For many, the journey to an endometriosis diagnosis feels like a marathon with no finish line. Join Dr. Akeem Adigun, an OB/GYN with Memorial Hermann Medical Group as we discuss the Endometriosis Diagnosis Delay. Learn how to spot the red flags, protect your fertility and advocate for the care you need.
Amanda Wilde (Host): For many, the journey to an endometriosis diagnosis feels like a marathon with no finish line. We're joined by Dr. Akeem Adigun, an OB-GYN with Memorial Hermann Medical Group to discuss the endometriosis diagnosis delay. We're diving into the groundbreaking non-surgical tools available and exploring how we can fast track the path to relief and fertility protection. If you've ever felt dismissed or stuck in the diagnostic gap, this episode is for you.
Welcome to Everyday Well®, a health and wellness podcast, brought to you by Memorial Hermann Health System. Tune in for the latest tips and information about health care topics that matter most to you. I'm Amanda Wilde. Dr. Adigun, thank you so much for being here.
Dr. Akeem Adigun, MD: Thank you for having me.
Host: Well, let's start simply with the definition of endometriosis. What is it?
Dr. Akeem Adigun: So, endometriosis is endometrial tissue that's located outside of the uterus. When a woman has her regular monthly cycle, she passes endometrial tissue from the uterus into the vagina and out of the body. And that tissue should come out once a month. However, in endometriosis, that tissue makes its way into the abdominal cavity and kind of implants on the walls and causes all sorts of pain and difficulty for the woman.
Host: And how common is endometriosis?
Dr. Akeem Adigun: It happens in about 6-10% of the population. And unfortunately, a lot of it goes undiagnosed, and that's why those numbers are lower than they really are.
Host: And how is it typically diagnosed?
Dr. Akeem Adigun: Endometriosis is usually diagnosed after a long, arduous elimination of a differential diagnosis, and then finally ended up in an OB-GYN office. And then, a diagnostic laparoscopy, which is a surgical procedure, is done and the endometriosis is found.
Host: So, you're saying it's common for a patient to have a delay in receiving an endometriosis diagnosis. From a clinical perspective, why is that?
Dr. Akeem Adigun: So, the actual quoted duration is about six to 10 years, which sounds unfortunate and unbelievable. But the reason why that is, is endometriosis mimics a lot of other medical conditions. And because of the location of the pathology, a lot of times other things are evaluated and treated before endometriosis is finally chosen as a possible diagnosis.
The other concern is the way it's diagnosed currently is via surgery, and a lot of patients are not willing to take that step, and that's why it adds to the delay.
Host: So, there are now new non-surgical tools that are changing All of that aren't There?
Dr. Akeem Adigun: There are, and they are in their infancy however. But hopefully, with the progression of technology, we will be there soon. Usually, imaging modalities, like MRIs can show implants that are larger than a centimeter, but the sub-centimeter implants are a little harder to find on imaging. So, the newest, which is recently being developed is a blood test to assess for endometriosis. I believe they're still working on getting approval, but that should be out hopefully in the next three to six months.
Host: If a standard pelvic ultrasound comes back normal, does that rule out endometriosis? Is there a difference between a routine scan and a specialized endometriosis scan?
Dr. Akeem Adigun: Unfortunately, an ultrasound has a lot of limitations in assessing endometriosis. As I mentioned earlier, an MRI would be a better option, but wouldn't be the first step. A lot of patients would have to present with specific symptoms that would point to an imaging modality as such as an MRI, but an ultrasound coming back normal does not rule out endometriosis.
Host: Well, if endometriosis can mimic IBS and bladder infections and even chronic fatigue, how do you work with patients to rule out those conditions without wasting time on the wrong treatments?
Dr. Akeem Adigun: So, the most important thing is having the right physician treat the problem. A lot of times, patients with these symptoms will present to a gastroenterologist or a different specialty and not an OB-GYN. And that puts endometriosis lower on the differential diagnosis and the testing and the evaluation and the treatment are for the other things except endometriosis.
If we were in the hands of the GYN, all those differentials will be evaluated simultaneously, making it higher up on the differential and easier to get to and actually shorter to get to that diagnosis and treatment.
Host: If a patient feels their concerns are being dismissed, what specific questions or requests should they make to allow their provider to take the next diagnostic step?
Dr. Akeem Adigun: So, the first and most important request is to ask for an OB-GYN if they're not in the hands of an OB-GYN. The hallmark of a great physician is the willingness to have another physician take over or take care of a problem. So, you should always ask if you're in the hands of an OB-GYN for a second opinion. And if that OB-GYN is willing to do that, then that lets you know that you're in good hands, because everybody should come to essentially the same conclusion or someone who has more experience with the pathology can better help.
Host: Many patients are told their ongoing pain is just a heavy period. And again, there's this sort of dismissal of the pain, but how can a patient distinguish between typical menstrual discomfort and the red flags that may point toward endometriosis?
Dr. Akeem Adigun: So, this is the part that causes the delay or adds to the delay, is it truly does mimic just the painful period. There are some warning signs that the patient can look out for things like, difficulty defecating or dyschezia, or painful intercourse or dyspareunia. But there's no good quantification of pain and we don't have any way to accurately diagnose if a pain is too much. And so, a lot of patients look to their family members for information or for help to ask, "Is this too much pain? Is that too little pain? And every woman experiences this pain differently. So, the first thing to do is if you feel that that symptom is more than what you feel should be usual, then discuss it with your OB-GYN. And we can have that conversation and walk through and see if this truly is just a painful period or something more.
Host: Now for people who actually have been diagnosed with endometriosis, for those who plan to become pregnant, what do they need to know?
Dr. Akeem Adigun: So, the great news is if they've had the diagnosis, that actually puts them ahead of the game because then the anticipation of fertility is already on the docket, meaning the doctor is anticipating that this patient would likely have a difficulty conceiving.
So first and foremost, we do not do anything. We just know that the diagnosis exists. We give the woman an opportunity to try to conceive on her own because a lot of endometriosis patients can conceive on their own. The ones who have really bad diseases may have difficulty. And so that conversation will happen after difficulty has occurred. Usually after six months of trying to conceive and being unsuccessful, then intervention can begin.
Host: And in general, if an individual has been diagnosed with endometriosis, what are the next steps in their healthcare journey?
Dr. Akeem Adigun: So, the first and most important thing is alleviating the pain and understanding the disease. If we can, usually, especially in my practice, we try to get away with just medical therapy. Unfortunately, medical therapy would mean some kind of birth control pill to regulate or delay or remove the periods completely because the pain is associated with periods.
Whenever they have a cycle, the endometrial tissue responds to ovarian hormone production and then causes pain. So, if they have no cycles, then they usually will have no pain because that endometrial tissue has nothing to respond to. But that's where we start with medical therapy. If the patient has really bad disease or it's unresponsive, there are three to four different medical modalities. And if they fail to respond to any one of those, then the surgical step would be next.
Host: Dr. Adigun, as an OB-GYN, is there anything else you'd like to add to this discussion?
Dr. Akeem Adigun: Yeah, I always want to take this opportunity to just let people know that going to the OB-GYN is not something you do once you have a problem. The most important thing is once a woman starts having her menstrual cycles, an OB-GYN should be part of her life as any problem can begin at that point. So, I highly recommend moms take their daughters to an OB-GYN as soon as they start having their cycles so we can start having a conversation. It doesn't necessarily have to be an invasive exam, it's just to have the conversation and to have a good resource to go to to address all those common issues.
Host: Got it. This is very helpful information and, hopefully, those listening will be able to more easily take next steps if they suspect they may have endometriosis. Dr. Akeem Adigun, thank you so much for sharing your expertise and insight into streaming the diagnosis of endometriosis.
Dr. Akeem Adigun: Thank you so much.
Host: That was obstetrician and gynecologist, Dr. Akeem Adigun. At Memorial Hermann, a specialized provider will help you navigate this common condition. Find an OB-GYN and schedule your appointment online by visiting memorialhermann.org/endometriosis. If you found this podcast helpful, please share it on your social media and check out our entire podcast library for other topics of interest to you.
Thanks for listening to Everyday Well®, brought to you by Memorial Hermann Health System.
