WEBVTT 00:00:05.296 --> 00:00:08.842 Endometriosis is a chronic inflammatory disease. 00:00:08.883 --> 00:00:11.469 We define it by having endometrial cells, 00:00:11.469 --> 00:00:13.430 so cells that are typically in the lining of the uterus 00:00:13.430 --> 00:00:15.056 when they're growing outside of the uterus, 00:00:15.056 --> 00:00:16.725 and when they implant to different places 00:00:16.725 --> 00:00:19.811 and cause inflammation and pain and downstream effects because of that. 00:00:20.562 --> 00:00:23.440 It can be very difficult to diagnose endometriosis, 00:00:23.440 --> 00:00:26.401 in large part because if those cells are implanted 00:00:26.401 --> 00:00:28.987 on different organ systems like the bowel or the bladder, 00:00:28.987 --> 00:00:31.364 it may manifest as bowel symptoms or bladder symptoms, for example. 00:00:31.364 --> 00:00:35.160 We don't quite understand why the disease happens, 00:00:35.160 --> 00:00:36.619 which makes it even harder to treat. 00:00:37.412 --> 00:00:41.041 For most patients. typically, they will respond 00:00:41.041 --> 00:00:43.126 to our first line treatments, like hormonal therapy. 00:00:43.126 --> 00:00:46.087 For those patients, though, who are refractory to those treatments alone. 00:00:46.087 --> 00:00:48.548 It typically does require a multimodal strategy, 00:00:48.548 --> 00:00:50.842 meaning tackling the symptoms through different agents 00:00:50.842 --> 00:00:53.386 beyond just the typical first line hormonal treatments, 00:00:53.386 --> 00:00:56.639 and sometimes that involves getting into other specialists if they need it. 00:00:57.515 --> 00:01:00.769 The gold standard diagnosis historically for endometriosis 00:01:00.769 --> 00:01:04.773 has been a surgical diagnosis, meaning we don't have great ways to diagnose it. 00:01:04.773 --> 00:01:08.526 Otherwise, 85% of patients with endometriosis don't have lesions 00:01:08.526 --> 00:01:09.944 large enough to be seen on imaging. 00:01:09.944 --> 00:01:12.572 So to actually diagnose a patient, 00:01:12.572 --> 00:01:14.657 if we're not doing it based off of symptoms alone, 00:01:14.657 --> 00:01:16.201 which we are now advocating to do so. 00:01:16.201 --> 00:01:19.037 In the past, the way that you can confirm a diagnosis is with a surgery, 00:01:19.037 --> 00:01:23.083 so many people will have a diagnostic surgery to take a look inside the abdomen. 00:01:23.625 --> 00:01:28.296 Some type of laparoscopic or robotic assisted laparoscopic surgery 00:01:28.296 --> 00:01:33.510 is preferred for endometriosis from the ability to be able to see much more closely and in detail 00:01:33.510 --> 00:01:37.055 to the tissue that you're looking at compared to something like open surgery, for example. 00:01:37.055 --> 00:01:41.351 We can bring a camera and really zoom in and see all of the tissue 00:01:41.351 --> 00:01:42.852 and look closely at it to find 00:01:42.852 --> 00:01:45.605 any potential lesions of endometriosis to resect it 00:01:45.605 --> 00:01:48.858 and get a pathologic diagnosis, meaning we send that tissue to our pathologist 00:01:48.858 --> 00:01:51.694 and they look under the microscope and they see are there endometrial cells, 00:01:53.530 --> 00:01:56.032 The resection of those lesions 00:01:56.032 --> 00:01:58.660 and the benefit in terms of pain is variable. 00:01:58.660 --> 00:02:01.996 So it's not well predicted to say a patient will have 00:02:01.996 --> 00:02:05.166 this much duration of time with pain relief after excision. 00:02:05.166 --> 00:02:09.671 But we do know that when you pair surgical excision with medication management, 00:02:10.046 --> 00:02:11.714 specifically hormonal management after the surgery, 00:02:11.714 --> 00:02:14.551 you have longer durations of pain relief compared to surgery alone. 00:02:14.551 --> 00:02:17.053 So it's a tool and it is not curative. 00:02:17.053 --> 00:02:21.099 When someone wants fertility sparing, then we'll use excision procedures like that. 00:02:21.224 --> 00:02:25.228 If someone is done with fertility and they're interested in surgery, 00:02:25.228 --> 00:02:27.313 that may have a longer lasting impact 00:02:27.313 --> 00:02:30.441 in terms of reducing their need for medicine and surgery in the future. 00:02:30.441 --> 00:02:32.652 That's when we consider surgeries like hysterectomy, 00:02:32.652 --> 00:02:34.487 which is removing the uterus and the cervix, 00:02:34.487 --> 00:02:36.447 and typically the fallopian tubes at the same time, 00:02:36.447 --> 00:02:39.242 and in rare circumstances, we would consider removing the ovaries as well, 00:02:39.242 --> 00:02:41.661 depending on the patient's health and risk factors. 00:02:41.661 --> 00:02:43.329 Those surgeries are still not curative. 00:02:43.329 --> 00:02:44.956 So it's important to know that surgery, 00:02:44.956 --> 00:02:47.917 while it can have good results for pain relief for many people, 00:02:47.917 --> 00:02:50.128 is not the end all be all in terms of treatment 00:02:50.128 --> 00:02:54.048 for patients who have particularly refractory endometriosis. 00:02:55.425 --> 00:02:58.428 I think what makes Yale probably a standout is honestly our research, 00:02:58.428 --> 00:03:00.930 in terms of leading the research on endometriosis 00:03:00.930 --> 00:03:04.267 and understanding the newer concepts that are coming out with the management 00:03:04.267 --> 00:03:08.646 and clinical diagnosis and thought processes around how we think about endometriosis, 00:03:09.480 --> 00:03:12.650 I think patients often want to feel empowered by the fact that there are options. 00:03:12.650 --> 00:03:14.569 When it feels like there are no options available, 00:03:14.569 --> 00:03:16.905 it can be a really isolating and scary experience 00:03:16.905 --> 00:03:21.034 and hearing someone say, we have all these other agents that we can try 00:03:21.075 --> 00:03:25.538 or other techniques that we can do can be something that patients find 00:03:25.580 --> 00:03:27.707 is a new experience for them, and that they're hopeful again, 00:03:27.707 --> 00:03:29.584 that there may be something that can help them 00:03:29.584 --> 00:03:31.920 when they were only told, all you have are birth control.