Clí­nica Universidad de Navarra

Monday 1 February de 2010

The diagnosis of endometriosis suffers an average delay of close to nine years

 

According to Doctor Manuel García Manero, specialist at the Clínica, it has been calculated that a patient visits up to five different Doctors until the disease is diagnosed.

“The diagnosis of endometriosis suffers an average delay of close to nine years and it has been calculated that a patient will visit up to five distinct GPs, gynaecologists and of other specialists until the disease is diagnosed”. This was the opinion of Doctor Manuel García Manero, specialist at the Department of Obstetrics and Gynaecology at the Clínica Universidad of Navarra, presented at a meeting on this pathology organized by this department in Pamplona and that was attended by specialists from distinct Spanish and European hospitals.

Endometriosis is a benign disease that affects women during their reproductive lifetime. It occurs when the endometrium is situated outside of the uterus, rather than at its original site. The main symptoms of this pathology are pain, both menstrual as well as during sexual relations (dyspareunia), and problems of fertility.

Between 5 and 10% of women in their reproductive years

The incidence of the disease is between 5 and 10% in women that are of reproductive age. The fact that endometriosis has become more widely referred to in recent years “is probably due to the improvements in diagnosis. However, while it is diagnosed more often, it is diagnosed late. This is frustrating for the patient because the doctor often says that there is nothing wrong and they are converted into patients that pass from one doctor to another”, highlights doctor García Manero.

As such, the specialist from the Clínica Universidad of Navarra considers that it is necessary to make our society aware of the incapacitating consequences of this pathology, “its high cost both in terms of the treatment and in terms of the loss of working hours. As such, it is also necessary to sensitise the general practitioner, as they are the first doctor that comes into contact with the patients, and a company doctors, as on occasions, despite the pain, the women have problems to obtain sick leave”.

In this sense, doctor García Manero assures that “we lack global endometriosis units in Spain that treat the patients’ disease integrally”.

Likewise, it is a shame that the research into this disease is focused principally on fertility, through assisted reproduction, “because it generates considerable frustration in those women that already have children and that whose problem is not the aim of the current research, even though they suffer considerable pain”.

Hormone Treatment and the use of new drugs

The usual treatments for endometriosis involve hormone therapy and surgery. “The hormone treatment provokes a state of pseudogestation and whilst under treatment, the symptoms improve but they generally reappear once it is suspended”, indicates doctor García Manero.

Another line of treatment that is been studied at the Clínica Universidad of Navarra, centres on the use of oncological drugs. “We have carried out studies that correlate the symptoms with the vascularization of the lesions. There is stronger pain when there is more vascularization, which could lead in the future to the use of antiangiogenic drugs to diminish this vascularization”.

Although the Clínica Universidad of Navarra, along with the University of Zaragoza, has initiated experimental studies in an animal model into the use of these oncological drugs, doctor García Manero recognises the difficulty in their application “in a benign disease and in patients that may wish to remain fertile in the future”.

Equilibrium between the benefits and the consequences of surgery

Although surgery may be the definitive treatment for deep pelvic endometriosis, this intervention is “that which presents most difficulties and challenges for a surgeon, on occasions even more than the surgery to treat a cancer”, states doctor Christhardt Köhler, of the Charité Berlin Campus Mitte (Alemania).

Doctor Köhler indicated that the surgeon must seek an equilibrium “between the benefits that can be obtained and the consequences for the patient. From the surgical point of view it is feasible to eliminate all the endometriosis, but at times the patient must pay a price in terms of altered function of the different organs that may be affected: bladder, rectum, urether… and even more so if we take into account that this operation is performed on young women”.

According to the German specialist, 10% of the cases involve deep pelvic endometriosis and they require this type of surgery. The intervention, he adds, “should be carried out by a highly specialised team that as well as a gynaecological surgeon, also includes a urologist and on occasions a general surgeon. The surgery performed should be personalized according to the symptoms, the extension of the disease, the desires for future motherhood …”

The value of ecography in the diagnosis

In addition, the meeting organized by the Clínica also dealt with the diagnosis through images of endometriosis, an issue addressed by the doctors Stefano Guerriero, of the University of Cagliari (Italia), and Juan Luis Alcázar, of the Clínica Universidad of Navarra.

According to the specialists, “ecography is very valuable for the diagnosis of endometriosis. Since it is a global pelvic pathology, it is necessary to perform an evaluation of the entire pelvis”. When compared with magnetic resonance, doctor Guerriero highlights the lower cost of ecography.

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