Gynaecologists at Abu Dhabi’s main maternity hospital have urged women go to for early check-ups if they continuously suffer from pain in the lower pelvic area, which could be symptomatic of endometriosis.
Doctors at Corniche Hospital told The National they have seen a rise in the number coming to them for diagnosis and treatment for endometriosis.
The disease is common and not life-threatening, but it can affect quality of life and make it difficult to have children if detected at a later stage.
The American Society for Reproductive Medicine found that 24 per cent to 50 per cent of women who experienced difficulty conceiving had endometriosis, but that treatment improved their chances of pregnancy.
“We urge women to seek specialised help if they experience any symptoms, particularly if it persists for more than six months,” said Dr George Botros, consultant gynaecologist and programme director for minimally invasive gynaecology and endometriosis at Corniche Hospital.
“Early diagnosis is key to reducing the risk of endometriosis progression and it may also result in better management of the symptoms.”
What is endometriosis?
It is a painful disorder in which tissue similar to the tissue that normally lines the inside of the uterus, known as the endometrium, grows outside the uterus. It varies in its severity but most commonly affects the ovaries, fallopian tubes and the tissue lining of the pelvis.
At times it is so extensive that it spreads to the rectum, and in some cases, it may require a hysterectomy — an operation to remove all or part of the uterus.
What are the symptoms?
Dr Botros said symptoms include pain before and during periods, heavy painful periods, pain during or after intercourse, and pain during bowel movements and urination, especially during periods.
If the pain persists for more than six months or does not respond to hormonal treatment within three to six months, expert advice should be sought.
What is the treatment?
Most of the time, the condition is not severe and can be resolved with simple keyhole surgery or hormone therapy.
The surgery is minimally invasive and allows a surgeon to access the inside of the abdomen through tiny cuts without making large incisions in the skin. It is the gold standard for accurate diagnosis and surgical treatment.
In the past year, doctors at Corniche Hospital carried out 350 laparoscopic procedures, of which more than 100 were performed on endometriosis cases.
Dr Botros said one of his patients who was born with one kidney was at risk of losing the vital organ because of the disease.
The endometriotic cyst on her ovary was so large that it had become infected and was pressing against her ureter, damaging her only kidney.
Endometriosis can spread to other organs in those with severe disease and require surgery.
There is no permanent cure for endometriosis, and those that get it at an early age are at a greater risk of getting it again, especially if the disease is severe at the initial diagnosis.
Which age group is most likely to suffer?
Endometriosis can occur anytime from puberty until menopause, and in some cases symptoms persist even after that.
Women between 25 and 35 years are most likely to suffer, with a peak age of 25, said Dr Jed Hawe, consultant gynaecologist and chief of gynaecology at the hospital.
There is no known cause of the condition that affects more than 170 million worldwide, according to a 2020 research paper published in International Journal of Environment Research and Public Health.
“No one really understands the cause,” Dr Hawe said.
“It is likely to be multifactorial with a number of causes working together, maybe it is an immune response or genetically related.
“There is the original theory called Sampson's theory which says it is a result of retrograde flow of menstrual discharge from the uterus through the fallopian tubes.”
Doctors at the hospital have seen patients as young as 15 with endometriosis, and many who had the disease but were given the wrong diagnosis.
“With an untrained eye, it may be difficult to spot,” said Dr Botros, who recalled seeing a 23-year-old whose main symptom was being unable to sit.
“She was seen by many gynaecologists. Her most distressing symptom was that she could not sit on a chair. The laparoscopy by an untrained eye didn’t show anything. I suggested an MRI because her symptoms were persistently suggestive of endometriosis.”
"The MRI showed a small nodule, and a physical check-up showed a large endometriotic nodule that was very deep in her pelvis. We removed it, and her symptoms were cured after the procedure.
“The problem of delayed diagnosis may not be much in this country, but in other countries where we have primary health care physicians and GPs as the first point of contact, the problem may persist as they'll keep giving medications,” Dr Hawe said.
“In the UAE, it is slightly different because a woman will come to see a specialist as soon as she can so they see the experts earlier instead of continuing to try hormonal treatments or pain relief pills and waiting another couple of years for laparoscopy.”
One in seven women suffer from endometriosis during their reproductive age, and it takes an average of seven years from when symptoms start until they are diagnosed, according to the International Journal of Environment Research and Public Health research paper.
Corniche Hospital handled 1,081 endometriosis cases in its outpatient clinics in 2021.