You are on page 1of 19

The

Journey of endometriosis pa3ents


seek care : Indonesian experience

Andon Hes3antoro

Reproduc3ve Immunoendocrinology Division


Department of Obstetrics and Gynecology
Faculty of Medicine, University of Indonesia
Dr. Cipto Mangunkusumo
Jakarta
Objec3ve
Deni3on of endometriosis
Prevalence of endometriosis
Pathogenesis of endometriosis
Impact endometriosis
Health problem associated with endometriosis
(Indonesian experience)
Novel diagnos3c model ?
Novel therapy for endometriosis ?
Deni3on
Endometriosis is a gynecological condi3on characterized by the growth of
endometrium-like 3ssues within and out- side of the pelvic cavity 1,2
It is an estrogendependent 3ssue and associated with chronic
inamma3on process 1,3

1. Bulun SE, Utsunomiya H, Lin Z, Yin P, Cheng YH, Pavone ME, Tokunaga H, Trukhacheva E, A^ar E, Gurates B et al.. Steroidogenic factor-1 and endometriosis.
Mol Cell Endocrinol 2009;300:104 108
2. Cumiskey J, Whyte P, Kelehan P, Gibbons D. A detailed morphologic and immunohistochemical comparison of pre- and postmenopausal endometriosis. J Clin
Pathol 2008;61:455-459
3. Giudice LC. Endometriosis. N Engl J Med 2010;362:2389-2398
Its is a disease with considerable prevalence in
communi6es

Prevalence
It may aect 10% - 15% of women in reproduc6ve age
and 35% to 50% of women with pelvic pain, infer6lity or
both. (1)

1. Due to suering from physical and mental symptoms,


thus it will impact on daily ac3vi3es and quality of life
2. It showed high hospital admission rate, morbidity
Impact
rate, absenteeism rate and more surgical procedure.
3. High nancial burden
4. Loss of produc3vity. (2,3)

1. Yi KW, et al. Int J Gynecol Obstet 2009; 105: 39-42


2. Simoens S, et al, Hum Reprod 2012; 27: 1292-1299
3. Mirkin D, et al. J Manag Care 2007; 13: 262-272
%
Length of 3me for seeking care and treated
(months)
Med = 28
Min = 12 Med = 25.5
1600
Max= 365 Min = 12
1400 Max= 350

1200

1000

800

600 Med = 9.5 Med = 5


Min = 2 Min = 1 Med = 3
400
Max= 16 Max= 9 Min = 1
200 Max= 9

0
Total length of 3me with Total diagnos3c delay Length of 3me before Length of 3me from Length of 3me from referral
symptoms seeking medical help consulta3on in primary care to secondary care to
to referral to secondary care diagnosis
Tradi6onal herbs used for relieving
What are the cause of delayed diagnosis
pain :

Cause of delayed diagnosis at pa3ents level 1. Curcuma


1. Normalisa3on of symptoms 2. Tamarind
Normal 3. Berry juice
Unlucky person 4. Green coconut water
Nothing compared to mother, 5. Garlic
while having baby 6. Ginger
2. Embarrassment and fear of being seen 7. Carrot
as unable to cope 8. Kaempferia galanga
Cause of delayed diagnosis at a medical 9. Galangal
level 10. Clove
1. Normalisa3on of symptom by GP 11. Aglaia odorata
2. Intermi^ent suppression of symptoms 12. Indian camphorweed
with hormones
3. Lack of knowledge regarding to early
endometriosis symptoms
Gynecological nding

15%
25%

35%
25%

Mrs. SA, 26 yo, P0A0, AMH = 1.43 ng/ml


Endometriosis can aect physical and mental health

Fourquet J, et al. Fertil Steril 2011;96:107112;


Con3nuum of Life

Pregnancy Baby / Child Adolescent Reproduc3ve Menopause

Risk Factors for Endometriosis (endocrine,


environment, gene3cs, immune system, life style)

Endometriosis
Stunted
Fetal origin adult DM
disease Endometriosis
Insulin resistance

Vulnerable
Suscep3ble
Problem in managing endometriosis
Early diagnosis and prompt treatment Management for
Preven3ng delayed treatment adolescent
endometriosis
Preven3ng recurrence
Start from the beginning ( during pregnancy )

Diagnos3c marker for endometriosis ?


Biochemical marker (Ca-125, Ca-19.9, PP14)
Immunologic marker ?
Biomolecular marker ? Stem cell ?
Proteomic marker ?
Aromatase marker ?
Angiogenesis marker ?
Prolifera3ve marker ?
Imaging (ultrasonography, MRI, CT scan) ?
History taking, Symptoms and Signs

Adolescent = bowel complained related pain more useful than


USG

Dysmenorrhea, non cyclical pain, dysparuenia would be a Indonesian


good predictor of endometriosis in Indonesia symptom-based
diagnos3c tools for
Fer3l Steril 2012;98:692-701 endometriosis
Unmyelinated nerve ber type C in menstrual blood endometriosis pa3ents

A
!

B
!

McKinnon, B., Fer3l Steril 2012; 97(2): 373-380


Cakra MA, Hes3antoro A. in prepara3on for publica3on
Epigene3c dysregula3on of endometriosis suscep3bility genes

Demethyla3on
of ER promoter

Koike N, et al. Mol Med Rep 2015;12(2)


Ecacy of Phaleria macrocarpa, DLBS 1442, ER-beta analog
VAS (median)
Reduced VAS
Before DLBS Aqer DLBS 1442
Type of pain aqer 3 cycles
1442 Cycle 1 Cycle 2 Cycle 3 (median)
(min-max) (min-max) (min-max) (min-max)

Menstrual pain 6.5 (4-10) 5 (1-8) 3 (0-8) 2 (0-3) 5 (3-8)

Premenstrual pain 2 (0-10) 0 (0-9) 0 (0-5) 0 (0-5) 1 (0-10)

Dyschezia 1 (0-9) 0 (0-1) 0 (0-0) 0 (0-0) 1 (0-9)

Dysuria 0.5 (0-6) 0 (0-6) 0 (0-2) 0 (0-0) 0.5 (0-6)

Wiweko B, et al . Medicinus 2013;26(2):35-38


Conclusion
Endometriosis is a chronic inammatory disease
which is associated with estrogen
Treatment = Medicinal and or Surgical (Classical)
Health problem =
No favorable diagnos3c tools
High recurrence rate
No protocol for long term treatment
Develop the Indonesian symptom-based
diagnos3c tools for endometriosis
Develop medica3on associated with ER SERM

You might also like