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Endometriosis And Other Eight Most Popular Gynecological Disorders

Gynecological disorders affect the organs in the female pelvic and abdominal areas. Chrisitan Becker – Associate Professor and Co-Director of the Oxford Endometriosis CaRe Centre – lists the most common gynecological disorders of our time and explains why one of them - endometriosis - deserves more attention than it's given now.

What are the most common popular gynecological disorders of our time?

From a prevalence perspective, it’s abnormal uterine bleeding

Whether that's a disease or that's a symptom – it’s another question. I’d say it's probably more of a symptom of issues and the underlying problem can be manifold including uterine fibroids, adenomyosis, endometriosis

Then PCOS or polycystic ovary syndrome, because that's very important for not only the irregularity of the periods but also for women trying to become pregnant. 

If you call infertility a disease and not a symptom, then yes. But again, I think it's more of a symptom rather than a disease. 

And from a malignancy perspective, I think people are most worried about ovarian cancer because it's so difficult to diagnose at an early stage. 

Cervical cancer, hopefully, will be much less prevalent in the future with the vaccination program and, obviously, with people going to their GPs regularly to have a smear test

Endometrial cancer also is relatively rare and women often have bleeding problems with it so it's easier to detect, whereas with ovarian cancer it’s quite difficult. Still, ovarian cancer is quite rare. Compared to the benign diseases I was talking about it's a very small number. PCOS, endometriosis, fibroids are obviously much more common. 

Why does endometriosis deserve attention and should be researched? 

Despite an estimated prevalence of up to 10 percent, endometriosis is an underrecognized condition so far. Its symptoms are neglected and not really thought about as a possible issue. 

Endometriosis should be further researched because it has a significant impact on the affected individual, their families, and society. 

Studies have shown, endometriosis has a significant impact on women’s lives, not only on their day-to-day work and their sex lives, and their families, and partners, but purely from an economic perspective. Women, when they are affected, are either not able to work or are not able to work as effectively as they could. And it does cost a lot of money. 

Despite an estimated prevalence of up to 10 percent, endometriosis is an underrecognized condition so far. Its symptoms are neglected and not really thought about as a possible issue.

If people were more aware of it and therefore more research would be done, and therefore better treatments were found and we would be able to improve the situation not for the individual only but also for society in general. 

It would hopefully cost less money because it has been shown that two-thirds of the costs of endometriosis are not linked to direct medical expenses including, hospital costs or medicine. The fact is that women with endometriosis often don't function properly when in pain. And that's why it costs a lot of money. 

So, therefore, even if the medical costs would rise because you identify more patients and you treat them, I think the overall costs would go down because you would get more women back to work. 

That's one thing. 

From a scientific perspective, it’s also very interesting. Even though the prevalence apparently is quite high, we know so little about it. 
  • Why is it mostly confined to the abdomen, in particular, the pelvis? 
  • Is it because women are standing all the time? 
  • Is it just a matter of gravity or is there something very different in the pelvis that makes it more sticky for the endometriosis lesions? 

These are the questions yet to be answered. Yes, you do sometimes have diaphragmatic lesions of endometriosis, in Caesarean section scars or around the lungs but that's very rare. 

Also, are we wrongly looking at it too simplistically as one disease? We subdivide into superficial peritoneal disease, ovarian and deep endometriosis, but the fact the success rate of medical or surgical treatment vary and are associated with high recurrence rates suggests that we need to rethink our classification and categorization.

As a researcher why do you think medicine has advanced to in understanding and management of such diseases as diabetes more than it has in endometriosis?

I think it is still not socially acceptable to talk about endometriosis. Women have diabetes as well as men, so we can talk about it, that’s fine. It affects both, so it's easier for both to understand this. I think that's probably one reason. 

I think it is still not socially acceptable to talk about endometriosis.

And there have been many more people talking about diabetes. So, I’m aware that it's ok to talk about diabetes. I find it's ok to talk about endometriosis. But people just don’t because it has a stigma of pain, periods and infertility. So, I think that's the main reason. 

Why companies who employ a majority of women do not invest in the advancement of endometriosis and adenomyosis is beyond belief.

People have to begin lobbying for it as well. As mentioned above, it is not only affecting directly but also their partners and families. It has a significant effect on the healthcare budget and society in general. Women are still underrepresented in many leading positions. Maybe once this imbalance is rectified or significantly improved, company executives will realize firsthand. 

Why companies who employ a majority of women do not invest in the advancement of endometriosis and adenomyosis is beyond belief.

How do you help women with endometriosis? Do they share the same stories?

You have these young women where they've had years and years of painful symptoms and it's the typical story that no one really took notice of it.

They were told, “Don't worry about it, women get painful periods, that’s not uncommon”. And they’ve had it since their first period and then they get to their 20s and then eventually they are thinking about children. Over here it’s getting later and later. 

Then they start to have sexual intercourse and they are on the pill, so life is often good at that point. And then when they come off the pill when they want to have children the pain comes back. So, when you see them in the clinic they're often very grateful because finally someone really listens to them and gives them a possible diagnosis. I think that's one of the things that women like and that's what I hear from patients “Thank you for listening. Someone is finally listening to me”, which is not because I'm such a good listener it's also because the GPs have very little time now. It's not necessarily their fault, it is often the system. 

Not everyone with painful and heavy periods has endometriosis or adenomyosis. However, if we would think about these diseases as possible reasons for the symptoms we would be a large step further. Education about it, at school and professional level, should be discussed.

Also, as endometriosis specialists, we have the benefit of seeing women who are pre-filtered by the GPs and therefore are much more likely to have endometriosis. Therefore, it is easier for us to identify the disease compared to GPs.

Not everyone with painful and heavy periods has endometriosis or adenomyosis. However, if we would think about these diseases as possible reasons for the symptoms we would be a large step further. Education about it, at school and professional level, should be discussed.

A lot of patients ask “I have endometriosis, will I be fertile, will I be able to have children?’ We should tell them ‘You should try to become pregnant when you are ready to, and we can do ultrasounds just to make sure everything looks fine”. And then if they experience difficulties getting pregnant, we can try to help them. Those patients I see quite often, and then if they can get pregnant even without having to do any surgery or IVF, that is obviously great.

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