Endometriosis - Yale Medicine Explains

Transcript

• 00:04Endometriosis
• 00:05is a disease where the
• 00:07endometrial lining of the uterus
• 00:09grows inside the abdomen. Endometrial
• 00:11cells respond to hormones, so
• 00:13they are the same cells
• 00:14that grow and shed when
• 00:15someone has their menstrual cycle
• 00:17or their period. When you
• 00:18have that tissue growing where
• 00:19it's not supposed to and
• 00:21essentially menstruating
• 00:22every month in the abdomen,
• 00:24internal bleeding every month, it
• 00:26causes a lot of pain
• 00:27and it can lead to
• 00:28infertility.
• 00:29Because the pain is predominantly
• 00:31in the pelvis
• 00:32and because most of these
• 00:34lesions grow in the pelvis,
• 00:36we've always thought of this
• 00:37as an isolated gynecologic
• 00:40disease. But largely because of
• 00:42some of the research we've
• 00:43done here at Yale, we're
• 00:45identifying that this disease has
• 00:47impacts throughout the body.
• 00:49For example, women can have
• 00:51concomitant cardiovascular
• 00:53conditions with endometriosis,
• 00:55neurologic conditions such as migraine,
• 00:57immunologic
• 00:59and autoimmune conditions such as
• 01:01fibromyalgia
• 01:02or chronic fatigue syndrome, which
• 01:04is indirect evidence that it's
• 01:06the disease that is not
• 01:08confined to pelvis, but rather
• 01:10affects
• 01:11entire body.
• 01:16I always had painful periods.
• 01:18I always had debilitating cramps
• 01:20and bad headaches,
• 01:22and that started when I
• 01:24was thirteen. Once I was
• 01:25fourteen, I started having really
• 01:27severe abdominal pain, and I
• 01:29was in the emergency room
• 01:31once every two weeks.
• 01:33The gold standard diagnosis historically
• 01:36for endometriosis
• 01:37has been a surgical diagnosis,
• 01:38meaning we don't have great
• 01:39ways to diagnose it. Otherwise,
• 01:41eighty five percent of patients
• 01:42with endometriosis
• 01:43don't have lesions large enough
• 01:45to be seen on imaging.
• 01:46Many people will have a
• 01:47diagnostic surgery to take a
• 01:48look inside the abdomen. This
• 01:50is done with laparoscopy, which
• 01:51means small incisions looking at
• 01:52the abdomen. We can bring
• 01:53a camera and really zoom
• 01:55in and see all of
• 01:57the tissue and look closely
• 01:58at it to find any
• 01:59potential lesions of endometriosis
• 02:01to resect it and get
• 02:02a pathologic diagnosis.
• 02:05Once it's diagnosed
• 02:07in a patient, I tell
• 02:08them we have good news
• 02:09and bad news. So the
• 02:11good news, we know why
• 02:12you had this much pain
• 02:14throughout your
• 02:15menstrual cycles and so on.
• 02:17The bad news is that
• 02:18endometriosis
• 02:19is chronic,
• 02:20and basically, a patient needs
• 02:22treatment for the entire length
• 02:24of reproductive lifespan.
• 02:26Typically treat endometriosis
• 02:28first medically.
• 02:30Often something as simple as
• 02:31a birth control pill can
• 02:33stop endometriosis
• 02:34from progressing.
• 02:35We have other drugs that
• 02:36modify hormones.
• 02:37However, when hormonal therapies don't
• 02:40work,
• 02:41we often need to perform
• 02:42surgery.
• 02:44The resection of those lesions
• 02:46and the benefit in terms
• 02:47of pain is variable. So
• 02:49it's not well predicted to
• 02:51say a patient will have
• 02:52this much duration
• 02:53of time of pain relief
• 02:55after excision, but we do
• 02:56know that when you pair
• 02:57surgical excision
• 02:58with medication management, specifically hormonal
• 03:00management after the surgery, you
• 03:02have longer durations of pain
• 03:03relief compared to surgery alone.
• 03:05So it's a tool and
• 03:06it's not curative.
• 03:08After we found the right
• 03:09medication or regimen, what what
• 03:12changed in your life? How
• 03:13did your life change?
• 03:15Everything
• 03:16changed. I gained my life
• 03:18back
• 03:19because I
• 03:21I didn't have a life.
• 03:22I was
• 03:23curled up in a ball
• 03:24in bed with a heating
• 03:26pad. I had rashes from
• 03:27my stomach because of how
• 03:28much I was using it.
• 03:30I was
• 03:32taking so many pain meds
• 03:34every single day. I had
• 03:35a pain management specialist.
• 03:37My entire life revolved around
• 03:39the appointments that I was
• 03:40going to.
• 03:41And now I'm working, I'm
• 03:44in school,
• 03:45I got my life back.
• 03:51I am a firm believer
• 03:52that endometriosis
• 03:53has to be diagnosed early
• 03:55in life, not when woman
• 03:56is in her thirties and
• 03:57planning pregnancy,
• 03:59but perhaps fourteen, sixteen, and
• 04:01so on when she is
• 04:02experiencing those painful periods.
• 04:05Several years ago, we identified
• 04:08micro RNAs in the blood
• 04:09as very sensitive,
• 04:11and specific
• 04:12biomarkers of endometriosis.
• 04:14We've looked,
• 04:15more recently at using these
• 04:17same type of biomarkers in
• 04:19adolescents and younger women when
• 04:20the disease first starts.
• 04:22We are not just diagnosing
• 04:24patients and providing clinical care.
• 04:27In this institution, we are
• 04:29doing cutting edge research
• 04:31on noninvasive
• 04:32biomarkers for endometriosis
• 04:34such as blood samples or
• 04:36saliva samples
• 04:38with hope and goal
• 04:40to have a blood test
• 04:42that can diagnose a patient
• 04:43with reliable certainty
• 04:46of endometriosis
• 04:47without need to be doing
• 04:49laparoscopy.
• 04:51We're also developing biomarkers that
• 04:52might help us choose the
• 04:53best treatment for somebody with
• 04:55endometriosis.
• 04:56The birth control pill is
• 04:57the most commonly used first
• 04:59line medication, but it doesn't
• 05:01always work. We've recently published
• 05:03a paper that shows that
• 05:04we can
• 05:05identify who's resistant to progesterone,
• 05:08who's not going to respond
• 05:10to birth control pills, so
• 05:11we can use personalized medicine
• 05:14to find the best treatment
• 05:15for each patient.
• 05:17This is an inflammatory
• 05:18disease.
• 05:19We're starting to understand the
• 05:21biology behind it, and I
• 05:22believe that will lead to
• 05:23new more specific treatments.