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What we would like our Doctors to know about Endometriosis
Findings suggest that endometriosis in locations distant from the pelvis may be more common than previously recognized.1
Presented at the 13th World Congress on Endometriosis - 2017
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Thoracic Endometriosis:
• The most frequent thoracic finding is diaphragmatic implants. 2 • The classic symptoms of diaphragmatic endometriosis are pain in the chest area (pleuritic, usually on the right side), shortness of breath (dyspnea), epigastric pain (upper GI pain), pain in the right shoulder, and upper abdominal pain (right or left side). 3 • Right Side most prevalent but Left and Bilateral occur. 4 • CT/MRI imaging increases sensitivity during symptomatic period. Compare imaging after symptom resolution. Negative imaging does NOT rule out presence of disease. 5 • Cyclic chest pain is the most common symptom but Catamenial Pneumothorax (CP) is most common Clinical Manifestation. 6 • Youngest documented case study CP – age 11 yrs. 7 Bowel Endometriosis: • Even when endometriosis does not occur directly on the bowel, it can cause bowel symptoms. Inflammatory mediators can affect the bowel and contribute to them.8 • Common complaints are frequently misdiagnosed as IBS • Nausea / Vomiting associated with small and large intestines.9 • Bowel changes with cycle alternating Constipation and Diarrhea Urinary Endometriosis: • Women with urinary tract endometriosis have few or no symptom. • Bladder involvement often presents like Interstitial Cystitis. Full-thickness lesions may cause blood in urine.10 |
Support through recovery is helpful:
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Recovery Time
Surgeries can take weeks or months to recover from. Societies’ support during this time is extremely important to healing. |
Diet
Anti-inflammatory, organic unprocessed food helps with cycle symptoms. Start with no sugar, dairy and refined flours. |
Physical Therapy
Patients educated about the neuroscience of pain are able to function better, exercise more and experience less pain.11 |
Thoracic Endometriosis Related Pneumothorax
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33% Lung Collapse in females were the result of Endometriosis
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Catamenial pneumothorax and thoracic endometriosis (TE) are still under-diagnosed. Infertility and uterine procedures are significantly associated. Scapular or thoracic pain during menses often precedes the occurrence of pneumothorax and is highly specific for the diagnosis of TE.12
Pain can occur during ovulation, PMS and menses. SPT outside of the Catamenial time frame DOES NOT rule out Endometriosis |
(TE) Clinical Manifestations:
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The current stage does not align to endometriosis and organ systems. ICD11 Codes will update this.
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Footnotes:
1. Micrometastasis of endometriosis to distant organs in a murine model. Elham N. Samani1, Ramanaiah Mamillapalli1, Fei Li1, Levent Mutlu1, Demetra Hufnagel1, Graciela Krikun1, Hugh S. Taylor1 www.impactjournals.com/oncotarget/index.php?journal=oncotarget&page=article&op=view&path%5B%5D=16889&path%5B%5D=54040
2. 2017 Journal of Minimally Invasive Gynecology, Vol. 19, Issue 6, p742–748: Thoracic Endometriosis Syndrome is Strongly Associated With Severe Pelvic Endometriosis and Infertility
3. Best Practices for Treating Diaphragmatic Endometriosis. www.nezhat.org/diaphragmatic-endometriosis/
4. Channabasavaiah A, Joseph JV. Revisiting the association between clinical presentation and thoracic pathology based on thoracoscopic findings in 110 patients.” Medicine. 2010;89(3):183-188
5. Rousset P et al. Thoracic endometriosis syndrome: CT and MRI features.Clin Radiol.2014;69(3):323-330. Rousset P et al. MR Diagnosis of diaphragmatic endometriosis. Eur Radiol. 2016;26(11):3968-3977
6. Alifano et al. Catamenial and noncatamenial endometriosis related or non-endometriosis related pneumothorax referred for surgery. Amer J Resp Crit Care 2007;176:1048-1053
Rousset-Jablonski et al. Catamenial pneumothorax and endometriosis-related pneumothorax: clinical features and risk factors. Hum Reprod Adv Access 2011;0(0)1-8.
7. Masters R et al. Refractory juvenile catamenial pneumothorax: a case report and brief literature review.” J Ped Adolesc Gynecol. 2016;29:187.
8. Center for Endometriosis Care: http://centerforendo.com/endometriosis-and-bowel-symptoms/
9. TENC Endometriosis Symposium 2014 - Dr Ken Sinervo. https://www.youtube.com/watch?v=j0gQwxqQ6os
10. Ferrero S, et al. Diagnosis and management of bladder endometriosis. J Endometr Pelvic Pain Disord 2009; 1(3_4): 113 - 121
11. Why Pelvic Pain Hurts. Adriaan Louw, Sandra Hilton and Carolyn Vandyken
12. Rousset-Jablonski et al. Catamenial pneumothorax and endometriosis-related pneumothorax: clinical features and risk factors. Hum Reprod Adv Access 2011;0(0)1-8
13. Channabasavaiah AD, Joseph JV. Thoracic endometriosis: revisiting the association between clinical presentation and thoracic pathology based on thoracoscopic findings in 110 patients. Medicine (Baltimore) 2010;89:183-188.
1. Micrometastasis of endometriosis to distant organs in a murine model. Elham N. Samani1, Ramanaiah Mamillapalli1, Fei Li1, Levent Mutlu1, Demetra Hufnagel1, Graciela Krikun1, Hugh S. Taylor1 www.impactjournals.com/oncotarget/index.php?journal=oncotarget&page=article&op=view&path%5B%5D=16889&path%5B%5D=54040
2. 2017 Journal of Minimally Invasive Gynecology, Vol. 19, Issue 6, p742–748: Thoracic Endometriosis Syndrome is Strongly Associated With Severe Pelvic Endometriosis and Infertility
3. Best Practices for Treating Diaphragmatic Endometriosis. www.nezhat.org/diaphragmatic-endometriosis/
4. Channabasavaiah A, Joseph JV. Revisiting the association between clinical presentation and thoracic pathology based on thoracoscopic findings in 110 patients.” Medicine. 2010;89(3):183-188
5. Rousset P et al. Thoracic endometriosis syndrome: CT and MRI features.Clin Radiol.2014;69(3):323-330. Rousset P et al. MR Diagnosis of diaphragmatic endometriosis. Eur Radiol. 2016;26(11):3968-3977
6. Alifano et al. Catamenial and noncatamenial endometriosis related or non-endometriosis related pneumothorax referred for surgery. Amer J Resp Crit Care 2007;176:1048-1053
Rousset-Jablonski et al. Catamenial pneumothorax and endometriosis-related pneumothorax: clinical features and risk factors. Hum Reprod Adv Access 2011;0(0)1-8.
7. Masters R et al. Refractory juvenile catamenial pneumothorax: a case report and brief literature review.” J Ped Adolesc Gynecol. 2016;29:187.
8. Center for Endometriosis Care: http://centerforendo.com/endometriosis-and-bowel-symptoms/
9. TENC Endometriosis Symposium 2014 - Dr Ken Sinervo. https://www.youtube.com/watch?v=j0gQwxqQ6os
10. Ferrero S, et al. Diagnosis and management of bladder endometriosis. J Endometr Pelvic Pain Disord 2009; 1(3_4): 113 - 121
11. Why Pelvic Pain Hurts. Adriaan Louw, Sandra Hilton and Carolyn Vandyken
12. Rousset-Jablonski et al. Catamenial pneumothorax and endometriosis-related pneumothorax: clinical features and risk factors. Hum Reprod Adv Access 2011;0(0)1-8
13. Channabasavaiah AD, Joseph JV. Thoracic endometriosis: revisiting the association between clinical presentation and thoracic pathology based on thoracoscopic findings in 110 patients. Medicine (Baltimore) 2010;89:183-188.