More on Endometriosis
Periodically I share new and relevant information about common deseases, treatments, and cures with my patients. I normally share this information by sending out an email to our confidential email list. However, the 2 articles I will discuss today present information that is very new so I thought it was important to share with all.The Clinically Important Article
In February of 2009, an Australian team reviewed 3700 live births and were able to determine that women with endometriosis, specifically with endometriosis in the ovary, had a 2-fold risk of preterm birth. I thought this was interesting when I saw it but believed that there was not a whole lot of additional data to support their findings. Recently, I read an article in a medical newspaper (Ob.Gyn News vol 44 N0. 10) discussing data that was presented at the European Society of Human Reproduction and Embryology. The researchers looked at a database of over 1.44 million births between 1992 and 2006. They determined that women who had been diagnosed with endometriosis has a 33% higher chance of delivering preterm. More interesting, and just as clinically relevant, they determined that there was a higher chance of other complications such a placental abnormalities, bleeding, and preeclampsia.
Based on this knowledge, I tend to agree with the authors’ conclusions that women with preconceptionally diagnosed endometriosis should be seen and managed (at least in consultation) by a board certified perinatologist (maternal fetal medicine specialist).
The (Well Sort Of) Interesting Article
In this months journal Human Reproduction there was a very interesting article that evaluated a diagnostic test for endometriosis. They compared endometrial biopsy (the endometrium is the inner lining of the uterus that is shed every month during menses) samples for the amount of microscopic nerve fibers and compared that to specimens obtained from inside the abdomen.
Currently, obtaining samples from inside the abdomen is the gold standard for diagnosing endometriosis. This requires an experienced laparoscopic surgeon and endometriosis diagnostician to obtain the proper sample. However, obtaining a sample of the lining of the uterus is very simple and requires no surgical skill in laparoscopy. So, there is a clear advantage to using endometrial biopsy if it proves to be a useful diagnostic adjuvant.
The current study suggests that there is a high degree of correlation between nerve fiber density on the endometrial biopsy specimens and the finding of endometriosis inside the abdomen and pelvis. If we could use endometrial biopsies to better diagnose endometriosis it would save a lot of patients from having unnecessary surgery and it would help us better plan for surgery in patients who do need surgical intervention.
I am reluctant to start using and relying on this technique at this time as this study has several weaknesses. There were weakness in their samples such that the overall quality of their samples we low (only 25% were “satisfactory”). They said in their article that they did not have all of the possible biopsies from inside the abdomen. Thus, they made some correlations based on visual diagnosis only – this creates a significant problem because instead of comparing apples to pears they are now comparing apples to pears plus oranges – further confounding the data.
I look forward to further study of this very promising technique.