Endometriosis: The Great Chameleon

Endometriosis is an inflammatory autoimmune disease that affects 1 in 10 women globally and affects women mainly during their reproductive years. Secondary to the ability of these inflamed tissues or inflammatory mediators possibly spreading to anywhere in the body, endometriosis is woefully underdiagnosed and misdiagnosed. Unfortunately, it can take an average of up to 15 years before a woman is diagnosed with endometriosis. Those intervening years of non-treatment, and constantly being exposed to the cognitive bias of psych-out bias, most women suffer excruciating pain, devastating disabilities, as well as, untreated fertility issues.

Alas, endometriosis can cause migraines with subsequent seizures. Many women with lung and heart issues are not asked about the occurrence of these symptoms with their menses, which should be a routine part of the history of reproductive-age women. Additionally, lung lesions are normally only realized when the patient’s lung collapses, and the patient undergoes emergency surgery.

Another issue with the prolonged misdiagnoses of endometriosis is the lack of understanding that Stage 0 endometriosis has no macroscopic or critical mass findings. Thus, endometriosis is a clinical diagnosis and not a pathological diagnosis. Unfortunately, there may not be enough tissue specimens to even send to pathology. A patient who has to go to the emergency room almost every month when having her menses due to excruciating pain, has endometriosis, even if there is no evidence of pathological disease upon diagnostic laparoscopy. However, if an endometrioma is found during laparoscopy, it is now recommended to ultimately perform an oophorectomy emergently for increased risk of ovarian cancer over time. In the face of pulmonary endometriosis, removal of the endometrioma normally results in the lung symptoms being resolved.

There is no cure for endometriosis at the moment, even if one removes both ovaries and uterus during surgery. The adrenal glands and the patient’s adipocytes, especially if overweight or obese will produce estrogen analogs/imitators, and can cause symptoms wherever there are endometriosis lesions or inflammatory mediators in the body.

The severity of the systemic endometriosis symptoms should be decreasing as one approaches menopause. However, there is postmenopausal endometriosis, although it is rare. With the advent of Telemedicine, psych-out bias and posterior probability bias should be greatly diminished relative to improved continuity of care. Thus, endometriosis with more education, awareness, and academic studies should be easier to diagnose over time. There is a blood test developed in England, but the sensitivity is only 90%, meaning the test can miss 10% of positive cases.

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