WEBVTT

NOTE duration: "00:05:33.184"


NOTE Confidence: 0.99572754

00:00:04.080 --> 00:00:04.580
Endometriosis

NOTE Confidence: 0.97703046

00:00:05.200 --> 00:00:06.799
is a disease where the

NOTE Confidence: 0.97703046

00:00:06.799 --> 00:00:08.639
endometrial lining of the uterus

NOTE Confidence: 0.97703046

00:00:08.639 --> 00:00:11.059
grows inside the abdomen. Endometrial

NOTE Confidence: 0.97703046

00:00:11.200 --> 00:00:12.794
cells respond to hormones, so

NOTE Confidence: 0.97703046

00:00:12.794 --> 00:00:13.995
they are the same cells

NOTE Confidence: 0.97703046

00:00:13.995 --> 00:00:15.115
that grow and shed when

NOTE Confidence: 0.97703046

00:00:15.115 --> 00:00:16.555
someone has their menstrual cycle

NOTE Confidence: 0.97703046

00:00:16.555 --> 00:00:17.835
or their period. When you

NOTE Confidence: 0.97703046

00:00:17.835 --> 00:00:19.114
have that tissue growing where

NOTE Confidence: 0.97703046

00:00:19.114 --> 00:00:20.875
it's not supposed to and

NOTE Confidence: 0.97703046

00:00:20.875 --> 00:00:21.935
essentially menstruating

NOTE Confidence: 0.9745745

00:00:22.235 --> 00:00:23.775
every month in the abdomen,

NOTE Confidence: 0.9745745

00:00:23.835 --> 00:00:25.869
internal bleeding every month, it

NOTE Confidence: 0.9745745

00:00:25.869 --> 00:00:27.170
causes a lot of pain

NOTE Confidence: 0.9745745

00:00:27.310 --> 00:00:28.109
and it can lead to

NOTE Confidence: 0.9745745

00:00:28.109 --> 00:00:28.609
infertility.

NOTE Confidence: 0.9970703

00:00:29.390 --> 00:00:30.849
Because the pain is predominantly

NOTE Confidence: 0.9970703

00:00:30.990 --> 00:00:31.810
in the pelvis

NOTE Confidence: 0.98285866

00:00:32.110 --> 00:00:33.729
and because most of these

NOTE Confidence: 0.98285866

00:00:33.790 --> 00:00:35.729
lesions grow in the pelvis,

NOTE Confidence: 0.98285866

00:00:35.949 --> 00:00:37.390
we've always thought of this

NOTE Confidence: 0.98285866

00:00:37.390 --> 00:00:39.170
as an isolated gynecologic

NOTE Confidence: 0.9885457

00:00:39.629 --> 00:00:41.955
disease. But largely because of

NOTE Confidence: 0.9885457

00:00:41.955 --> 00:00:42.915
some of the research we've

NOTE Confidence: 0.9885457

00:00:42.915 --> 00:00:44.455
done here at Yale, we're

NOTE Confidence: 0.9885457

00:00:44.755 --> 00:00:46.755
identifying that this disease has

NOTE Confidence: 0.9885457

00:00:46.755 --> 00:00:48.295
impacts throughout the body.

NOTE Confidence: 0.9820963

00:00:48.755 --> 00:00:50.995
For example, women can have

NOTE Confidence: 0.9820963

00:00:50.995 --> 00:00:52.215
concomitant cardiovascular

NOTE Confidence: 0.8861003

00:00:52.595 --> 00:00:53.930
conditions with endometriosis,

NOTE Confidence: 0.9671875

00:00:54.630 --> 00:00:56.650
neurologic conditions such as migraine,

NOTE Confidence: 0.99316406

00:00:57.350 --> 00:00:57.850
immunologic

NOTE Confidence: 0.90399843

00:00:58.870 --> 00:01:00.870
and autoimmune conditions such as

NOTE Confidence: 0.90399843

00:01:00.870 --> 00:01:01.370
fibromyalgia

NOTE Confidence: 0.9564306

00:01:02.390 --> 00:01:04.390
or chronic fatigue syndrome, which

NOTE Confidence: 0.9564306

00:01:04.390 --> 00:01:06.405
is indirect evidence that it's

NOTE Confidence: 0.9564306

00:01:06.405 --> 00:01:07.844
the disease that is not

NOTE Confidence: 0.9564306

00:01:07.844 --> 00:01:09.924
confined to pelvis, but rather

NOTE Confidence: 0.9564306

00:01:09.924 --> 00:01:10.424
affects

NOTE Confidence: 0.98413086

00:01:10.884 --> 00:01:11.865
entire body.

NOTE Confidence: 0.9738206

00:01:16.405 --> 00:01:18.479
I always had painful periods.

NOTE Confidence: 0.9738206

00:01:18.479 --> 00:01:20.159
I always had debilitating cramps

NOTE Confidence: 0.9738206

00:01:20.159 --> 00:01:21.140
and bad headaches,

NOTE Confidence: 0.9934419

00:01:22.240 --> 00:01:23.759
and that started when I

NOTE Confidence: 0.9934419

00:01:23.759 --> 00:01:25.119
was thirteen. Once I was

NOTE Confidence: 0.9934419

00:01:25.119 --> 00:01:27.039
fourteen, I started having really

NOTE Confidence: 0.9934419

00:01:27.039 --> 00:01:29.360
severe abdominal pain, and I

NOTE Confidence: 0.9934419

00:01:29.360 --> 00:01:31.005
was in the emergency room

NOTE Confidence: 0.9934419

00:01:31.005 --> 00:01:32.384
once every two weeks.

NOTE Confidence: 0.9462193

00:01:33.405 --> 00:01:35.564
The gold standard diagnosis historically

NOTE Confidence: 0.9462193

00:01:35.564 --> 00:01:36.225
for endometriosis

NOTE Confidence: 0.9453014

00:01:36.525 --> 00:01:38.045
has been a surgical diagnosis,

NOTE Confidence: 0.9453014

00:01:38.045 --> 00:01:39.485
meaning we don't have great

NOTE Confidence: 0.9453014

00:01:39.485 --> 00:01:41.104
ways to diagnose it. Otherwise,

NOTE Confidence: 0.9453014

00:01:41.165 --> 00:01:42.365
eighty five percent of patients

NOTE Confidence: 0.9453014

00:01:42.365 --> 00:01:43.024
with endometriosis

NOTE Confidence: 0.9975586

00:01:43.405 --> 00:01:44.685
don't have lesions large enough

NOTE Confidence: 0.9975586

00:01:44.685 --> 00:01:45.744
to be seen on imaging.

NOTE Confidence: 0.9749747

00:01:46.100 --> 00:01:47.219
Many people will have a

NOTE Confidence: 0.9749747

00:01:47.219 --> 00:01:48.420
diagnostic surgery to take a

NOTE Confidence: 0.9749747

00:01:48.420 --> 00:01:49.619
look inside the abdomen. This

NOTE Confidence: 0.9749747

00:01:49.619 --> 00:01:50.899
is done with laparoscopy, which

NOTE Confidence: 0.9749747

00:01:50.899 --> 00:01:52.100
means small incisions looking at

NOTE Confidence: 0.9749747

00:01:52.100 --> 00:01:53.460
the abdomen. We can bring

NOTE Confidence: 0.9749747

00:01:53.460 --> 00:01:54.820
a camera and really zoom

NOTE Confidence: 0.9749747

00:01:54.820 --> 00:01:56.659
in and see all of

NOTE Confidence: 0.9749747

00:01:56.659 --> 00:01:58.100
the tissue and look closely

NOTE Confidence: 0.9749747

00:01:58.100 --> 00:01:59.085
at it to find any

NOTE Confidence: 0.9749747

00:01:59.085 --> 00:02:00.305
potential lesions of endometriosis

NOTE Confidence: 0.97091675

00:02:00.845 --> 00:02:01.805
to resect it and get

NOTE Confidence: 0.97091675

00:02:01.805 --> 00:02:03.105
a pathologic diagnosis.

NOTE Confidence: 0.9892578

00:02:04.925 --> 00:02:06.145
Once it's diagnosed

NOTE Confidence: 0.9722493

00:02:06.525 --> 00:02:07.885
in a patient, I tell

NOTE Confidence: 0.9722493

00:02:07.885 --> 00:02:09.245
them we have good news

NOTE Confidence: 0.9722493

00:02:09.245 --> 00:02:10.605
and bad news. So the

NOTE Confidence: 0.9722493

00:02:10.605 --> 00:02:12.044
good news, we know why

NOTE Confidence: 0.9722493

00:02:12.044 --> 00:02:13.645
you had this much pain

NOTE Confidence: 0.9722493

00:02:13.645 --> 00:02:14.544
throughout your

NOTE Confidence: 0.98291016

00:02:14.960 --> 00:02:16.800
menstrual cycles and so on.

NOTE Confidence: 0.98291016

00:02:16.800 --> 00:02:18.080
The bad news is that

NOTE Confidence: 0.98291016

00:02:18.080 --> 00:02:18.580
endometriosis

NOTE Confidence: 0.8927002

00:02:18.959 --> 00:02:19.620
is chronic,

NOTE Confidence: 0.9696327

00:02:20.080 --> 00:02:22.400
and basically, a patient needs

NOTE Confidence: 0.9696327

00:02:22.400 --> 00:02:24.160
treatment for the entire length

NOTE Confidence: 0.9696327

00:02:24.160 --> 00:02:25.540
of reproductive lifespan.

NOTE Confidence: 0.8796387

00:02:26.480 --> 00:02:27.700
Typically treat endometriosis

NOTE Confidence: 0.88342285

00:02:28.160 --> 00:02:29.060
first medically.

NOTE Confidence: 0.9813029

00:02:29.575 --> 00:02:30.935
Often something as simple as

NOTE Confidence: 0.9813029

00:02:30.935 --> 00:02:32.474
a birth control pill can

NOTE Confidence: 0.9813029

00:02:32.614 --> 00:02:33.594
stop endometriosis

NOTE Confidence: 0.99902344

00:02:33.974 --> 00:02:34.635
from progressing.

NOTE Confidence: 0.997733

00:02:34.935 --> 00:02:36.135
We have other drugs that

NOTE Confidence: 0.997733

00:02:36.135 --> 00:02:37.034
modify hormones.

NOTE Confidence: 0.9916585

00:02:37.415 --> 00:02:39.974
However, when hormonal therapies don't

NOTE Confidence: 0.9916585

00:02:39.974 --> 00:02:40.474
work,

NOTE Confidence: 0.99975586

00:02:40.775 --> 00:02:42.454
we often need to perform

NOTE Confidence: 0.99975586

00:02:42.454 --> 00:02:42.954
surgery.

NOTE Confidence: 0.9969727

00:02:43.720 --> 00:02:45.739
The resection of those lesions

NOTE Confidence: 0.9886952

00:02:46.120 --> 00:02:47.400
and the benefit in terms

NOTE Confidence: 0.9886952

00:02:47.400 --> 00:02:49.000
of pain is variable. So

NOTE Confidence: 0.9886952

00:02:49.000 --> 00:02:50.760
it's not well predicted to

NOTE Confidence: 0.9886952

00:02:50.760 --> 00:02:52.120
say a patient will have

NOTE Confidence: 0.9886952

00:02:52.120 --> 00:02:53.099
this much duration

NOTE Confidence: 0.9871993

00:02:53.480 --> 00:02:54.599
of time of pain relief

NOTE Confidence: 0.9871993

00:02:54.599 --> 00:02:55.800
after excision, but we do

NOTE Confidence: 0.9871993

00:02:55.800 --> 00:02:56.919
know that when you pair

NOTE Confidence: 0.9871993

00:02:56.919 --> 00:02:57.915
surgical excision

NOTE Confidence: 0.9317133

00:02:58.474 --> 00:03:00.474
with medication management, specifically hormonal

NOTE Confidence: 0.9317133

00:03:00.474 --> 00:03:01.995
management after the surgery, you

NOTE Confidence: 0.9317133

00:03:01.995 --> 00:03:03.194
have longer durations of pain

NOTE Confidence: 0.9317133

00:03:03.194 --> 00:03:04.734
relief compared to surgery alone.

NOTE Confidence: 0.9317133

00:03:04.794 --> 00:03:05.915
So it's a tool and

NOTE Confidence: 0.9317133

00:03:05.915 --> 00:03:06.814
it's not curative.

NOTE Confidence: 0.99209756

00:03:07.915 --> 00:03:09.275
After we found the right

NOTE Confidence: 0.99209756

00:03:09.275 --> 00:03:11.594
medication or regimen, what what

NOTE Confidence: 0.99209756

00:03:11.594 --> 00:03:13.120
changed in your life? How

NOTE Confidence: 0.99209756

00:03:13.120 --> 00:03:14.260
did your life change?

NOTE Confidence: 0.99902344

00:03:15.360 --> 00:03:15.860
Everything

NOTE Confidence: 0.9980469

00:03:16.160 --> 00:03:18.320
changed. I gained my life

NOTE Confidence: 0.9980469

00:03:18.320 --> 00:03:18.820
back

NOTE Confidence: 0.9458008

00:03:19.200 --> 00:03:20.180
because I

NOTE Confidence: 0.9941406

00:03:20.560 --> 00:03:21.940
I didn't have a life.

NOTE Confidence: 0.9941406

00:03:22.000 --> 00:03:22.900
I was

NOTE Confidence: 0.9927832

00:03:23.200 --> 00:03:24.480
curled up in a ball

NOTE Confidence: 0.9927832

00:03:24.480 --> 00:03:25.760
in bed with a heating

NOTE Confidence: 0.9927832

00:03:25.760 --> 00:03:27.435
pad. I had rashes from

NOTE Confidence: 0.9927832

00:03:27.435 --> 00:03:28.475
my stomach because of how

NOTE Confidence: 0.9927832

00:03:28.475 --> 00:03:29.855
much I was using it.

NOTE Confidence: 1

00:03:30.315 --> 00:03:31.215
I was

NOTE Confidence: 0.9975411

00:03:31.915 --> 00:03:33.515
taking so many pain meds

NOTE Confidence: 0.9975411

00:03:33.515 --> 00:03:34.795
every single day. I had

NOTE Confidence: 0.9975411

00:03:34.795 --> 00:03:36.415
a pain management specialist.

NOTE Confidence: 0.9940389

00:03:37.035 --> 00:03:38.955
My entire life revolved around

NOTE Confidence: 0.9940389

00:03:38.955 --> 00:03:40.155
the appointments that I was

NOTE Confidence: 0.9940389

00:03:40.155 --> 00:03:40.975
going to.

NOTE Confidence: 0.88612586

00:03:41.310 --> 00:03:43.550
And now I'm working, I'm

NOTE Confidence: 0.88612586

00:03:43.550 --> 00:03:44.210
in school,

NOTE Confidence: 0.9984375

00:03:45.470 --> 00:03:46.930
I got my life back.

NOTE Confidence: 0.9734933

00:03:50.910 --> 00:03:52.190
I am a firm believer

NOTE Confidence: 0.9734933

00:03:52.190 --> 00:03:52.930
that endometriosis

NOTE Confidence: 0.9851602

00:03:53.415 --> 00:03:54.694
has to be diagnosed early

NOTE Confidence: 0.9851602

00:03:54.694 --> 00:03:56.135
in life, not when woman

NOTE Confidence: 0.9851602

00:03:56.135 --> 00:03:57.174
is in her thirties and

NOTE Confidence: 0.9851602

00:03:57.174 --> 00:03:58.075
planning pregnancy,

NOTE Confidence: 0.9719587

00:03:58.614 --> 00:04:01.015
but perhaps fourteen, sixteen, and

NOTE Confidence: 0.9719587

00:04:01.015 --> 00:04:02.375
so on when she is

NOTE Confidence: 0.9719587

00:04:02.375 --> 00:04:04.155
experiencing those painful periods.

NOTE Confidence: 0.9921387

00:04:05.254 --> 00:04:06.875
Several years ago, we identified

NOTE Confidence: 0.95654297

00:04:07.629 --> 00:04:09.310
micro RNAs in the blood

NOTE Confidence: 0.95654297

00:04:09.310 --> 00:04:10.290
as very sensitive,

NOTE Confidence: 0.9951172

00:04:10.830 --> 00:04:11.569
and specific

NOTE Confidence: 0.9999349

00:04:11.870 --> 00:04:13.090
biomarkers of endometriosis.

NOTE Confidence: 0.975708

00:04:13.870 --> 00:04:14.849
We've looked,

NOTE Confidence: 0.9367547

00:04:15.150 --> 00:04:16.669
more recently at using these

NOTE Confidence: 0.9367547

00:04:16.669 --> 00:04:18.510
same type of biomarkers in

NOTE Confidence: 0.9367547

00:04:18.510 --> 00:04:20.110
adolescents and younger women when

NOTE Confidence: 0.9367547

00:04:20.110 --> 00:04:21.410
the disease first starts.

NOTE Confidence: 0.98669434

00:04:22.335 --> 00:04:24.115
We are not just diagnosing

NOTE Confidence: 0.98669434

00:04:24.414 --> 00:04:26.595
patients and providing clinical care.

NOTE Confidence: 0.9945204

00:04:26.974 --> 00:04:28.735
In this institution, we are

NOTE Confidence: 0.9945204

00:04:28.735 --> 00:04:30.115
doing cutting edge research

NOTE Confidence: 0.93481445

00:04:30.815 --> 00:04:31.955
on noninvasive

NOTE Confidence: 0.9986165

00:04:32.255 --> 00:04:33.634
biomarkers for endometriosis

NOTE Confidence: 0.92550224

00:04:34.095 --> 00:04:36.495
such as blood samples or

NOTE Confidence: 0.92550224

00:04:36.495 --> 00:04:37.589
saliva samples

NOTE Confidence: 0.9749756

00:04:38.389 --> 00:04:39.850
with hope and goal

NOTE Confidence: 0.99128604

00:04:40.230 --> 00:04:41.770
to have a blood test

NOTE Confidence: 0.99128604

00:04:41.830 --> 00:04:43.430
that can diagnose a patient

NOTE Confidence: 0.99128604

00:04:43.430 --> 00:04:44.889
with reliable certainty

NOTE Confidence: 0.9998779

00:04:45.510 --> 00:04:46.169
of endometriosis

NOTE Confidence: 0.99174803

00:04:46.870 --> 00:04:48.330
without need to be doing

NOTE Confidence: 0.99174803

00:04:48.550 --> 00:04:49.050
laparoscopy.

NOTE Confidence: 0.999646

00:04:50.665 --> 00:04:52.425
We're also developing biomarkers that

NOTE Confidence: 0.999646

00:04:52.425 --> 00:04:53.464
might help us choose the

NOTE Confidence: 0.999646

00:04:53.464 --> 00:04:54.825
best treatment for somebody with

NOTE Confidence: 0.999646

00:04:54.825 --> 00:04:55.325
endometriosis.

NOTE Confidence: 0.99750435

00:04:56.025 --> 00:04:57.464
The birth control pill is

NOTE Confidence: 0.99750435

00:04:57.464 --> 00:04:59.225
the most commonly used first

NOTE Confidence: 0.99750435

00:04:59.225 --> 00:05:00.985
line medication, but it doesn't

NOTE Confidence: 0.99750435

00:05:00.985 --> 00:05:02.919
always work. We've recently published

NOTE Confidence: 0.99750435

00:05:02.919 --> 00:05:04.199
a paper that shows that

NOTE Confidence: 0.99750435

00:05:04.199 --> 00:05:04.860
we can

NOTE Confidence: 0.985083

00:05:05.240 --> 00:05:07.740
identify who's resistant to progesterone,

NOTE Confidence: 0.98433256

00:05:08.199 --> 00:05:09.800
who's not going to respond

NOTE Confidence: 0.98433256

00:05:09.800 --> 00:05:11.240
to birth control pills, so

NOTE Confidence: 0.98433256

00:05:11.240 --> 00:05:13.659
we can use personalized medicine

NOTE Confidence: 0.98433256

00:05:13.720 --> 00:05:15.400
to find the best treatment

NOTE Confidence: 0.98433256

00:05:15.400 --> 00:05:16.300
for each patient.

NOTE Confidence: 1

00:05:16.755 --> 00:05:17.975
This is an inflammatory

NOTE Confidence: 0.94628906

00:05:18.355 --> 00:05:18.855
disease.

NOTE Confidence: 0.9707288

00:05:19.155 --> 00:05:20.515
We're starting to understand the

NOTE Confidence: 0.9707288

00:05:20.515 --> 00:05:22.115
biology behind it, and I

NOTE Confidence: 0.9707288

00:05:22.115 --> 00:05:23.315
believe that will lead to

NOTE Confidence: 0.9707288

00:05:23.315 --> 00:05:25.015
new more specific treatments.