this in our field, empiric treatment of endometriosis. Medical treatment options for endometriosis utilize hormones or hormone modulators that work to counter the effect of estrogen within the body and decrease the amount of estrogen that these endometriosis lesions can receive.

This tries to shrink them so that they are not so active and don't cause so much inflammation and pain. And we have many different types. We have pills, patches, implants, intrauterine devices and injections that can all be tried and have some pretty good effects on improving a patient's pain symptoms and thus their quality of life. For patients who don't respond well to medical management, they can be consulted on the surgical options. In many parts of the country, gynecologic surgeons often recommend something called laparoscopic excision of endometriosis, where small incisions are made on a patient's abdomen so that a small camera can go inside with smaller instruments and they can be used to excise or cut out all the visible endometriosis within a patient's abdomen or pelvis.

Often the uterus is left in place specifically for those patients who want future children, because preservation of someone's fertility is the most important aspects for many patients and important for the quality of life. However, in patients who had done having children, they know they don't want to have more kids we make the decision together, if they want me to also perform a hysterectomy to remove any possible endometriosis that resides deep into the muscle uterus. Again, what we call adenomyosis. Most importantly, our surgery is often performed with our surgical colleagues from other fields, such as urology and colorectal surgery when we suspect endometriosis might be found on the bladder or colon, respectively. You know, we strive to have our patients meet with these specialists before surgery if we have a high clinical suspicion that they have endometriosis on these organs as well, to make for a more comprehensive and safer surgery.

And last, we often work with physical therapists who focus on healing the muscle pain that the pelvic floor may have from the repercussions of years and years of pelvic pain from their endometriosis. These specialists called pelvic floor physical therapists, and can see a patient both before and after surgery, which is nice.

Host: So UK Healthcare provides services to people all across Kentucky, sometimes hours away. Do you offer these Telecare services and how could they be used for a patient that's suffering from endometriosis?

Dr. Movilla: You know, that's a great question. I just moved from Boston, where they were so many hospitals in such a small metropolitan area. So, this is a new phenomenon for me to have patients travel like two to three hours sometimes. It's definitely different. So, we do offer Telecare services. And I actually think that for many of my patients suffering from painful periods and pelvic pain, a Telecare meeting is totally appropriate for the first visit. A Telecare visit can allow for me to learn about all the patient's symptoms to get a true understanding of what they've been dealing with and suffering from.

And this very often allows me to make a suspected or presumed diagnosis of endometriosis and allows me to begin creating a personalized treatment plan for them even before we meet.

Host: And wrapping up here, if surgery is needed, what does that recovery look like? How can surgery, how can surgery improve a quality of life?

Dr. Movilla: Well, this is a good one. Don't quote me on it because everyone's a little different, but if you need surgery, the recovery varies depending on how much endometriosis has to be removed. Most patients, however, go home the same day or the day after. And many patients take off about two weeks from work, following surgery and have about a six-week period of time where I tell them they may feel a little bit more tired than usual as they kind of heal internally and they should be getting more and more energy back each day.

For many patients, surgery can actually significantly improve the quality of life by decreasing that pain. However, due to the complexity of pain, especially pelvic pain, I tell patients that surgery often is helpful in about 50 to 60% of patients, with the remainder of patients, either having only minimal relief or no improvement at all, which, you know, it's tough to tell somebody, but this is why careful counseling and about the outcomes from surgery needs to be honest and open because patients still suffering for pain after surgeries still need our help.

We must help these patients still try to figure out what's the other causes of the pain. If we rule out this gynecologic cause from endometriosis and also support them in finding good, efficient ways that are nonsurgical in treating their pain so that that pain no longer just dictates their lives.

Host: Great doctor. Anything else you want to add to this conversation about endometriosis?

Dr. Movilla: You know, it is a disease that we're still learning a lot about. And I just hope that patients who are dealing with it right now know that there are a lot of smart minds out there, in this country and around the world, looking to figure out how to best treat our patients. And hopefully we'll have more options. And even a non-invasive non-surgical routine way to diagnose this disease. So, I'm optimistic about the future and I hope they can be too.

Host: Well, thank you so much for joining us and talking with me today, doctor. You can read more about endometriosis on our website@ukhealthcare.uky.edu, and to get connected with one of our providers. That wraps up another episode of UK HealthCast with the University of Kentucky Healthcare. Please remember to subscribe, rate and review this podcast and all the other University of Kentucky Healthcare shows. I'm Caitlin Whyte. Thanks for listening.