About this Research Topic
“What is endometriosis?” was the third most searched health-related question on Google in 2018. Therefore, patients suffering from endometriosis-related symptoms and their caregivers are desperately seeking answers and better outcomes than are currently available. Endometriosis prevalence is estimated to be between 2 to 12% in reproductive-aged women. The associated health, psychological, social, and financial burdens of endometriosis are substantial. To add further complication, women present with heterogenous or vague symptoms and the manifestation of disease-causing endometriotic lesions (anatomical distribution, depth of infiltration, size and quantity) does not correlate with the severity of symptoms experienced by patients. There is no one-size-fits-all approach to medical management as patient response to treatments are varied and unpredictable, in part related to their individual disease. Globally, increased campaigning and lobbying by patients, researchers and health professionals for improved awareness, education and research has grown, and recent funding allocation is being awarded to improve fundamental understanding of disease aetiology and pathophysiology and better outcomes for patients.
Women with endometriosis suffer lengthy diagnostic delay. In part, this is the consequence of nonspecific and overlapping symptomology with other common gynaecological and gastrointestinal diseases. As such, endometriosis may be confused or even misdiagnosed as an entirely different condition. In addition, social or cultural taboos associated with pelvic pain and menstrual health problems mean that many women dismiss their symptoms and numerous theories surrounding endometriosis and its clinical features are anecdotal in nature. The challenge for health professionals is increased further by growing research observations indicating that women with endometriosis also demonstrate a high incidence of gynaecological and non-gynaecological comorbidities and chronic conditions. Reported gynaecological comorbidities include (but are not limited to) uterine fibroids, adenomyosis, pelvic inflammatory disease, and rarely, ovarian and endometrial cancers. Comorbid non-gynaecological conditions include irritable bowel syndrome, interstitial cystitis, food allergies and intolerances, cardiovascular conditions, autoimmune diseases, migraine headache, sleep disturbance, and anxiety and depressive disorders. Although data are growing in this area, more evidence-based research is necessary to improve the strength of the epidemiological information associating endometriosis and comorbid conditions, including the magnitude of these associations. In the setting of endometriosis, it is crucial to identify and validate the risks and implications of associated comorbid conditions, to help reduce diagnostic delay and to improve the quality of life of women with this disease.
This Research Topic aims to contribute to improving the understanding of the risks and implications of comorbid gynaecological and non-gynaecological conditions on symptom severity, diagnosis, management, and patient quality of life. The following research questions and themes are welcomed, but not limited to:
· Comorbid gynaecological and non-gynaecological conditions associated with endometriosis: myth versus truth and cause or effect.
· What symptoms are most bothersome to endometriosis patients, those that are endometriosis-specific or those associated with the comorbid condition? Are symptoms worse in those who have more than one comorbid condition?
· Do specific comorbidities affect the anatomical presentation of the disease and symptom severity - how?
· What are the outcomes of surgical treatment for patients with comorbidities?
· Is there an association between endometriosis related infertility and comorbidities?
· Clinical consequence and patient outcomes for treating multiple conditions and multiple symptoms – role for and utilisation of multidisciplinary care.
· Can increased collaboration between gynaecologists and gastroenterologists lead to improved treatment outcomes?
· Can high-risk groups be better identified, screened and managed based on a positive endometriosis diagnosis and/or a diagnosis of a comorbid disease? For example, should screening tools for endometriosis be employed in pain clinics / gastroenterology clinics/ urology clinics?
· What is the evidence to suggest that endometriosis patients should be more widely screened and followed-up for other high-risk medical conditions (for example, cardiovascular disease)?
· Would reclassification of endometriosis as a heterogenous phenotype based on symptoms, clinical findings and comorbidities improve diagnosis, management and patient outcomes?
Women with endometriosis suffer lengthy diagnostic delay. In part, this is the consequence of nonspecific and overlapping symptomology with other common gynaecological and gastrointestinal diseases. As such, endometriosis may be confused or even misdiagnosed as an entirely different condition. In addition, social or cultural taboos associated with pelvic pain and menstrual health problems mean that many women dismiss their symptoms and numerous theories surrounding endometriosis and its clinical features are anecdotal in nature. The challenge for health professionals is increased further by growing research observations indicating that women with endometriosis also demonstrate a high incidence of gynaecological and non-gynaecological comorbidities and chronic conditions. Reported gynaecological comorbidities include (but are not limited to) uterine fibroids, adenomyosis, pelvic inflammatory disease, and rarely, ovarian and endometrial cancers. Comorbid non-gynaecological conditions include irritable bowel syndrome, interstitial cystitis, food allergies and intolerances, cardiovascular conditions, autoimmune diseases, migraine headache, sleep disturbance, and anxiety and depressive disorders. Although data are growing in this area, more evidence-based research is necessary to improve the strength of the epidemiological information associating endometriosis and comorbid conditions, including the magnitude of these associations. In the setting of endometriosis, it is crucial to identify and validate the risks and implications of associated comorbid conditions, to help reduce diagnostic delay and to improve the quality of life of women with this disease.
This Research Topic aims to contribute to improving the understanding of the risks and implications of comorbid gynaecological and non-gynaecological conditions on symptom severity, diagnosis, management, and patient quality of life. The following research questions and themes are welcomed, but not limited to:
· Comorbid gynaecological and non-gynaecological conditions associated with endometriosis: myth versus truth and cause or effect.
· What symptoms are most bothersome to endometriosis patients, those that are endometriosis-specific or those associated with the comorbid condition? Are symptoms worse in those who have more than one comorbid condition?
· Do specific comorbidities affect the anatomical presentation of the disease and symptom severity - how?
· What are the outcomes of surgical treatment for patients with comorbidities?
· Is there an association between endometriosis related infertility and comorbidities?
· Clinical consequence and patient outcomes for treating multiple conditions and multiple symptoms – role for and utilisation of multidisciplinary care.
· Can increased collaboration between gynaecologists and gastroenterologists lead to improved treatment outcomes?
· Can high-risk groups be better identified, screened and managed based on a positive endometriosis diagnosis and/or a diagnosis of a comorbid disease? For example, should screening tools for endometriosis be employed in pain clinics / gastroenterology clinics/ urology clinics?
· What is the evidence to suggest that endometriosis patients should be more widely screened and followed-up for other high-risk medical conditions (for example, cardiovascular disease)?
· Would reclassification of endometriosis as a heterogenous phenotype based on symptoms, clinical findings and comorbidities improve diagnosis, management and patient outcomes?
Keywords: Endometriosis, Comorbidities, Risks, Implications, Symptoms, Diagnosis, Treatment
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