Specialised healthcare in the Instituto Bernabeu endometriosis unit

Endometriosis is the presence outside the uterus of tissue from the uterus known as the endometrium (the lining that covers the uterus where the embryo embeds). It can implant anywhere in the body, except the spleen.

Endometriosos is a common illness which affects between 10 and 15% of women, mainly those who are of childbearing age, but also girls, adolescents and, less commonly, following the menopause.

Its cause is unknown but we are well aware of its consequences.

Endometriosis affects quality of life in different ways although almost all patients will suffer from painful periods or dysmenorrhea. Other forms of pain are also associated with endometriosis: pain during sexual intercourse, chronic pelvic pain, pain when urinating, pain during bowel movements and constipation, amongst others. This variability in symptoms is explained by the fact that endometriosis can be located anywhere within the pelvis and generate adhesions as a result of chronic inflammation.

One of the problems for patients and for medical staff is the fact that the intensity of pain, where it is situated and its duration does not always appear to coincide with what shows up on an ultrasound scan. The patient can often feel misunderstood and frustrated when nothing provides for a conclusive diagnosis and there appears to be no way of getting rid of the pain.

As a result, many women who have endometriosis have never actually been diagnosed has having it. Any number of episodes of menstrual pain in young women will have been labelled ‘normal’ because standard checks have not revealed anything and the illness has gone undetected.

If we add to that the fact that many patients with endometriosis find it hard to go to the gynaecologist because they are young, they lack information or because of the frustration of not having found anything in previous checks, diagnosis becomes even more complicated. All of this means that, in Spain, the average delay in diagnosing endomestriosis is 8 years. This is unacceptable because as the illness progresses, it becomes more difficult to treat and its consequences (particularly in terms of fertility) are greater.

Instituto Bernabeu has set up a unit that specialises specifically in early diagnosis and treatment of endometriosis.

The process begins with questions on quality of life and gathering together medical records, data on symptoms and how daily life is being affected.

The check-up is a personalised and careful process carried out by specialised gynaecologists. This is followed by high-resolution ultrasound scans both in 2D, 3D and using contrasts aimed at detecting the endometriosis both in the ovaries and in the pelvic area or even in the rectovaginal fascia.

However, not all cases of endometriosis can be detected with an ultrasound scan, even with top-of-the-range equipment, and it is for this reason that we opt for detection through a blood sample and biomarkers.

The biomarkers that we look at are substances that appear in the inflammation caused by endometriosis. Sometimes, since they are present in the initial stages of the illness, they facilitate early diagnosis even when no signs show up on the ultrasound.

As well as early diagnosis, they also help us to get to know more about how far the endometriosis has progressed and if it is in an active or inactive state.

As specialists in reproductive medicine, when endometriosis has been diagnosed, we also carry out a personalised counselling session on reproduction. This helps to prevent potentially devastating consequences later down the line. In those cases where premature ovarian ageing is suspected, we also inform the patient about the option of egg vitrification in order to prolong childbearing years.

In the Instituto Bernabeu Endometriosis Unit we also help patients who have been diagnosed with endomestriosis and are facing reproduction issues to achieve pregnancy with individually designed treatment processes. Endometriosis, when carefully controlled, does not appear to affect reproductive medicine results although embryo implantation can sometimes be affected by a variant of the illness known as adenomyosis (endometriosis of the uterus). Endometriosis may also be the cause of embryo implantation failure. Therefore, our unit coordinates its work with that of other units specialising in poor ovarian response, implantation failure and recurrent pregnancy loss.

Certain foods can have an effect on the intensity of the illness and symptoms as well as increases and decreases in them. Therefore, the Endometriosis Unit is also given support by our endocrinology and nutrition team in the form of nutritional evaluation and advice. The aim is to make the most of natural resources in the fight against the illness and to hold back the associated symptoms.

In order to improve quality of life and by way of a complementary treatment to the endocrinological and gynaecological healthcare being given, acupuncture can help to relieve pain and we also, therefore, offer this type of specialist treatment.

In short, the earlier the diagnosis, the better. Meanwhile, correct evaluation and treatment of the illness can help to reduce pain, improve quality of life and preserve affected women’s childbearing years.

Dr. Belén Moliner, gynaecologist at Instituto Bernabeu

Dr. Rafael Bernabeu, Medical Director of Instituto Bernabeu

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