Specialised healthcare in the Instituto Bernabeu endometriosis unit
Comprehensive, personalised healthcare in order to improve quality of life by reducing pain and preventing potential complications as well as improving and preserving fertility.
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Endometriosis is an illness in which tissue from the uterus (endometrium) grows outside the uterine cavity. It affects between 10 and 15% of women in childbearing years and can affect up to 50% of women who have fertility issues. Its cause it still unknown and its affect on fertility is variable. For example, cases include those in which there are significant endometrial lesions but which do not affect fertility and others in which less significant lesions cause reproduction issues.
On occasions, endometriosis does not only the make the tissue from the uterus that we call endometrium grow outside it. It can also occur in the form of cysts on ovaries (that cause endometriomas), in the fallopian tubes or in any other part of the body, except the spleen. Such endometrial implants respond to hormones in the same way as the endometrium and, as such, during menstruation they can grow month after month and even lead to slight bleeding or intense pain.
Endometriosis can cause different symptoms. Menstrual cramps are the most common (dysmenorrhea). Also, abundant bleeding during periods and, depending on where the implant is situated, constipation or diarrhoea, hematuria (urinating blood) during periods and painful sexual intercourse .
Without a doubt, one of the symptoms that women affected by endometriosis worry most about is issues falling pregnant. The reproduction issues it can cause range from repeat pregnancy loss, embryo implantation issues, ovulation abnormalities and obstruction of the fallopian tubes, amongst others.
TYPES OF ENDOMETRIOSIS:
The most commonly used classification is the one established by the American Society of Reproductive Medicine in 1996:
- Stage I: minimal.
- Stage II: mild.
- Stage III: moderate.
- Stage IV: severe.
There are two basic issues with this classification system. The first is that there is no link to the fertility issues the patient may have and the second is that this system requires surgery in order to make a classification. Therefore, nowadays, we tend to classify endometriosis as follows:
- Superficial: detected mainly following surgery.
- Endometriomas: presence of cysts on ovaries.
- Severe: severe endometrial implants detected through surgery or in ultrasounds.
One of the problems for patients and for medical staff is the fact that the intensity of pain, where it is situated and its duration does not always appear to coincide with what shows up on an ultrasound scan . The patient can often feel misunderstood and frustrated when nothing provides for a conclusive diagnosis and there appears to be no way of getting rid of the pain.
In the Endometriosis Unit in Instituto Bernabeu, we are pioneers in using the very latest in diagnosis methods through the analysis of new, reliable biomarkers (immune system indicators): cytokines. In a simple blood sample, we take a look at the indicators in the endometriosis inflammatory process, thus generating a precise diagnosis and obtaining highly useful information in terms of the stage and seriousness of the illness. This means that, in most cases, we are able to avoid diagnosis through surgery and the effects that this can have on fertility.
Correct evaluation and treatment of endometriosis often calls for a multi-disciplinary approach by gynaecologists with experience in diagnostic imaging technology and skilled laparascopists with experience in assisted reproduction.
Years ago, treatment almost always involved surgery. Today, however, we believe that we need to be cautious when dealing with the ovaries since removing endometrial tissue involves removing important follicles from the ovary. This leads to a reduction in ovarian reserve.
Years ago, the established method for diagnosis was anatamopathological. In other words, the implant had to removed and the illness was confirmed following analysis. This aggressive procedure that often worsens things for the couple in terms of reproduction, is no longer necessary.
Instituto Bernabeu has high-resolution ultrasound equipment and this means that a reliable diagnosis can be carried out. However, many of our patients already come to us with the diagnosis. Our experience means we are able to determine how far the illness has progressed and provide a prognosis.
To that, we can add a blood sample analysis with new genetic biomarkers: cytokines. Cytokines are proteins produced by various types of cells that act as mediators in inflammatory processes and in immune responses. As such, these biomarkers can be present in large quantities in cases of suspected endometriosis.
Such a combination of means of advanced diagnosis is very useful in patients who have been diagnosed with infertility of unknown origin since we can, at last, determine the cause.
Adenomyosis is when endometrial tissue is situated within the muscular wall of the uterus (endometriosis in the uterus). This can complicate embryo implantation.
Further to the use of three-dimensional ultrasound equipment in our daily work routine at the clinic, our aim has been to diagnose this little-known pathology.
We are now able to interpret the different images adenomyosis gives in ultrasounds and one of our lines of research work includes establishing how capable the uterus is of correctly implanting embryos based on how severe the adenomysis is.
Endometriosis leads to decreased ovarian reserve as time goes by. We therefore believe it is necessary to first of all carry out a thorough ovarian reserve diagnosis in order to be able to give the patient feedback on the likelihood of falling pregnant in the future. Ovarian reserve is evaluated by means of an antral follicle count, anti-Mullerian hormone levels and the patient's age, amongst other factors.
Depending on the severity of the endometriosis, pelvic anatomy may be distorted and this can affect, amongst other structures, the fallopian tubes. In order to look into this, we carry out a sonohisterography test. This has replaced the hysterosalpingography test which requires injecting a fluid into the pelvic area and is a painful procedure.
During the process, and taking into account each patient and all potential benefits, where necessary, a hysteroscopy is a useful procedure in obtaining a direct evaluation of the endometrial cavity and in backing up the information obtained from ultrasound images.
ENDOCRINOLOGY, NUTRITION AND ACCUPUNCTURE FOR ENDOMETRIOSIS
Certain foods can have an effect on the intensity of the illness and symptoms as well as increases and decreases in them. Therefore, the Endometriosis Unit is also given support by our endocrinology and nutrition team in the form of nutritional evaluation and advice. The aim is to make the most of natural resources in the fight against the illness and to hold back the associated symptoms.
In order to improve quality of life and by way of a complementary treatment to the endocrinological and gynaecological healthcare being given, acupuncture can help to relieve pain and inflammation and we also, therefore, offer this type of specialist treatment.
Instituto Bernabeu offers personalised solutions and has a number of on-going specific research projects in which conventional treatment has been refractory. We also have two units that specialise in the significant issues that endometriosis can cause:
Preserving fertility: EGG VITRIFICATION
Egg vitrification is a technique that facilitates the preservation of 'eggs' when patients are young. Taking into account the fact that endometriosis can affect fertility as years go by, with vitrification, patients wish to become mothers, have the option of doing so.
When did you have your first period?
Before the age of 10
Between the ages of 11 and 15
Older than 16 years of age
Are your periods painful?
Do you suffer from pain during sexual intercourse?
Do you need to take painkillers during your period?
Have you ever needed to go to hospital due to painful periods?
Have you had issues falling pregnant?
Yes, it took me at least 6 months
Yes, I've had assisted reproduction treatment
Do any members of your family have endometriosis?
I don't know
How many sanitary towels or tampons do you need on the heaviest days of your period?
Under 6 tampons/sanitary towels a day
Between 6 and 11 tampons/sanitary towels a day
More than 12 tampons/sanitary towels a day
Have you been diagnosed with any malformations in the uterus?
Have you been diagnosed with any auto-immune or rheumatological illness?
Have you or any close relative been diagnosed with uterine fibroids?
I have not, but a family member has