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Experts highlight challenges in endometriosis patient care

Found in a large number of young girls and teens with pelvic pain and painful periods, endometriosis does not manifest before the onset of menstruation.

Endometriosis is a condition where tissue similar to the lining of the uterus (the endometrial stroma and glands, which should only be located inside the uterus) is found elsewhere in the body.

Endometriosis is one of the most common gynaecological conditions but there is a lack of awareness about the disease and its exact causes are still unknown. Over 621 medical experts from Nigeria and other countries across Africa, the Middle East and Asia recently came together to learn how to tackle and advocate for better management of infertility in patients of endometriosis.

According to Abayomi Ajayi, a fertility expert and managing director at Nordica Fertility Centre some patients try to treat suspected cases of the medical condition with certain medications, making symptoms to avoid undergoing surgical procedures.

“One of the ways to tackle the scourge of endometriosis is by ensuring that doctors are equipped with the necessary knowledge and skills to diagnose and manage endometriosis properly,” Ajayi said. “We have to understand the biggest problem in endometriosis because more than 64 percent of cases endometriosis occurs before patients are 30 years old.” This means knowing about endometriosis in infertility and Assisted Reproductive Technology (ART)”.

There are many controversies about what causes endometriosis, its prevalence and symptoms, up to its effect on fertility, and how to manage the condition.

Ajayi explained a study published in February 2020 the issue of prevalence is always either over or underestimation of endometriosis.

“We don’t even know the prevalence of this case or dynamic in our community, so it depends on where you’re looking at it. If it’s a hospital-based signal it is likely to be overestimated. If we take community-based fever it is likely to be underestimated. And so that’s one of the things that we faced with endometriosis,” he said.

The fertility expert also said that looking from a diagnosis point of view on endometriosis; he noted that data show approximately 25 percent of fertile women have endometriosis. However, citing another paper from Israel which looked at about 2 million people, one-third of women who have infertility actually will also have endometriosis.

“We do not seem to agree on the prevalence and there is no symptom that’s particular for endometriosis. We sometimes call it a masquerade of a disease and it has caused a lot of delay in diagnosis in the majority of people, especially in the developing part of the world.

“Even in developed parts of the world, we know that they have about four to seven years of delay in diagnosis. Majority of these people are misdiagnosed, mislabeled and misunderstood,” he said.

According to Abayomi, in my centre (Nordica), we did a 10 years review of what the symptoms of endometriosis are like and what we saw was that this was published in the Journal of endometriosis and pelvic pain disorders in 2016.

“We saw that 73.8 percent of our patients had dysmenorrhea, and so we thought that was a predictive symptom of endometriosis then interestingly, 62.5 percent of this patient had severe endometriosis based on laparoscopic evidence. And also, interestingly, about 52.5 percent of this patient had blocked either one or two tubes.

“And therefore, we saw that there was a big need. Of course, it was not surprising the majority of them had severe endometriosis and also the tubes were involved. Therefore, ART is a very important aspect of the management of endometriosis, at least in the population that we reviewed,” he explained.

He added that the relationship between endometriosis and infertility is still unknown, noting that there is no causal relationship and there is a lot that might be responsible for the infertility that we’ll find in endometriosis.

“The most appropriate treatment for endometriosis-related infertility is still controversial. Diagnostic laparoscopy should be discouraged in endometriosis,” he urged.

Also speaking at the webinar, Prakash Trivedi, a consultant gynaecologist and pioneer of hysteroscopy surgery and laparoscopic suturing 3D Light in Asia said that endometriosis is a subject which is the disease of the millennium.

“We have to understand that nobody has understood endometriosis and there are many unanswered questions. Management of endometriosis starts much early, but we are not always in a hurry to operate on young patients because if you operate at 19, there might be a recurrence at 23. So you have to be very concerned about when you will operate on an adolescent for this complication.”

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