Endometriosis: the importance of early diagnosis and prevention of recurrence

Endometriosis: the importance of early diagnosis and prevention of recurrence



Olav Istre, MD Bjorn Busund, MD Anton Langebrekke, MD
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Roberta Speyer: “This is Roberta Speyer and I am reporting for the EndoZone here from beautiful Cancun, Mexico. I have three doctors from Europe, who are going to introduce themselves, and we are going to have a discussion about endometriosis treatment; is there anything new on the horizon and is there anything that a woman should really think about when they find out they have this disease, gentlemen?”

All: “Olav Istre from the Department of Gynaecology and Obstetrics, at Ullevaal Hospital in Oslo, Norway; Bjorn Busund from the same hospital in Oslo, Norway; and I am Anton Langebrekke from the same department at Ullevaal University Hospital.”

Roberta Speyer: “When we talk about endometriosis we are talking about a chronic, debilitating disease. The people, who are going to watch this interview on EndoZone, are either people who treat this disease or are concerned because they have a patient population that is presenting with it, or perhaps they have it themselves. What do you find as surgeons, what do you think is the important thing for these women or doctors, who perhaps have not really had a lot of experience with it, to realise that they need to know about endometriosis?”

Olav Istre, MD: “First of all the physicians, they have to think about it. If they are presented with a young girl with pain they shouldn’t just give her painkillers or something like that. They should think about it and make the diagnosis.”

Roberta Speyer: “Is time of the essence with this disease? Is it important that they catch it earlier?”

Olav Istre, MD: “Yes, because they are suffering these young girls so they can be treated and it can be worse if it goes on for a long time.”

Roberta Speyer: “Is there really, do you think, any good medical treatments or can you start with a medical treatment? Is surgery always necessary? What’s your opinion?”

Bjorn Busund, MD: “You usually have to make a laparoscopy to make the diagnosis. By the time you do the laparoscopy you should be able to treat what you see of the endometriosis. Then the next thing is to avoid recurrence of the disease and that is mainly medical.”

Roberta Speyer: “How is that? How do you avoid the recurrence of the disease?”

Bjorn Busund, MD: “I think the most important thing is to reduce the amount of blood during menstruations. That is using an oral contraceptive or the Mirena coil to reduce menstruation.”

Anton Langebrekke, MD: “I think also that it is very important that these patients seek contact with people who are trained in and are aware of the problem. I think that endometriosis is a thing that needs experts in endoscopic surgery and I think that during the diagnosis it is an advantage also. Like Dr. Busund says: to be able to see and treat at the same time and then do a follow up of that patient because then you have the diagnosis and you know that sooner or later it probably will come back.”

Roberta Speyer: “So this disease is going to be probably something that’s going to recur. You’re treating it but you’re not truly curing it and it needs to be watched throughout someone’s reproductive years?”

Bjorn Busund, MD: “Most of the treatment is surgical treatment to remove the lesions, but you haven’t done anything with the conditions that caused the disease in the first place. So therefore you have quite a number of recurrences.”

Roberta Speyer: “So, question: What causes endometriosis? We don’t know – but does anybody have any theories on that? What do you guys think?”

Olav Istre, MD: “We still don’t know where endometriosis comes from but there are theories that it’s multiple, small cells and it’s difficult to really find out about that.”

Bjorn Busund, MD: “I think there is one single thing that corresponds most to the occurrence of endometriosis and it is the number of menstruations a woman has. What we see is an increasing number of endometriosis patients, and I think it has something to do with women are now having more menstruations during their lifetime than they had before. If you go years back people usually had lots of kids and the number of menstruations was of course less.”

Anton Langebrekke, MD: “So what we think is that the retrograde menstruations are probably the most important cause, the frequent bleeding.”

Bjorn Busund, MD: “But it’s not enough to explain all the endometriosis. You can find endometriosis in men on oestrogenic therapy. So one of the explanations, which isn’t the most important, but it is there, is the transformation of cells with multi-potential developments from the peritoneum for instance.”

Olav Istre, MD: “Hey come on, it must be like that, or otherwise the retrograde menstruation couldn’t explain why you can get it in the lungs and the brain. So it must be some other mechanism.”

Bjorn Busund, MD: “ The most frequent cause of endometriosis is retrograde menstruation, so if you eliminate or reduce the menstruation you will also reduce the recurrence of endometriosis.”

Roberta Speyer: “What about your feelings about a lot of the research and discussion about dioxins and the toxic environment that we live in nowadays, that that might be exacerbating certain people’s potentiality? Do you have any comments about that anyone?”

Anton Langebrekke, MD: “I think that so far in the research it’s not proven at all. We know that in Belgium, for example, Professor Jacques Donnez has talked about the influence of maybe a toxic environment on the adenomyotic disease. It might be of some importance but it is difficult really to prove so far.”

Bjorn Busund, MD: “It might be that the environmental factors can influence the immunological system, which may be important to avoid the development of endometriosis, even if it’s retrograde menstruation.”

Roberta Speyer: “Do you agree?”

Olav Istre, MD: “Yes.”

Roberta Speyer: “So you’ve got a multi-faceted disease. You really don’t have anything new out there that’s going to treat this disease, but you believe that there is a better recognition of the disease in the medical community in your experience at this time than there was 10-15 years ago? Is that improving?”

Olav Istre, MD: “That’s improving, really. And the surgical treatment is also improving because we can do it now with the endoscope – the laparoscope. And we can do it more extensively.”

Anton Langebrekke, MD: “And I even think that there are countries and places in the world that still treat advanced endometriotic disease with radical operations like hysterectomy and BSO and we are now reducing that to treat localised disease, and only in advanced stages, after years, we are now more aggressive with radical treatment. Concerning new treatments, we started a study with antagonist treatments. Not agonists but antagonists.”

Roberta Speyer: “How did that work?”

Anton Langebrekke, MD: “Well, it immediately creates a hypo-oestrogenic environment instead of the latent phase like a GnRH-agonist has. But these studies are not finished and it’s early to say what is going to be certain, and it is a very expensive treatment.”

Roberta Speyer: “From the medical treatment stage would you say it’s still very early to look towards a future where we’re going to be able to treat endometriosis without surgery coming in?”

Bjorn Busund, MD: “Yes, because the medical treatment is not very efficient and it has quite large side effects, so it would, for the near future, it would be an adjuvant treatment to the surgical one.”

Olav Istre, MD: “Still, we have the Mirena as we were talking about before. It can also help.”

Roberta Speyer: “It helps?”

All: “Yes.”

Roberta Speyer: “And when would you administer this? After you do surgery and then you would insert the Mirena as more of a control for reoccurrence? Am I correct?”

Olav Istre, MD: “Yes. Correct in some cases, yes. But many of these patients are infertile so they won’t be pregnant. ”

Roberta Speyer: “So that’s then another part of the whole dilemma because you have to preserve their fertility, and some of the things that are going to help them with their disease are going to render them infertile?”

Bjorn Busund, MD: “But in many of these infertile endometriosis patients it is a good idea to do surgery, maybe use GnRH-analogs or other medical treatment for a few months and then take them right into an IVF unit for assisted reproduction.”

Roberta Speyer: “Thank you very much for taking the time to talk to us about this disease. I appreciate it very much and we have to now let these doctors get to the beach in Cancun. Thank you.”

All: “Thank you.”




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