Well we are now fully into the swing of endometriosis awareness month so let’s kick things off with some posts.
First off there is study from China looking at how the type and position of endometriosis can determine the symptoms. This study took 177 women with deeply infiltrating endometriosis (DIE) and 177 women with non-DIE and compared their symptoms and what their disease looked like. This is a summary of they found:
- Women with DIE had been suffering with their symptoms for an average of 13.8 years compared to 5.2 years for women with non-DIE
- The infertility rate for both DIE and non-DIE sufferers was about the same (36% and 35% respectively)
- Women with DIE were more likely to have a higher stage of the endometriosis (58.8% of women with DIE were stage IV; the majority of the non-DIE women were stage III, 43.5%)
- Severe dysmenorrhoea, chronic pelvic pain, deep dyspareunia, dyschezia and dysuria were all more common in women with DIE. It’s interesting that dysuria (painful urination) was only found in the DIE patients (although, this study only looked at a relatively small number of women).
- Women with non-DIE were more likely to have endometriotic lesions on the surface of the uterus, bladder peritoneum and the broad ligament. Women with DIE were more likely to have lesions on the uterosacral ligaments, fallopian tubes, ureter and the rectum. Women with DIE were also much more likely to have obliteration of the cul-de-sac (44.6% compared to 22% for non-DIE), which may explain the higher frequency of dyspareunia.
- Women with DIE were also more likely to also have adenomyosis than those with non-DIE (15.8% compared to 4.7%, respectively)
- If the patient also had ovarian endometriotic cysts, women with DIE were more likely to have them on both ovaries (35.2%), whereas women with non-DIE were more likely to have them just on one side (31.6% on the left, 22.6% on the right side).
These types of studies are potentially very useful and much larger studies like this are needed. This is because, if a certain type/location of endometriotic lesions are associated with certain symptoms, this should give surgeons a better idea of where to look for the disease, thus increasing the accuracy of diagnosis. More posts coming soon!
Matt- what are the diagnostic criteria for DIE? Is it surgical observation?ReplyDelete
Yes, as with most other types of endo, visualisation at laparoscopy is considered the gold standard for DIE, however DIE lesions can be difficult to spot (if they are small) so if you suspect you have DIE it is important to get a skilled, specialist surgeon to perform your surgery. However, there are methods being developed to use MRI for the diagnosis of DIE as this method is especially good at identifying DIE associated with the rectum. There is a great free-to access paper on the subject of DIE which provides some great info here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2905889/
Wishing you all the best,