Endometriosis is a common gynecological disorder affecting approximately 10% of women of reproductive age. Severe dysmenorrhoea and urinary pain are common symptoms of endometriosis. However, recent studies have shown that these symptoms may be predictive of a specific type of endometriosis known as deep infiltrating endometriosis (DIE). This article explores the latest research on how severe dysmenorrhoea and urinary pain can help predict the presence of DIE and how this can aid clinicians in diagnosing and treating this often debilitating condition. This research is important for healthcare professionals involved in the care of women with endometriosis, including doctors, nurses, and pharmacists in the field of gastroenterology.
A recent study conducted in Singapore has shown that severe dysmenorrhoea, pain related to urinary and gastrointestinal tracts, higher fertility desire, and infertility rate are all associated with deep infiltrating endometriosis. On the other hand, heavy menstrual bleeding is predictive of adenomyosis.
The study accessed the database of the National University Hospital in Singapore and identified patients undergoing index surgery for endometriosis or adenomyosis from 2015 to 2021. The social and epidemiological features of those diagnosed with endometrioma only, adenomyosis only, and deep infiltrating endometriosis were then compared.
The study found that patients with pain symptomatology and subfertility should be referred early to a tertiary center with the capability to diagnose and manage deep infiltrating endometriosis. Overall, 259 patients met the inclusion criteria, of whom 59 had ovarian endometrioma only, 47 adenomyosis only, and 152 deep infiltrating endometrioses.
Regarding specific symptoms, deep infiltrating endometriosis showed higher rates of severe dysmenorrhoea and out-of-pocket private surgical care versus endometrioma only. The former also correlated with a higher fertility desire and a lower body mass index when compared to adenomyosis only. On the other hand, heavy menstrual bleeding occurred more frequently in those with adenomyosis.
Notably, the duration between diagnosis and surgery was almost double among patients with deep infiltrating endometriosis compared to those with endometrioma only. They were also more likely to undergo a private class of surgery despite this method being more expensive in Singapore, which has an out-of-pocket funded healthcare system.
The researchers noted that the awareness of long delays in the diagnosis of endometriosis and disappointing treatments have been raised since the 1980s. Though efforts have been made in public education and primary care consultation to accelerate the identification of symptoms and treatment of patients, the longer duration between diagnosis and the index operation in this study further demonstrated the delay in receiving treatments and the underlying challenges in providing care for this most debilitating form of endometriosis.
Patients with severe pain symptomatology should be referred to a tertiary center with the ability to diagnose and manage deep infiltrating endometriosis as this may frequently require complicated excisions of endometriotic deposits affecting the urinary or gastrointestinal tracts.
In conclusion, endometriosis still presents challenges in diagnosis and management. Pain symptomatology and subfertility should prompt early referral to a tertiary center for targeted management. Research and development of improved diagnostic and therapeutic methods for deep infiltrating endometriosis can help address the challenges in providing care for this condition.
In conclusion, severe dysmenorrhoea and urinary pain have been identified as potential predictors of deep infiltrating endometriosis. This information is crucial for healthcare professionals in the field of gastroenterology as it can aid in the timely diagnosis and treatment of this debilitating condition. It is essential to stay up-to-date with the latest research and medical advancements in this area to provide the best possible care for our patients. As always, being attuned to our patients’ needs and symptoms is of utmost importance in the diagnosis and management of endometriosis. Let us continue to work together to improve the quality of life for women experiencing this condition.
