Endometriosis: comprehensive approach and new horizons
“Between 30% and 50% of Women with Endometriosis Have Difficulty Conceiving”, Dr. Juan Giles
Today, March 14, marks Endometriosis Awareness Day, a condition estimated to affect 10-15% of women of reproductive age. Nearly half of them experience or will experience difficulties conceiving. Despite its high prevalence, endometriosis diagnosis still takes an average of seven years, largely due to the variety of symptoms and the lack of fully validated non-invasive tests.
In recent years, there have been significant advancements in diagnosing endometriosis, starting with greater awareness among healthcare professionals regarding patients’ symptoms and their correlation with the potential location of lesions.
Advancements in Imaging Techniques and Minimally Invasive Surgery
Improvements in imaging techniques, particularly MRI and ultrasound, represent perhaps the most significant progress. Another field that has seen advancements is endoscopy, particularly in minimally invasive surgical techniques. These have helped reduce risks and recovery time while enabling doctors to more accurately detect endometriotic lesions and collect biopsies for analysis.
Blood, Urine, or Peritoneal Fluid Biomarkers: New Horizons in Endometriosis Detection
Current research on endometriosis detection focuses on the use of biomarkers in blood, urine, or peritoneal fluid. One of the most promising techniques is gene analysis through mRNA.
The application of artificial intelligence to analyze ultrasound or MRI images to identify endometriosis-related lesions is also a diagnostic tool of the future. While already in use, it still requires further refinement.
While new diagnostic techniques continue to develop, regular medical check-ups and a thorough evaluation of lesion extent remain essential for effective treatment.
Endometriosis and Infertility: The Reasons
It is estimated that 30% to 50% of women with endometriosis experience difficulty conceiving. The impact of endometriosis on fertility varies depending on the severity of the disease and the location of the lesions.
For example, pelvic adhesions may distort anatomy and block the fallopian tubes, which are essential for transporting the egg from the ovaries to the uterus. Tubal motility may also be impaired, affecting this transport process.
At the ovarian level, recent studies suggest that endometriosis primarily leads to a reduction in ovarian reserve and, in some cases, ovulatory dysfunction.
Additionally, the inflammatory environment in the peritoneal cavity may hinder the interaction between the egg and sperm, while at the uterine level, this inflammation could compromise embryo implantation.
For women seeking pregnancy, Assisted Reproductive Technologies (ART) may be an option. For those considering long-term family planning, fertility preservation should be considered, particularly before age 36 and preferably before undergoing surgery.
The Importance of a Comprehensive Approach to Endometriosis
Women with endometriosis should understand that managing this condition requires a comprehensive, personalized approach that addresses both physical and emotional symptoms.
A precise initial diagnosis regarding the location and extent of endometriotic lesions is crucial, along with regular medical follow-ups.
A balanced diet and regular physical activity can help reduce inflammation, alleviate symptoms, and contribute to hormonal balance.
Surgery Should Be the Last Resort for Endometriosis
Endometriosis treatment should be symptom-based, primarily targeting pain associated with menstruation, intercourse, and sometimes urination or bowel movements.
It is important to note that treatment is not curative. Many of the medications used prevent pregnancy and do not improve fertility after discontinuation.
Moreover, surgery should be the last resort and only considered when medical treatment fails—contrary to the approach taken just a few years ago. Efforts should be made to perform surgery only once, though this is challenging, as lesions and symptoms recur in 50% of cases after surgery.
When treating a woman with endometriosis, it is crucial to determine whether she wants to conceive now or in the future. In the first case, ART is often necessary. In the second, fertility preservation should be considered.
A recent study conducted at IVI highlights that outcomes are significantly better when a woman preserves her fertility before age 36 and before undergoing surgery. Therefore, assessing ovarian reserve, disease extent, and reproductive priorities is essential.
Endometriosis Requires a Holistic Perspective
Recent studies suggest a potential link between emotional or psychological factors—especially those experienced during childhood or adolescence—and the onset or progression of endometriosis. This reinforces the need for a multidisciplinary approach that also includes emotional support.
Ultimately, continuous education on endometriosis is crucial for reducing diagnostic delays and improving treatment for this disease, which not only causes debilitating pain and discomfort but also significantly impacts fertility. Keeping up with advancements and addressing each case comprehensively allows for a more promising reproductive future and an improved quality of life for patients.