Endometriosis: One Of The Most Painful Conditions

endometriosis welcome to talking with docs I'm Dr Brad weenie and I'm Dr Paul salzow and I'm Dr Sandy Sharma if you have endometriosis I would say you are a hero because it sounds like a visceral painful condition and if you are able to function somehow in your day you are a hero can you please tell us about endometriosis yeah well for starters it's a far more common condition than we you know we may have thought how come uh you know I'd say as upwards of 20 percent of women in menstrual age would have some features that you could suspect it now I want to preface this by all women with painful periods which is the most common symptom right don't have it right but if we look at patients who have a combination of painful periods painful bowel or urinary happens during their cycle painful intercourse and infertility you're going to find in that clustering of patients a significantly High proportion of patients have endometriosis okay okay common problem common anything you're dealing with and we should probably go back and say what is it well essentially it's a condition where for starters it's only going to be occurring from the onset of menstrual periods or puberty to menopause so the natural courses endometriosis will get better once a woman achieves menopause okay but between then there's going to be various points in their life where it's going to affect their life and how initially it's going to cause painful periods loss of school or work function affecting relationships because of painful sex later in life as a woman trying to get a family it may significantly influence fertility okay okay so pathophysiologically which is a fancy of saying what's really going on so essentially the menstrual cells that are normally shed each month I for reasons we don't exactly know can deposit and there's different theories behind is it coming through the tubes is it already in microscopically in the pelvis it has a predisposition to grow but regardless it finds a way to implant and live outside of the menstrual lining and it can live typically in the pelvic organs like the Fallopian tubes and ligaments around the cervix and the Deep pelvis on the pelvic structures like the bowel the bladder it can live on the ovaries obviously and it can cause large cysts on the ovaries right that sometimes is the way it's found it can deposit on the appendix it can deposit on I've seen it on the diaphragm I've seen it on liver we've seen it deposit as far out as the lung in you know it's not a common way for that to happen but that can so it can get outside of even the perineal cavity it can okay but typically it's a disease of the lower pelvis so along the deepest part of the pelvis the you know uterus the ligaments the ovaries and the cervix in the lower part and you're the rectum okay and if you find this hard to believe you're not alone it cells that are supposed to live in the uterus are now outside of the uterus in your abdomen in your visceral cavity that's why the pain and those cells are very specifically hormonally sensitive and driven so they cause intense inflammation and it is important when we have conversations with our patients when we either clinically suspect or have confirmed with imaging endometriosis that we remind them this is not just a surgical fix right this is a disease similar to like Crohn's disease where you got to manage things with medication surgery is used for specific indications of pain that's not responding let's say to typical treatments cysts that are getting larger affecting other organs perhaps and also at times fertility management as well okay and the typical surgeries we would do would be laparoscopy to try to manage disease excise the disease sometimes we ablate the disease we'll remove the cysts or at times if we're trying to preserve the ovary just remove a portion to allow the cyst bulk to reduce and then the definitive or the treatment of the Cure is to remove all of the organs which would involve uterus cervix Fallopian tubes ovaries and if there's any additional deposits so it is a tough disease to manage in fact there are specialized centers that we refer our patients to when we find disease of an advanced nature because this is a very specialized surgery yeah um the Mainstay of treatment especially in our patients that are suitable candidates would be the birth control pill and not because the reason for birth control but we're using it for suppressing and managing the symptoms and it does work probably because the progesterone counterbalances some of the estrogen in that and that dominance allows for regression or control of symptoms there are other medications we use complementary to that and that would include anti-inflammatories which you gentleman prescribe a lot of so any of the classes of the the ibuprofen naproxen class of medications can be used concurrently in naturopathic uh medications there are some great ways to reduce endometrial symptoms by altering your diet okay I think it works well I think some of that has to do with also just reducing inflammation markers in general I can't honestly say that I often refer patients to a nutritionist or just say you know go online and Empower yourself with diets that seem to work and find out what works for you a little bit of trial and error it is and and also it's individualized because some people just don't want to be restricted into other aspects of their lifestyle other classes of drugs that are used are used that you can use injectable progesterone called Depo-Provera used for birth control but also in that similar dose regimen would suppress endometriosis for local disease or another condition that's associated with adenomyosis we can use Mirena which is a progesterone IUD which also reduces pain and it releases progesterone level you can see there's a progesterone theme here right right the estrogen dominance is what we're trying to offset and there are tablets that are designed dinogest being the product um or the the compound and it's a very specific highly potent progesterone or progestin actually that counterbalances or counter-attacks the estrogenic components in these deposits so it makes the pain go away the periods go away because there are game changing drugs but final one I want to talk about is the class that induces menopause so that's what really gets relief right and these medications are called GnRH agonists and essentially they're injectable medications typically where it makes you feel like you're in menopause but whilst you're there you're not having pain but you bring on it again we talked about the risks and the benefits the risks of this product also involve bone loss and hot flashes menopausal symptoms so we do give it with something called ad back therapy where we give a tiny just enough dose of estrogen or a compound similar to it to offset the symptoms and the and the side effects also assuming you can't conceive during that time absolutely so again we look at the life cycle of a woman where she's trying to manage your pain in periods is she also looking for birth control yeah is she trying to get pregnant well if that's the case early intervention with the fertility clinic is recommended someone's having toggles getting pregnant with it it is I tell patients it's best not to waste your time with me when you're trying to get pregnant because you need to get to a fertility clinic let me help you get there yeah okay having babies actually helps it the pregnancy phase plus the breastfeeding phase puts the endometriosis into a quiescent phase where it's not bothering them anymore wow there you go there's a perk for you if you had a pregnancy I think the only one I've ever heard of so endometriosis basically you know whenever we say oh so it's at the end of something it's not good so the endometrium is sort of spreading in other parts of your body and the symptoms are pain pain pain with your cycle and the treatment sorry did you paint outside of the cycle absolutely I wanna actually it's a good point so yeah I get more concerned when patient says I have Painful periods but I have non-menstrual pelvic pain or I call nmpp in my short forms but that is actually to me more worrisome because that's when you're getting into neural pain where neuropathic pain where you may not even find anything on laparoscopy but there's there's inflammation there in the background and that's the hardest to treat again that's where I say we need escalate our therapy to something more Global like generator antagonist or generate antagonist therapy both of which would work for that and yeah that's a good point and there's a lot of overlap of IBS type symptoms which you may need to work help the GI specialist as well and there is a lot of mood and depression that can come with having all this pain and it does affect quality life in other aspects so using pain modulus like Gabapentin or Lyrica can sometimes help with managing the pain we were a little horse before the cart there but so when you are getting diagnosed obviously you take the history which we do and it's important part of this you do the physical exam and unless someone has a large mass I'm assuming Matt's not going to be particularly useful what is the definitive diagnostic test for confirming a diagnosis well unfortunately the single best test is laparoscopy which we don't want to use as our diagnostic test anymore and we've gone away from that I can tell you from my training days it was a diagnostic laparosa was a commonly used procedure laparoscopy is where we just put a camera inside your and have a woman yeah exactly so we we now say it's a clinical diagnosis if you have the right symptomatology the physical exam often you'll identify areas of tenderness sure you have enough to make the diagnosis and proceed with treatment so there is no requirement to do a laparoscopy before saying I think you have endometriosis here's the treatment let's go after this you will have a you know up to upwards of 20 to 25 percent of patients where they're not getting better you have to change the treatment or you have to now re-evaluate the need for whether laparoscopy's going to provide any additional pain relief any role for ultrasound CT MRI so ultrasound is a Mainstay because ultrasound will especially a good ultrasound Clinic should be able to see certain things we refer to them as sliding sign you can look for nodularity you look for ovarian cysts there's a condition called adenomyosis which also often lives with endometriosis or they their partners in crime so yes MRI is extremely helpful but costly and sometimes difficult to access especially in our Canadian system CT is not a hugely used modality but you know a lot of specialists in endometriosis care do their own ultrasound in their clinic setting or evaluation settings so that they themselves can get a better sense so when we send patients for you know tertiary level referrals for endometriosis they're often getting ultrasounds done at a much higher level which a higher sensitivity detecting it as well can I try this summary Brad oh yeah we were ready for that before no you ready now yeah okay so we talked about endometriosis is the symptoms which is pain which can be outside your cycle thank you and um we you're on you're gonna do a physical examination which is really going to be your diagnosis history and physical examination some tests that you might do include an ultrasound or other Imaging but the diagnosis is really made on history and physical exam we used to do laparoscopy to diagnosis we don't do that anymore thank God that's a very invasive way to diagnose something and if you're confused about the treatment that's okay so am I because it's very variable and it's very customized to where you are in your stage of Life child bearing trying to have kids not trying to have kids near the end of your menstrual cycle you mean your light menstrual life so that the treatment is very complicated and is a combination of surgical intervention in addition to Medical intervention and within the medical interventions there's different types of medical interventions however can you give us some good news is treatment ultimately successful or are there a lot of people out there with this condition that are just you know what I've tried everything and I'm miserable well we know that definitively if someone's tried everything and they're miserable we can we'd have to have completion surgery um really that's the treatment uh that would be final endpoint um and but there are ways to manage it we're getting you know more and more accepted acceptance of using things like gender antagonist therapy with advocac for prolonged periods of time we're talking several years to keep suppression going okay so I think um there's there is light at the end of the tunnel but the tunnel is long and you need to make sure that you've got a game plan and you've got a patient who's got realistic expectations yeah because I think that's what we have to do is set the expectations as to you'll never be pain free but we can make your quality life improve better that's a good way to summarize we can't make you pain-free but we can try and improve your quality of life and at the end of the day there's a salvage procedure that does work menopause yeah menopause will fix it so we can get the patient with menopause their problems and symptoms should naturally go away too wow there you go so now you know if you have endometriosis this is a very real thing um your symptoms and and your troubles are very validated and it can affect all aspects of your life but please talk to your healthcare provider about your diagnosis and possible treatment if you like this video please like it subscribe to our Channel and remember you may need to try and find a specialized Center that specializes in your treatment of this condition because it's so complicated and variable from one person to another you are in charge of your own health and thanks to Dr Sharma for joining us again thank you [Music]

Channel: Talking With Docs

Views: 36,620

Keywords: endometriosis, endometriosis pain, endometriosis symptoms, endometriosis diagnosis, endometriosis treatment, what is endometriosis, endometriosis pathophysiology, endometriosis causes, what causes endometriosis, endometriosis diet, signs and symptoms of endometriosis, endometriosis period, endometriosis back pain, endometriosis explained, endometriosis pathology, symptoms of endometriosis, endometriosis menstruation, endometriosis dysmenorrhea

Id: CNjQFX-tUh0

Length: 13min 29sec (809 seconds)

Published: Fri May 26 2023