Endometriosis and Polycystic Ovary Syndrome (PCOS) affect millions of individuals worldwide. Whilst symptoms may appear similar, they are two very different diseases. Perth gynaecologist, Dr Sean Copson, delivered a presentation to our members about all thing’s endometriosis & PCOS. Here are some of the points he covered.
The basics of endometriosis
Endometriosis is a chronic inflammatory disease affecting approximately 1 in 9 people. It’s characterised by a multitude of symptoms such as pain, fatigue, and bowel issues. It is also significantly prevalent in those with infertility struggles, with rates ranging from 30% to 50%. This condition not only inflicts physical pain but also takes a toll on various aspects of life including quality of life, physical function, education, work, intimacy, and relationships. Unfortunately, diagnosis is often delayed by an average of 8 years, emphasising the urgent need for awareness and education. It’s worth noting that the severity of the disease’s stage does not necessarily correlate with the intensity of pain experienced, adding to the complexity of managing this condition.
Some of the symptoms of endometriosis
- Pain
- Pelvic pain
- Cyclical/constant pain, abdominal pain, leg pain
- Painful periods
- Painful intercourse
- Pain with defecation
- Fatigue
- Bowel dysfunction
- Nausea
- Subfertility
How is endometriosis diagnosed?
Diagnosing endometriosis could consist of a combination of medical history assessment, physical exams, imaging studies, and laparoscopic surgery for definitive confirmation.
Biomarkers diagnosis
There is increasing talk about the role of biomarkers in diagnosing endometriosis. As of now, biomarkers cannot be utilised for the direct diagnosis of endometriosis. However, promising research is underway to explore this avenue. Ongoing studies are investigating the potential of blood tests and saliva samples as potential biomarkers for diagnosing this complex condition, offering hope for more accurate and non-invasive diagnostic methods in the future.
Diagnostic imaging
Sometimes diagnostic imaging tools such as ultrasounds and MRIs can detect the disease. However, this is not always the case. Ultrasound, while effective in detecting deep infiltrating endometriosis, might not effectively identify superficial cases. On the other hand, MRI, though costlier, is often used by gynaecologists as it is valuable in planning surgeries for severe endometriosis and also serves as an alternative when ultrasound is excessively uncomfortable or painful for the patient.
Laparoscopic surgery: The gold standard
While clinical assessment, ultrasound, and MRI are valuable tools, they cannot entirely replace the precision of laparoscopy in confirming the presence of endometriosis. Laparoscopic surgery stands as the gold standard for endometriosis diagnosis and treatment.
Treatment of Endometriosis
Endometriosis encompasses various complexities and potential issues, requiring a multifaceted approach to management. There is no cure for endometriosis therefore, treatments focus on symptom management.
Laparoscopic surgery for treatment of endometriosis
Surgical treatments for endometriosis, involving excision and ablation techniques, showcase about a 70% success rate in alleviating pain. However, around 20%-30% of individuals may not experience substantial relief. Notably, these procedures can also enhance pregnancy rates for those with mild to moderate cases of the condition.
Hormonal treatment of endometriosis
Some people find hormonal treatments helpful in managing endometriosis. There are a variety of options, starting with cost-effective choices like Levlen and progressing from there can be effective. Progesterone-only pills, Depot Provera, and Mirena are also common choices. However, some people experience side effects such as weight gain, bloating, acne, and gastrointestinal issues.
Treatment of Endometriosis Pain
People with endometriosis can experience pain in various ways and at various points in their cycle. Some common medications used to alleviate pain include:
- Paracetamol
- Anti Inflammatories
- Ibuprofen
- Naproxen
- Suppositories
Neuropathic and Nociceptive Pain Management
Research suggests that endometriosis affects not only the pelvic area but also the nerves and surrounding cells, leading to neuropathic and nociceptive pain. Collaborating with a pain specialist is recommended in addressing this, often through medications like tricyclic antidepressants such as Nortriptyline and Amitriptyline. Mindfulness, meditation, and education can also contribute to pain management strategies.
Pelvic floor dysfunction treatment
Pelvic floor dysfunction, commonly addressed by pelvic health physiotherapists, involves assessing and treating tense pelvic floor muscles. Through targeted interventions, physiotherapy can alleviate discomfort and enhance overall well-being. Pain management strategies, along with recommendations for low-impact exercises, are integral components of addressing pelvic floor dysfunction effectively.
Treating endometriosis-related fertility issues
The majority of individuals with endometriosis do not encounter fertility problems. However, many people with fertility problems do have endometriosis. To ensure accurate assessment, potential factors like ovulation, fallopian tube patency, and semen analysis are considered. Surgical intervention proves beneficial for mild to moderate cases, enhancing fertility outcomes, while those with severe stage 4 endometriosis might require more advanced interventions such as in vitro fertilisation (IVF) to address fertility challenges.
Addressing mental health & wellbeing
Endometriosis places strain on relationships, finances, and overall well-being, often leading to adverse effects on mental health. This impact is particularly pronounced when pre-existing mental health conditions are present. Incorporating psychology support can offer valuable assistance in navigating and mitigating the emotional challenges associated with this condition.
The basics of PCOS
Polycystic Ovary Syndrome (PCOS) is a common hormonal disorder that affects 6-10% of the population. Its complexity is rooted in its genetic nature, often presenting as a complex genetic trait influenced by both genetic and environmental factors. This disorder disrupts the hormonal balance, causing the ovaries to produce excessive levels of androgens, which have wide-ranging effects on the body.
Some of the symptoms of PCOS
- Difficulty falling pregnant
- Hyperandrogenism
- Menstrual irregularity
- Irregular cycle
- No menstruation
- Heavy or painful periods
- Polycystic ovaries
- Obesity
- Insulin resistance
Treatment of PCOS
The treatment of PCOS is guided by a range of goals aimed at addressing its diverse symptoms and potential health risks. These objectives encompass managing excessive hair growth and acne, closely monitoring, and treating diabetes or insulin resistance, safeguarding the uterine lining from precancerous or cancerous changes, offering conception options, aiding individuals in conceiving, and ultimately working to regulate the menstrual cycle. The multifaceted nature of PCOS necessitates a comprehensive approach that addresses the various aspects of this complex disorder.
Common treatments
Similar to endometriosis, PCOS treatment options encompass a variety of approaches tailored to individual needs. Oral contraceptives play a crucial role, not only in providing contraception but also in mitigating the risk of uterine cancer and establishing a regular menstrual cycle. Combined oral contraceptive pills (COCP) are preferred due to their reduced androgenic impact. Alternatively, progesterone pills can be administered for 10-14 days every 2-3 months to induce a period. Intrauterine devices like Mirena and injections like Depot Provera are also viable options. Metformin assists in managing insulin resistance, while Spironolactone addresses hirsutism and acne by reducing androgen activity.
Fertility treatments
PCOS can often lead to fertility challenges due to disrupted ovulation and hormonal imbalances. However, when treating, it’s also important to rule out other potential causes of fertility issues first. Interventions like ovulation induction using medications such as Clomiphene and Letrozole can stimulate egg release. Laparoscopic surgery may be considered for certain cases. In more severe instances, in vitro fertilisation (IVF) might be recommended to enhance the chances of conception.
You can watch the online event with Dr Sean Copson here.