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We talk to Dr. Jan Olek, Deputy Head of the Hospital of St. Józef in Dortmund, co-founder of Miracolo Clinic.
Joanna Lewandowska: Doctor, we hear about endometriosis more and more often, but what is this disease really?
Dr Jan Olek: Endometriosis is the presence of tissue that lines the uterus, called the endometrium, outside the uterus. This tissue is governed by the laws of the endometrium, i.e. it grows during the menstrual cycle and bleeds during menstruation. Bleeding causes pain, inflammation, wounds. Healing wounds lead to the formation of adhesions. Even though endometriosis has many features in common with cancer, it is a benign disease in the histological sense. It expands, infiltrates various organs, spreads. Endometriosis can and often makes it difficult to get pregnant, it also increases the risk of miscarriage and ectopic pregnancy and, to a small extent, cancer.
Endometriosis is spoken of as a mystery disease, is it because the causes of its origin are still unclear?
It is a very insidious and cunning disease, which is why it is often compared to a chameleon. Why? Endometriosis is not visible. Women affected by endometriosis are young, slim and healthy looking people! Endometriosis is not usually seen on ultrasound, nor is it seen on laboratory tests because there is no marker of the disease at all. It is difficult for a man to believe what he does not see. Are the reasons unclear? There are more and more studies showing the influence of toxins, especially dioxins (TCDD) on the occurrence and advancement of endometriosis. In Shanghai, a 2017 study was published that suggested the effect of intestinal dysbiosis on endometriosis. The influence of the immune system on the development of the disease is also very well documented.
How many women in Poland are sick?
It is not known exactly. Only estimates of about 10% of women of reproductive age are available. According to a Janssen study published in 2013 in Human Reproduction, 70 percent. a teenager with dysmenorrhea had endometriosis. One-third were stage III or higher. In Poland, I am not aware of any studies on the incidence of endometriosis. The need for laparoscopy to make a definitive diagnosis is quite a limiting factor.
Who gets sick most often?
Young women of childbearing age, most often thin, with heavy and painful menstrual bleeding. Depending on the source, 40 – 80 percent. women with infertility suffer from endometriosis. Autoimmune diseases, most often Hashimoto’s disease, coexist with endometriosis. A large percentage of women also present symptoms of intestinal dysbiosis, such as flatulence, constipation, diarrhea, but also headaches, fatigue, depressed mood and libido.
What symptoms should be alarming for a woman?
Pain and infertility. Especially menstrual cramps, which reduce the quality of life, prevent normal functioning and force you to take painkillers, should raise the suspicion of endometriosis. Spotting and premenstrual pain are also common. If it is difficult to get pregnant for over 12 months, semen analysis should be performed and laparoscopy with fallopian tube patency test and hysteroscopy should be considered.
In addition to pain, infertility is one of the main symptoms of endometriosis. What is the effect of endometriosis on infertility?
Endometriosis is a cunning disease not only because you can’t see it, but also because you don’t always feel it. 20 percent patients with endometriosis have absolutely no pain, which makes diagnosis very difficult and delayed. Endometriosis, through inflammation and adhesions, may impair ovulation, reduce the quality of the egg, and may lead to obstruction of the fallopian tubes. Endometriomas release pro-inflammatory cytokines that can slow down the peristaltic movements of the fallopian tubes, increasing the risk of ectopic pregnancy. Endometriosis may hinder sperm transport and disrupt the process of embryo implantation.
The problem of infertility in terms of endometriosis is not limited only to the medical aspect. It also has its reflection on the patient’s psyche. What does it come down to?
Endometriosis is an overlooked and neglected disease entity. Women experiencing pain are often lonely heroines who do not always find understanding among their loved ones and among doctors. This is the social aspect. Let’s not forget about the inflammatory background of the disease and the often coexisting intestinal dysbiosis, which can lead to a reduced production of neurotransmitters such as serotonin. Serotonin is the happiness hormone. The vast majority of serotonin does not come from the brain, but from enterochromatophilic cells in the intestine. This is why it is said that happiness is born in the gut. Depressed mood, chronic fatigue, and sometimes sleep disturbances, can also have a negative impact on the psyche of patients.
What are the classic treatments for endometriosis?
The gold standard is laparoscopy with the removal of as many lesions as possible. It should be emphasized that surgical treatment is treating the effects of a disease, not its source. The second pillar in treatment is hormone therapy. However, it has limitations in the group of women with infertility. It is impossible to get pregnant during the therapy, and treatment with hormones before trying to get pregnant does not increase the pregnancy rate. Then you can take advantage of alternative medicine, which often turns out to be very helpful. Diet therapy has an anti-inflammatory effect, strengthens the immune system and regulates the intestinal flora. Osteopathy is often helpful in the fight against pain. The support of a psychologist is also very helpful.
How is endometriosis diagnosed?
Laparoscopy is the gold standard in both diagnosis and treatment. Unfortunately, there is no other 100%. diagnostic method. Stage I-II endometriosis is invisible on ultrasound. Higher stages of endometriosis, especially in the presence of endometriotic cysts, can be detected with high probability on ultrasound. Unfortunately, it is not possible to diagnose endometriosis on the basis of laboratory tests.
What is the role of transvaginal laparoscopy in treating and fighting infertility? What is the innovation of this method?
In the diagnosis of endometriosis, it is important to assess the condition of the pelvic organs, and in the case of infertility, also to assess the condition of the uterus and fallopian tubes. Transvaginal laparoscopy allows us to very accurately assess all of the above-mentioned structures under high magnification. The examination begins with hysteroscopy, that is, viewing the uterus from the inside. If we find any changes, such as septum, polyp or myoma, we can remove these changes immediately thanks to the surgical mantle. Then we enter the pelvic cavity through the posterior vaginal fornix. In the pelvis, we can very precisely assess the condition of the posterior wall of the uterus, ovaries, fallopian tubes, Douglas sinus, appendix and the final segment of the large intestine. If we detect endometrial changes, we can remove them very precisely and sparingly for the patient with a laser. During the examination, you can inject a contrast into the uterus and assess the patency of the fallopian tubes. The procedure is performed in an aquatic environment, which reduces the risk of postoperative adhesions and diametrically reduces the level of postoperative pain. The big advantage of this treatment is the cosmetic effect in the form of no scarring on the abdomen.