Evaluation of Awareness of Endometriosis

Abstract

This paper discusses the awareness of endometriosis. The importance of symptoms and diagnoses of endometriosis is vital for women suffering with the disorder. The outcome all women want is a cure. There has only been one proven cure, which is laparoscopic  surgery.

Introduction

Many women around the world are affected by a disorder called endometriosis. According to Endometriosis Foundation of America, “Endometriosis is a disease of menstruation. It occurs when tissue similar to the lining of the uterus, or endometrium, migrates outside of the womb where the tissue would not be (What is Endometriosis? 2019). The article goes on to explain that at least 200 million women have been diagnosed with the disorder, but many are unaware they even have it. Endometriosis pain can hinder the lives of many women. The article explains, “Endometriosis can impact all aspects of life- school, careers, finances, relationships, and overall well being (What is Endometriosis? 2019). Mayo Clinic offers a great description on signs and symptoms of the disorder. Mayo Clinic reports, “The primary symptom of endometriosis is pelvic pain, often associated with menstrual periods. Although many experience cramping during their menstrual periods, those with endometriosis typically describe menstrual pain that’s far worse than usual. Pain may also increase over time” (Mayo Clinic, 2019).  There are several other signs and symptoms that Mayo Clinic addresses. Endometriosis can cause painful intercourse, dysmenorrhea, painful periods, diarrhea, excessive bleeding, and infertility. Unfortunately, whenever a couple is trying to conceive are unable to, endometriosis can sometimes be the cause.

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While the cause of endometriosis is unknown, there is a theorist who tried to determine what does cause endometriosis and his theory is still used in today’s teachings. Dr. John Sampson became interested with endometriosis when he came into contact with so many of his patients that were diagnosed with it. Dr. Sampson came up with the theory that this cause of endometriosis was retrograde menstruation. Retrograde menstruation is where there is a backflow of the menstruation blood. The endometrium is the lining that sheds of the uterus monthly, and Sampson proposed that if all the debris goes back up into the fallopian tubes, back up to the ovaries and all around the pelvic area causing it to implant. Surprisingly, retrograde menstruation is normal for most women but there is not a way to be certain it happens because women can’t feel it when back flow does happen. There is no known cause as to why retrograde menstruation happens. Many other doctors believe that retrograde menstruation is a myth and tend to believe that endometriosis is a genetic disorder along with the retrograde menstruation.

Endometriosis is known to cause infertility and painful intercourse. Both conditions can not only take a toll on the woman but also her partner. According to Endometriosis.org, “Because endo can cause pain on intercourse, women with the disease may have to cope with the lack of sex or sexual pleasure. This may have significant effects on a woman’s feelings or sexuality or femininity” (Endometriosis.org, n.d.). Endometriosis.org goes on to explain that most women go years without being diagnosed with it and it is often known as the silent illness. Early diagnosis is very important when it comes to this disorder. Women can suffer for years and be mis-diagnosed with different disorders other than endometriosis.  Jena Hailes describes in her article the importance of being aware of the symptoms and the importance of early diagnosis. Within her article, she has charts for references. In the “Early Diagnosis is Important” column. It states, “Women face a 7-8-year delay for surgical diagnosis and up to 13 years for deep infiltrative diseases (DIE)” (Jean Hailes, 2016). Hailes also points out what should be included in the patient’s assessment. When assessing the patient, one would want to ask about the patient’s menstrual history. After the subjective data is collected, the nurse may want to use objective data by palpating the abdomen and watch the patient’s face for grimacing from pain. If the woman is sexually active, the nurse will want to perform a vaginal exam for nodules and ovarian cysts. Hailes describes that the way to diagnose endometriosis is by combining laparoscopic exploratory surgery and verifying with the patient that they have a family history of endometriosis.

Case Studies of Endometriosis

National Center for Biotechnology Center is a government-based website that provides information on medical testing and is provided by Cochrane Library. There was a randomized controlled trial and the treatment process for endometriosis. The background of this study states, “Endometriosis is the presence of endometrial glands or stroma in sites other than the uterine cavity and is associated with pain and subfertility. Surgical interventions aim to remove visible areas of endometriosis and restore the anatomy” (Laparoscopic Surgery for Endometriosis, 2014). The point of this study was to prove that the only cure to endometriosis is laparoscopic surgery. There were 973 women chosen to participate in the study. There were several comparable RCT studies done during this time. They compared groups of women who underwent laparoscopic excisions compared to women who underwent ablations. There were other RCT of women who were given hormone therapy such as birth control or gonadotropin- releasing hormone analogue or also known as GnRHa. The women who took the hormone therapy were laparoscopically diagnosed with endometriosis. The main results reported, “When laparoscopic ablation was compared with diagnostic laparoscopy plus medical therapy (GnHRa plus add-back therapy), more women in the ablation group reported they were pain free at 12 months. The difference between laparoscopic ablation and laparoscopic excision in the proportion of women reporting overall pain relief at 12 months on a VAS 0 to 10 pain scale was a 0” (Laparoscopic Surgery for Endometriosis, 2014).

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An older case study was chosen to establish evidence of how endometriosis should be assessed and treated. This case was performed in 1993, and doctors were still faced with the same evidence they are in today’s medicine.  The objective of the study was, “To undertake quantitative overviews of the following commonly used treatments for endometriosis-associated infertility: ovulation suppression, laparoscopic ablation, and conservative laparotomy” (Department of Obstetrics and Gynecology, McMaster University, 1993). The participants were chosen were women who had been visually diagnosed with endometriosis and had complaints of infertility. This study was also a randomized controlled trial. Hormone therapy also known as ovulation suppression was used and that treatment was deemed insignificant to treating the pain from endometriosis. The end of the results explains, “Laparoscopic data were similar to those from conservative laparotomy studies. Studies assessing conservative surgery plus danazol compared to danazol alone showed significant benefit from this adjunct” (Department of Obstetrics and Gynecology, McMaster University, 1993). In other words, if one has the surgery done, they are then given hormone therapy to keep the endometriosis from growing back. The conclusion of this study reveals, “Ovulation suppression alone is an ineffective treatment for endometriosis- associated infertility. Well-designed trials of laparoscopic ablation deserve a high priority” (Department of Obstetrics and Gynecology, McMaster University, 1993).

Conclusion

Endometriosis is a very painful and can be debilitating for some women. Women can experience symptoms such a painful period, pelvic pain in between periods, painful coitus, and infertility. All of these can cause physical and psychological effects on a woman’s life and femininity. Theorists and doctors still aren’t 100% sure what the cause of the disease is. Clinical studies state that it is vital to diagnose endometriosis as early as possible to relieve the painful symptoms. Clinical studies have proven the only relief for endometriosis is laparoscopic surgery to have an excision or ablation performed.

References

• Hughes, E. G., Fedorkow, D. M., & Collins, J. A. (1993, May). A quantitative overview of controlled trials in endometriosis-associated infertility. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/8486196
• Duffy, J. M., Arambage, K., Correa, F. J., Olive, D., Farquhar, C., Garry, R., . . . Jacobson, T. Z. (2014, April 03). Laparoscopic surgery for endometriosis. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/24696265
• Jean Hailes for Women’s Health, 2016 (PDF)
• Endometriosis.org. (n.d.). Psychology and endometriosis « Endometriosis.org. Retrieved from https://endometriosis.org/resources/articles/psychology-and-endometriosis/
• Endometriosis. (2019, March 23). Retrieved from https://www.mayoclinic.org/diseases-conditions/endometriosis/symptoms-causes/syc-20354656