Non-Surgical Approaches to Diagnosing Endometriosis

In this Pharmaceutical Executive video interview, Dr. Lawrence B. Werlin, MD, FACOG of HRC Fertility (@md.lawrence.werlin on TikTok), discusses the challenges of addressing fertility misinformation on social media. He emphasizes the importance of providing accurate and reliable information and encourages patients to consult with healthcare professionals. He also discusses the ethical considerations of using social media to share personal and professional experiences in the field of fertility.

How are new radiological techniques revolutionizing the diagnosis of conditions like endometriosis? What impact will this have on patient outcomes?

Just to give your listeners a picture endometriosis, the normal lining of the uterine cavity is endometrium, and what typically happens is, when you get your period, that endometrial tissue breaks down and you pass it through the cervix and out through the vagina. However, if your fallopian tubes are open, which we hope that they are, then the likelihood is, is that you probably have a menstrual fluid that goes out through your tubes as well. So, when you look at endometriosis, the definition is you see endometrial tissue in places other than inside the uterus, and the two most common places that you end up seeing it are on the ovary and in the bottom of the pelvis. And it makes sense to you why 80% of the disease is found there, and part of the reason for that is the fallopian tube sits right on top of the ovary.

So if you have retrograde menstruation, meaning the fluid is coming out through the tube, you could picture that it might land on the ovary, and secondly, you could picture that it would be in the bottom of the pelvis, because gravity would pool that fluid down there and in the right environment, in the right milieu, whatever that may be for that particular patient, that tissue will stick and then form endometriosis. So that tissue can bleed just like you bleed when you have your period, it goes through the same hormonal changes, and so that when you're having a period, the tissue that's in other places can bleed as well. That's how, for example, you'll get these Endometriotic cysts in your ovary.

Effectively, they're just little blind pockets of old blood with the lining of that cyst being endometrial, and so it's a significant factor. Now the gold standard always was making the diagnosis by laparoscopy. Laparoscopy is a surgical procedure where the patient is asleep, and you go, you put a scope through her belly button, and you're able to look at the pelvic organs. So, it actually serves two purposes.

One, it's diagnostic in that you can look and see if it there's a problem there, like endometriosis, scar tissue adhesions, whatever it may be. And then secondly, it can be therapeutic, in that you can, you can treat the disease at the time. If there are adhesions, you can lyse those adhesions. If there's endometriosis, you could use a laser or cautery to ablate or remove the tissue. So, it's beneficial, and it's always been the gold standard to make the diagnosis. Previously, if you saw things on ultrasound, like an echo genetic cyst in the ovary, meaning it had junk in there, like old blood, for example. You might say, well, there's a good likelihood that this is Endo, but you can't say it definitely that that's the case.

But now things are truly changing, and there are now more radiographic indications of what endo really looks like. Ultrasound techniques are so dramatically better that you can use those to make better definitions without doing laparoscopy, and also things like MRIs have proved proven to be much more beneficial. So, the tide is changing. I think, honestly, speaking, the ultimate gold, gold standard will always probably be laparoscopy, because it serves those two purposes. In that one, it's diagnostic, and two, it can be therapeutic, but certainly the radiological ultrasound MRI have really improved the ability to non-surgically make the diagnosis.