Endometriosis is one of the commonest reasons for major gynecological survey among African-American women. Also, Black women are more likely to die from endometrial cancer than women from other racial or ethnic groups.
Below is an interview with Prof Renner, MD, who is deputy director of the Gynecological Hospital of the University Medical Center Erlangen, scientific and clinical head of the University Endometriosis Center Frankonia as well as head of the Gynecological University Cancer Center Frankonia. He is also president of the European Endometriosis League (EEL).
His area of expertise is endometriosis, a chronic pelvic disease affecting 10 % of the world’s female population, yet often undetected even by medical professionals. During Daysy’s interview, Prof Renner reveals how to detect, treat and prevent endometriosis.
Prof Renner is heading Daysy’s clinical study into endometriosis. The aim is to determine whether basal body temperature can be an early indicator of endometriosis.
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Here is Daysy’s interview with Prof Renner.
Prof Renner, endometriosis is a very common, however often undetected disease in women. What are the typical symptoms of endometriosis?
Prof Renner: A typical symptom of endometriosis is pelvic pain occurring during or shortly before menstruation. During disease persistence, pelvic pain may also occur at any other point during the female cycle. Depending on the location of the disease, pain during sexual intercourse, urination or bowel movement may be experienced. In addition, some patients experience infertility.
What do you advise women who notice these symptoms? What are the types of diagnosis and where are these offered?
First I advise women to actively address their gynecologist. Unfortunately, experience tells us that menstrual pains are often not taken seriously. They are still considered “normal”, even among gynecologists. Statements like “Don’t make such a fuss” or “All women experience this type of pain” sadly do not happen only on rare occasions. In such cases, a change of gynecologist, or finding a specialist on her own is all that a patient can do. These specialists can be found, for instance, in specialized endometriosis centers. Contact information can be found here.
Is it known why some women develop endometriosis?
No, it is not. This is one of the mysteries of this disease. There are some theories, of which some are older than 100 years, but none of them has been proven. The most popular theory is the transplantation theory, which is based on retrograde menstruation, i.e. bleeding through the fallopian tubes and into the peritoneal cavity. Endometrium that enters the peritoneal cavity this way can implant and show the typical signs of endometriosis. However, since most women bleed into the peritoneal cavity during menstruation, albeit to different extent, other factors must exist that foster the development of endometriosis in only some of these women. Evidence in favor of this theory is the ability to induce endometriosis in mice by injection of menstrual blood. Opposing this theory is the fact that even women lacking their uterus are affected by endometriosis.
Another theory is based on the assumption that cells of the peritoneal cavity re-differentiate due to some external factors, i.e. from healthy peritoneum into typical endometriosis cells. This phenomenon is called “metaplasia”, hence “metaplasia theory”.
What does the diagnosis “endometriosis” mean for women planning to have children?
In most cases, a randomly discovered endometriosis is no reason to panic. Most women with endometriosis become pregnant without experiencing any problems. However, the rate of patients with endometriosis is elevated in sterility collectives (sterile patients), which is pointing towards the disease having a potential effect on pregnancy rate.
Are there any treatments? If so, what are the chances of cure for each of the treatment options?
There are medication-based and surgery-based treatment options. Medicinal treatment options include pain relief medication as well as hormonal therapies such as oral contraceptives, progesterone, intrauterine devices (IUD) or menopause therapy (GnRH analogs). Some of these therapies are not approved for the treatment of endometriosis and have various side effects, or contraindications.
Especially in the case of strong pain, medicinal therapies should not be “experimented” with for too long, instead the initial diagnosis should be quickly confirmed by surgery. During this (in most cases) minimally invasive procedure called laparoscopy, the lesion should be removed. In case of relapse, the decision for medication- or surgery-based treatment has to be made for each patient individually.
Is it possible to prevent endometriosis through a balanced diet?
No, there is no evidence for that. A balanced diet may, similar to doing sports, improve the condition. Especially weight reduction has been shown to have positive effects. Nevertheless, it is not at all proven that nutrition can be directly responsible for endometriosis.
Are there any other ways to prevent endometriosis?
No, unfortunately not. In this context, however, it is important that the level of suffering in these patients is often very high over years, until, eventually, the diagnosis is made. Although prevention is not possible, it seems rational to raise awareness, in order to decrease the time interval until start of adequate treatment.