For anyone with endo or suspected endo

[Brambledoggy]

DR PETA WRIGHT (Taken from Instagram recently) Just a VERY interesting opinion for anyone interested in the bigger picture of endometriosis. Long read!

Study hot off the press from Dr Karen Joseph. This study looked at women who underwent laparoscopy for pelvic pain over a twelve month period. Around half of the women had endo which was excised and the other half had no endo found. The study looked at frequency of emergency presentations for these women following surgery. They found that not only were Emergency Department visits prior to and following surgery independent of the presence of endo lesions, but also that ED visits after surgery for pain flares were not reduced by having had surgery.

This paper really highlights the need to question the efficacy of surgery in every woman presenting with persistent pelvic pain, consider other factors that drive pain and also to continue to look for interventions that actually reduce the burden of pain for women. Early intervention and treatment for women with pelvic pain is imperative, but we have to be critical in our thinking about what that may mean. It seems simple to suggest that every woman with pelvic pain should have a laparoscopy to diagnose endo but if evidence is showing us that it might not actually be helping, we have to think bigger picture. Is early laparoscopy helping us or trapping us?

Every podcast, social media post, the majority of the patients I see and whose stories I hear daily tell the same tale - they had surgery - often multiple - and still had daily pain or severe period pain. It’s only when they took a wholistic approach and engaged with pelvic floor physio, tried a hormone treatment, managed their stress, understood about the neuroscience of pain, that their pain and symptoms shifted. There is much more going on with pelvic pain than just endometriosis (evidenced by the fifty percent of women in this study with no endo and in the way surgery often fails to reduce the burden of pain) and most of it can’t be cut away with surgery after surgery that frequently leaves women worse off than they started. If you you need ten surgeries it’s not an effective treatment and as a healthcare system if this is the best we have to offer we are failing women. I welcome this research and more like it that critically evaluates what actually helps women with pelvic pain.

[Cailleach]

The only comment I would have is that the research assumes that if endo is present it will be found and effectively treated during every laparoscopy. In fact this is not necessarily the case depending on the training, skill and experience of the surgeon.

Therefore some people who have had laparoscopy may not have had all endo present actually located and treated and some people where endo was not found may actually have endo. In both cases they are likely to continue to present with symptoms.

Of course I would fully agree that laparoscopy should not be the only solution for pelvic pain, which is a complex issue. It is often not effective for endometriosis in the long term in any case. I also welcome any research though I do wonder if the premise for this is slightly flawed.

Thanks for posting this interesting information.