Endometriosis is a silent disorder affecting millions of women each year across the globe.
World Health Authority (WHO) recognise there are many challenges for women living with endometriosis. Estimating 10% of reproductive aged women are suffering from Endometriosis globally.
For centuries women’s health disorders have been continually under diagnosed and healthcare providers don’t appreciate the ongoing suffering outcomes women live. Underestimate stress, anxiety, emotional and psychological hardship the disorders bring to every woman, who lives health disorders daily. The ignorance and misunderstanding around genealogical disorders continue globally. There seems to be little correlation between the extent of endometrial lesions and severity or duration of symptoms: Some women have mild symptoms while others more severe outcomes. With painful occurrences.
W.H.O states in many countries, the general public and most front-line healthcare providers are not aware of the distressing and life-altering pelvic pain lived is not normal, leading to a normalisation and stigmatisation of symptoms and significant diagnostic delay (2,3).
The disorder is also linked to infertility due to its retrograde actions internally.
Endometriosis is the second most common genealogical condition affecting women in the UK. A woman’s quality of life is affected drastically causing many health and emotional issues 24/7. Involved in fertility / IVF disappointments. Emotionally and psychologically undermining and tainting life. Affecting every part of a woman’s life. Sexual relationships are painful with this condition. Keeping a career going and looking after a family is a big challenge with endometriosis, a very debilitating condition, with fatigue and Anaemia.
Disorder retrograde reactions
Tissue similar to the lining of the uterus grows outside the uterus, causing pain and/or infertility. Causing a chronic inflammatory reaction that may result in the formation of scar tissue (adhesions, fibrosis) within the pelvis and other parts of the body. Infertility occurs due to the probable effects of endometriosis on the pelvic cavity, ovaries, fallopian tubes, or uterus.
The inside of the uterus has several layers of cells which make up the lining (or endometrium) that grows and is shed every month during menses. After about two weeks of increasing hormone (primarily oestrogen) stimulation in the early part of the menstrual cycle, the cells increase in number to create a lush surface for an embryo to implant, dig in and create a pregnancy. Endometriosis causes lining dysfunction. Extreme thinness or extreme thickness can cause a problem with uterine receptivity to the embryo trying to implant.
Unfortunately, endometriosis is a health condition under acknowledged and under supported in today’s medical care spectrum. Globally the situation is mirrored.
W.H.O state, women who could benefit from medical symptomatic management are not provided with treatments due to limited awareness of endometriosis among primary healthcare providers.
Outside causes to hormonal imbalance and endocrine-disrupting chemicals.
Stress and hormonal mimicking can play a role in hormonal imbalance. Certain chemicals, both synthetic and natural, known as ‘endocrine disruptors’ can interfere with endocrine function and upset the body’s hormone balance. Endocrine disruptors can be found in many everyday items, including some kinds of makeup and skin creams: certain plastics and cleaning products, heavy metals such as Arsenic. Heavy metal an mimic chronic exposure can interfere with metabolism, heightening the risk of hormonal disruption.
Endocrine disruptors mimic natural hormones in the body, which effectively “confuses” the body’s normal hormone signals and changes hormone production levels.
Origins of endometriosis are thought to be multifactorial, meaning that many different factors contribute to its development.
Hormonal influences are part of the cause and from a Joy Wisdom Trust perspective that needs urgent attention to reduce the symptoms and cause. US Dr. John Lee recognised hormonal imbalance as the core issue. Back in the 1990s Dr Lee, helped women by prescribing progesterone cream (not available in UK) he successfully helped to reduce symptoms and helped correct many infertility issues. (Read Dr. Lees books for more information).
Treatment options for infertility
Due to endometriosis actions, treatment options include laparoscopic surgical removal of endometriosis, ovarian stimulation with intrauterine insemination (IUI), and in vitro fertilization (IVF), but success rates vary (4). Other conditions may occur alongside endometriosis, requiring diagnosis and management.
Endometriosis has significant social, public health and economic implications. A complex disease that affects some women from the onset of their first period (menarche) through menopause regardless of ethnic origin or social status.
Most current hormonal management is not suitable for women suffering from endometriosis who wish to become pregnant, since medication may affect ovulation.
Due to diagnostic delays, prompt access to available treatment methods, including non-steroidal analgesics (painkillers), oral contraceptives and progestin-based contraceptives is often not achieved.
Multidisciplinary treatment addressing different symptoms and overall health should involve different specialists, such as pain specialists, pelvic physiotherapists, complementary and alternative medicine specialists, general practitioners, and psychologists, in addition to gynaecologists, to be most effective (W.H.O 2/10).
As the 2020 government women’s health survey highlighted there was a lack of understanding and broader picture is unrecognised by health care providers. And Endometriosis UK, is calling for more to be done to remove stigma and help women who suffer daily from this painful and debilitating disorder.
W.H.O suggestions on addressing current challenges and priorities Due to limited capacity of health systems in many countries, access to specialised surgery for those who need it is sub-optimal. In addition, and especially in low and middle-income countries, there is a lack of multi-disciplinary teams with the wide range of skills and equipment needed for the early diagnosis and effective treatment of endometriosis.
Essentially WHO states there is not enough prevention and education to make change.
Although primary health care professionals should play a role in screening and basic management of endometriosis, tools to screen and accurately predict patients and populations who are most likely to have the disease are lacking. In addition, many knowledge gaps exist, and there is need for non-invasive diagnostic methods as well as medical treatments that do not prevent pregnancy.
For instance, in some areas of devolved government hospital trusts there may only be one endometriosis nurse available per hospital. This makes waiting times elongated and women miss out on early diagnosis and treatment due to lack of health care services, cutbacks, and no women’s health care specialists.
W.H.O current priorities related to endometriosis include:
Raising awareness about endometriosis among health care providers, women, men, adolescents, teachers, and wider communities.
Local, national, and international information campaigns to educate the public and healthcare providers about normal and abnormal menstrual health and symptoms are needed.
Training all healthcare providers to improve their competency and skills to screen, diagnose, manage, or refer patients with endometriosis. This can range from basic training of primary healthcare providers to recognize endometriosis, to the advanced training of specialist surgeons and multidisciplinary teams.
Ensuring that primary health care plays a role in screening, identifying, and providing basic pain management of endometriosis, in situations where gynaecologists or advanced multidisciplinary specialists are unavailable.
Advocating for health policies that ensure access to at least a minimum level of treatment and support for patients with endometriosis.
Setting up referral systems and care pathways consisting of well-linked primary healthcare centres and secondary and tertiary centres with advanced imaging, pharmacologic, surgical, fertility and multi-disciplinary interventions.
Strengthening capacity of health systems to achieve early diagnosis and management of endometriosis.
WHO aims to stimulate and support the adoption of effective policies and interventions to address endometriosis globally, especially in low and middle-income countries. We need more research natural progression and environmental risk factors, non-invasive bio markers. Disease classification, personal centred care/ treatments. Interventions in endometriosis. (2.5) Accelerating collaborative global action to improve access to reproductive health care for women globally, including in low- and middle-income countries.
Joy Wisdom Trust www.joywisdomtrust.org
1. World Health Organization (WHO). International Classification of Diseases, 11th Revision (ICD-11) Geneva: WHO 2018.
2. Zondervan KT, Becker CM, Missmer SA. Endometriosis. N Engl J Med 2020; 382:1244-56.
3. Agarwal SK, Chapron C, Giudice LC, et al. Clinical diagnosis of endometriosis: a call to action. Am J Obstet Gynecol 2019(4):354-64.
4. Johnson NP, Hummelshoj L, World Endometriosis Society Montpellier Consortium. Consensus on current management of endometriosis. Hum Reprod 2013;28(6):1552-68.
5. Horne AW, Saunders PTK, Abokhrais IM, et al. Top ten endometriosis research priorities in the UK and Ireland. Lancet 2017; 389:2191-92.
6. Johnson NP, Hummelshoj L, Adamson GD, et al. World Endometriosis Society consensus on the classification of endometriosis. Hum Reprod 2017;32(2):315-24.
7. Wen X, Xiong Y, Qu X, et al. The risk of endometriosis after exposure to endocrine-disrupting chemicals: a meta-analysis of 30 epidemiology studies. Gynecol Endocrinol 2019;(35):645-50.