Cheryl Martin (Host): If you or your loved ones experience pelvic pain, heavy periods, or gynecologic challenges, you'll want to listen to this episode. We're diving into a topic that affects nearly one in 10 women of reproductive age, yet it's widely misunderstood and underdiagnosed - endometriosis. This condition can disrupt your daily life, including work and wellbeing, but there is hope.

Dr. Katie Czyszczon is a specialist in minimally invasive gynecologic surgery and Co-Director of Robotic Surgery here at VCU Health. She's here to share the latest advances in diagnosing and treating endometriosis. She'll explain how to recognize symptoms, when to seek help, and how advanced treatments, including laparoscopic and robotic surgery can improve your quality of life.

 This is Healthy with VCU Health. I'm Cheryl Martin. Hello, Dr. Czyszczon. Welcome to the podcast.

Dr. Katherine Czyszczon: Hi, there. Thanks.

Host: First, what exactly is endometriosis?

Dr. Katherine Czyszczon: Well, endometriosis is when tissue that is very similar to the uterine lining, grows outside the uterus in the abdominal cavity, often on the ovaries, fallopian tubes, bladder, even occasionally the intestines. This tissue's hormonally responsive. So, every month as our normal hormone changes occur, they affect this tissue just like they would that uterine lining. But in the wrong place, this can lead to inflammation, swelling, and significant pain in progressive or advanced endometriosis can even lead to scarring, adhesions where organs can stick together. This can ultimately lead even to nerve sensitivity and make pain feel even more intense. The good news is that the earlier we recognize it, the more personalized we can create the care plan. And with the right specialists, it is very treatable.

Host: So, who's at risk of developing endometriosis?

Dr. Katherine Czyszczon: Well, anyone with a uterus, it often appears in young women. It may run in families to some degree. We're also learning how certain lifestyle factors may affect the course and progress of endometriosis and even holistic things like reducing inflammation through good nutrition, better sleep patterns, minimizing stress. All can help with pain relief, although they certainly don't cure endometriosis.

Host: Talk about some common symptoms.

Dr. Katherine Czyszczon: The most common symptom and the most important way that it presents is with very painful periods. And pain usually presents just before the cycle starts. It can progress to chronic pelvic pain, even between cycles. It often can be a source of pain during sex, heavy menstrual bleeding, even bloating, and some bowel dysfunction. In some cases, it can even result in some challenges in becoming pregnant, although many women with endometriosis have no fertility problems.

Host: So, what can you do if you suspect you have endometriosis?

Dr. Katherine Czyszczon: I just think we need to be very cognizant that those concerns are real and valid. And you shouldn't have to push through it. I would hope that our patients would have access to doctors and providers like myself. If you've tracked your symptoms, you know when you hurt, how often, you can bring that information to an appointment, ideally with someone who specializes in pelvic pain or minimally invasive gynecologic surgery. Going to a specialist like myself and the ones at VCU Health, help ensure a thorough evaluation and treatment plan without needing a lot of referrals to different physicians. We ask about all of your symptoms, take a really comprehensive medical history. We have a team that's really adept at acquiring previous records, including imaging. And this can help us avoid delays in getting care and ideally create a personalized plan.

Host: So, this is what you specialize in at VCU Health.

Dr. Katherine Czyszczon: That's right. As a minimally invasive gynecologic surgeon, our focus is in endometriosis among other pelvic disorders. And it's really common for this disease to be very complex. It is typical for it to take some time and often several visits to create a plan. And most of the time, I'm seeing patients that have been seen for many years, and sometimes even told that their symptoms might be normal. If that's the experience that the patients having, they're not alone. And I can ensure that we'll listen. Our goal is to make sure our patients are heard, that they have a really good understanding about their recommendations, whether that's medication, surgery, really walk people through their diagnosis all the way through their recoveries.

And the nice thing about being in an academic medical center like VCU Health is that our surgeons and team are trained on the latest technologies, including robotic surgery. We offer robotic surgery even as an outpatient surgery center, really optimizing convenience for our patients, and we work closely with other experts around the health system, including colorectal surgeons, urologists, and even occasionally thoracic surgeons, to make sure the care is comprehensive and complete.

You know, in addition, VCU in particular just has a culture and expectation for safety that's nationally recognized and deeply embedded in every step of the patient care we provide. And this level of coordinated specialized care is rare, and it's available right here at VCU.

Host: You talked about the diagnosis of endometriosis; it can sometimes be complicated. Why is that?

Dr. Katherine Czyszczon: Well, because these implants can really be anywhere, the symptoms can be very diverse and complex. Some people have very little pain even with advanced disease, while others have really severe pain with less evident disease. And a diagnosis really can be hard to attain, but would include obviously a detailed symptom review, most likely a pelvic exam, and then often imaging, including ultrasound or even MRI.

The only way to really definitively confirm an endometriosis diagnosis is through laparoscopy or minimally invasive surgery where we can see and often remove the tissue. However, surgery's not always required to start getting treatment, and a high clinical suspicion is often enough. Seeing a MIGS-trained specialist like myself can certainly help ensure an accurate diagnosis is made and the right treatment approach is started from the beginning.

Host: So, let's talk treatments. What are the options that patients have?

Dr. Katherine Czyszczon: There's really three big strategies. The first one is managing the pain and symptoms. Mostly, the pain and symptoms are generated from inflammation surrounding these lesions. So even something as simple as higher dose anti-inflammatory medications and more holistic things like heating pads, pelvic floor physical therapy, and lifestyle changes as we alluded to before, like dietary changes, good sleep, those things can all really start the first arm of our more conservative approach to treatment. Certainly, hormonal treatments and medications that manipulate hormones are going to be a really important part of treatment of endometriosis. Because it's hormonally driven, when we manipulate those hormones, we can cease the growth of the lesions.

And then, lastly, surgery becomes an important third aspect of most patient's care. Sometimes that can be less definitive or invasive, and we will utilize just excision of the lesions themselves. And then, at times, we have to do more definitive surgery when the patients ready for it.

Host: Can you go into more detail about the minimally invasive gynecologic surgery and also just why it's so beneficial?

Dr. Katherine Czyszczon: Well, minimally invasive surgery really has transformed endometriosis care, facilitating access to surgery for more patients than ever before. The risks are lower with minimally invasive surgery because we're using just a few small incisions and utilizing a camera to better visualize the abdominal cavity and the pelvis. Even in complex cases, we're able to achieve most surgeries through these methods.

Other benefits include faster recovery, lower infection, less pain after surgery, and even a reduced risk of complications. Many of my patients go home the same day.

Host: Now, are there any other new therapies or treatment options on the horizon?

Dr. Katherine Czyszczon: There are actually. We're seeing some promising research in immune therapies and even molecular treatments therapies that may really help treat endometriosis at its root cause and improve long-term outcomes. Being at VCU's academic environment means our teams are always current with the emerging technology and therapies and bringing the latest, best practices to patient care.

Host: Doctor, any final thoughts on this topic?

Dr. Katherine Czyszczon: Well, just if you're struggling with pain and you think it might be endometriosis, please know that you deserve answers, support, and hopefully relief. Help is available and getting care from an obstetrician gynecologist or pelvic health specialist, especially trained in MIGS, ensures you're going to receive the most advanced evidence-based compassionate treatment.

Host: Dr. Katie Czyszczon, thank you so much for this important conversation. We hope it helps listeners feel seen, supported, and empowered to get the care they deserve. Thank you. Very informative.

Dr. Katherine Czyszczon: Well, thank you for having me.

Host: To schedule an appointment at VCU Health, call 804-828-4409. Ask for a minimally invasive gynecology appointment with Dr. Czyszczon or Dr. Webb, and no referral is needed. If you found this helpful, please share it on your social channels and check out the full podcast library. This is Healthy with VCU Health. Thanks for listening.