Day 106. Endometriosis

In November 2012 on November 26, 2012 at 11:01 pm

Today at the National Health and Medical Research Congress I witnessed one of the most compelling presentations in my short life as a scientist.

Before I start, you need to know a little about endometriosis; it’s a condition in which the tissue that lines the uterus is also found outside the uterine cavity. This might not sound like such a big deal, but remember that in menstruating women the lining of the uterus undergoes a monthly, hormone-regulated cycle of growth and loss. So, in effect, women suffering with endometriosis have pockets of tissue in abnormal sites in their abdominal cavity that are swelling and subsiding on a regular basis. This has consequences for many organs in the vicinity – such as bowel, bladder, ovaries – and can create inflammation and scarring in places that are normally very stable.

Now, back to the presentation. Dr Susan Evans is an Adelaide-based clinician whose area of expertise is described in her abstract (a presentation summary) contained in the conference booklets for attendees. Here are some excerpts:

Dr Susan Evans is a Gynaecologist, Laparoscopic Surgeon and Pain Medicine Physician from Adelaide, Australia. She is author of the book ‘Endometriosis and Pelvic Pain’ the eBook ‘Pelvic Pain’ and co-author of the policy paper ‘The Pelvic Pain Report: The $6Billion Woman and the $600Million Girl’.

Her presentation provides an understanding of how the ‘big picture’ of chronic pelvic pain fits with the concept of endometriosis as a systemic, hormonally-influenced, multi-organ, inflammatory, neurovascular condition.

[Susan] believes that pelvic pain is a substantially under-researched area with enormous potential for new discoveries. She hopes to explain the overall clinical picture of pelvic pain to stimulate new and original thought in this area.

Susan speaks in a wonderfully strong and confident voice, and as an audience we were all mesmerised. I took the following notes as I sat, spellbound:

“The endometriosis sufferer, let’s think about her experience. There a lot of evidence that these women have abnormal experiences right from the start of menarche. A study of Dutch children showed comparable low experience of chronic pain in both boys and girls up to about the age of eleven; after that, the group of girls who will later be diagnosed with endometriosis start to have pelvic pain on a regular basis”

“I’ve had a problem from the beginning” they say.

“It’s hard to imagine the impact that regular pain can have on a teenager – impact on sexuality, school, work, miss out on education, employment, relationsips, reduced confidence”

“Chronic pelvic pain; it means everyone’s confused, it’s so difficult to find care”

“Bloating, food sensitivities, bloated bowel, sharp pains, painful sex, baldder pain, fatigue, headaches, anxiety, depression”

“Let’s think about period pain:  it’s the sum of a woman’s menstrual experience”

“Think about the pain experience – as you get chronic pain, and central nervous system amplification of the pain response, the brain is busy worrying about pain all the time AND the pain is an emotional experience all of the time; this pushes the pain into an overwhelming experience all the time”

“What about treatment? All we have at the moment is surgery and hormonal therapies. Other treatments that should be considered include

  • Education;
  • Dietary changes;
  • Pelvic physiotherapy;
  • Botox for pelvic muscle spasm;
  • Medications for bladder overreactivity’
  • Topical treatments;
  • Treat the central nervous system sensitisation – this hardly ever happens”

I shan’t go on least I repeat myself, but I hope I’ve managed to convey how Susan came across as a clinician with a complete and holistic approach to understanding and managing endometriosis and pelvic pain.

I found Susan thoroughly enlightening.

More conference tomorrow! Can’t wait.

[image thanks to Hey Paul Studios on flickr]


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