Dr. Patrick Yeung is an Associate Professor and Director of the Center for Endometriosis at the Saint Louis University School of Medicine. New medical student graduate and FACTS Student Ambassador Brianna Wynne recently spoke with Dr. Yeung in order to better understand endometriosis, a disease that can effect many women and negatively impact both their quality of life and their fertility. We were particularly interested about the intersection between charting and the detection of endometriosis, as well as different viable treatment options and success rates. Below are Dr. Yeung’s answers to a few questions we found particularly interesting. We hope you enjoy learning more about endometriosis this #EndometriosisAwarenessMonth!
What are some early warning signs that a woman has endometriosis?
How early can a woman detect that she has endometriosis?
The two main symptoms of endometriosis (sometimes referred to as “endo”) are pain and infertility. Early warning signs that could indicate endometriosis are: painful periods (that lead to missing work or school or requiring narcotic pain meds), chronic pelvic pain not associated with periods, pain with deep penetration during sex, and pain with urination or defecation. Taking hormonal suppression or birth control pills for pain and not feeling better is also a reason to do surgery. The definitive diagnosis of endometriosis is from surgical biopsy, nowadays typically done through minimally invasive surgery called laparoscopy. If a woman is charting her cycle, certain charting abnormalities might be associated with endometriosis including limited cervical mucus, and sometimes abnormal bleeding.
Is endo common in adolescents or does it take time to develop?
Endometriosis can be present in adolescents and I advocate for addressing issues earlier than later and here’s why. Historically, endometriosis was known as the “working woman’s disease” because it was thought that it only affected women who waited later to have children and then struggled with infertility. Now, however, endometriosis is recognized as affecting 10% of women of all ages, and is one of the most under-diagnosed diseases. We’ve found that if you surgically remove all visible lesions suspicious for endometriosis while the patient is young, the rate of recurrence or persistence of endometriosis can be very low (zero in our study, versus 50% recurrence in 2 years after ablation – or burning – endometriosis which is how endometriosis is usually treated.). This finding implies that treating endometriosis early, might help preserve down the road fertility, but this has to be further studied. The location of endometriosis (the uterine tissue outside of the uterus) can be atypical in younger patients and may also look differently, such as appearing white, red, brown, as blisters, or in retraction pockets (sunken in areas of perineum), which can lead to misdiagnosis or inadequate removal of lesions. I advocate for early diagnosis and treatment of endometriosis, part of which involves teaching young girls/pre-teens about what should be expected with periods, and encouraging to seek medical assistance if they suffer from intense pain, especially pain that does not improve with hormonal suppression (like birth control bills) or high-dose anti-inflammatories (ie. NSAIDs). Part of the issue is simply raising awareness about endometriosis, its symptoms, and the damage it can cause to fertility if not adequately treated. Up to 1 in 2 women with endometriosis develop issues with infertility. In fact, Padma Lakshmi at Endometriosis Foundation of America is doing some great advocacy work in this area. She wants women’s bathrooms in high schools and colleges to be equipped with the following posters stating “Killer Cramps are NOT Normal” and information about endometriosis and how to get help.
Can you detect endometriosis from a woman’s chart?
If so, how so?
Endometriosis can be detected by irregularities in a woman’s chart. Endometriosis can throw off cycles and hormone levels and present in a variety of ways, so its difficult to pinpoint a single specific chart finding that definitively indicates endometriosis. Women with endometriosis can have irregular bleeding or abnormal bleeding (bleeding outside of menses) for cysts of endometriosis called endometriomas, luteal phase defects such as long luteal phase or short post-peak phase, and low mucus scores (this is specific to the Creighton system of FABM).
In terms of those women that seek help for infertility, what are your success rates for pregnancy after endometriosis removal?
We haven’t published this data on specific success rates for pregnancy after excision surgery, but in our patients trying to conceive up to 70% get pregnant within 1-2 years after surgery. To help fertility chances, often other hormonal treatments or supplements are used to optimize the non-surgical environment, in addition to optimizing the anatomy through surgery.
What about for pain free cycles after surgery?
Most of my patients feel better after surgery, but pain is subjective and so it’s not a great indicator of success. There are different types of pain – some types improve with surgery while others do not.We find endometriosis in over 80% of patients that we take to surgery, which is a high rate of finding endometriosis (and we always get a tissue diagnosis since we are removing the disease, which is the gold standard). Again, like for fertility, looking for and treating atypical or subtle disease is very important, especially in younger patients, in improving pain. Over 90% of my patients report improved quality of life after surgery. This is what is important to patients and is a better measurement of successful outcome.
Thanks for the interview Dr. Yeung! Please visit the Center for Endometriosis webpage for more information and research articles published by Dr. Yeung and his team.
 Yeung et al. Complete laparoscopic excision of endometriosis in teenages: is postoperative hormonal suppression necessary? Fertility and Sterility. Vol. 95, No. 6, May 2011. pp 1909-1912.