Endometriosis, the clinical history as a fundamental key for its diagnosis
Endometriosis is considered to be a chronic hormonal-dependent inflammatory disease, that is, affected by hormones. This disease influences the quality of life of women who suffer from it, it can be painful, very uncomfortable and even affect their fertility. Its symptoms tend to be thought of as normal by most women thus delaying its diagnosis.
Studies have analyzed that Endometriosis in economic terms involves a high cost. It is estimated that the annual expenditure per woman per year is about €9.579, of which €3.113 are health expenses and €6.298 are estimated for loss of productivity, due to absenteeism and lower productivity of these women when working.
This cost is even higher in cases of severe Endometriosis. Early diagnosis and treatment will allow the improvement of the quality of life in these patients and will reduce this high cost (1).
Why is Endometriosis diagnosed so late?
Many times, the diagnosis can be wrong, it is estimated that this occurs in about 70% of cases.
The onset of symptoms can start at very early age, at least 20% of adolescents who already have symptoms when they are young will go on to be diagnosed in adulthood.
In many cases, their doctors and their own family normalize the pain and symptoms, thus delaying the diagnosis. The same happens with the use of contraceptives that can improve the quality of life however they mask the symptoms and delay the diagnosis.
How to avoid a late diagnosis of Endometriosis?
To try to find an early diagnosis of Endometriosis it is essential to have a good clinical history of the patient, to study it and look for specific symptoms, many times the patient herself can give us the key to the diagnosis (2). It is important to know the family history, since it is common that other women in the family suffer or have suffered from it, to know if there is a family history of hysterectomy (removal of the uterus) due to pain or significant bleeding.
Specialists should think about Endometriosis when the symptoms of Dysmenorrhea (menstrual pain) worsen and are accompanied by:
- Disquiet (constipation).
- Dysuria (pain when urinating).
- Dyspareunia (pain when having sex).
- Rectorrhagia (rectal bleeding).
- Hematuria (blood in the urine).
- Chronic pelvic pain (pelvic pain).
Symptoms that intensify at the time of menstruation are also an important factor to consider and we must also pay special attention to other less frequent symptoms such as pneumothorax, sciatica, pain in the right iliac fossa, more intense colicky lumbar pain during your periods. All these symptoms guide us towards the diagnosis of Endometriosis.
In cases of Deep Endometriosis, the symptoms presented by the patients are more severe, in these cases the disease rarely occurs asymptomatically. We should suspect Endometriosis when the symptoms referred by the patient do not correlate with the size of the lesions observed on ultrasound and in cases of long-standing Dysmenorrhea (menstrual pain) and severe pelvic pain, especially when accompanied by gastrointestinal symptoms, as well as a history of school or work absenteeism.
It is important to distinguish if it is only Endometriosis located at the ovarian level which only occurs in about 10% of cases. Faced with a patient who comes to the hospital emergency room with very intense pain in which only the presence of ovarian Endometriosis is observed, we must consider that this patient will most likely also has Deep Endometriosis and the emergency doctor will not be able to solve her problem because optimal treatment requires the participation of a multidisciplinary team that adequately and individually evaluates each case.
On the other hand, more than about 45% of women who suffer from severe Endometriosis present Adenomyosis, especially if severe uterine bleeding, Dysmenorrhea and Dyspareunia.
The clinical studies will help us guide the diagnosis and the imaging tests will help us to confirm it. Both ultrasound and magnetic resonance imaging (MRI) have a similar sensitivity and specificity, in most cases simple transvaginal ultrasound (3) will give us the diagnosis and in those cases with suspected deep Endometriosis with bladder and rectum involvement. sigma, the study will be completed using pelvic MRI.
In cases in which despite the highly suggestive symptoms there are no findings in the imaging tests, an Amenorrhea test can be used, Amenorrhea (absence of the menstrual cycle) is induced either by means of continuous contraceptives, use of progestogens, or gonadotropin-releasing hormone analogs and if symptoms improve, the diagnostic test for this entity is considered.
In short, with only a good, detailed and oriented medical history and an ultrasound can we make a good diagnosis in most cases.
At Clínica Fertia we strive to follow these guidelines in order to offer patients an early diagnosis and adequate treatment for Endometriosis. Medical treatment allows for a good response in about 85% of cases, that is, being able to control the symptoms, stop the progression of the disease or even its regression, prevent its reappearance, as well as preserving fertility or at least not reducing it.
We cannot continue to normalize menstrual pain. If you have any of the symptoms that we have discussed in this post, we encourage you to make an appointment at our clinic so that we can study your medical history and find out how we can help you.
References
- Della Corte L, Di Filippo C, Gabrielli O, Rappucia S, La Roca VL, Ragusa R, Fichera M, Commodari E, Bifulco G, Giampaolino P.The burden of endometriosis on women´s lifespan:A narrative overview on quality of life and psychosocial wellbeing. Int J Environ Res Public Health. 2020; 17:4683.
- Agarwal SK, Chapron C, Giudice LC, Laufer MR, Layland N, Missmer SA, Singh SS, Taylor HS. Am J Obstet Gynecol.2019;220:354
- Van den Bosch T, Van Schoubroeck D. Best Pract Res Clin Obstet Gynecol.2018;51:16-24.
