To hear Dr. Ceana Nezhat’s full presentation about the future endometriosis treatment, play the video above.

This is endometriosis, and endometriosis is an enigmatic disease. It is not one disease. It’s a process, and it walls any part in the body. What I would like to focus on is pelvic pain, infertility, malignancy and see where we would be going in the future to treat this disease.

Two things we know for a fact today, because everything else is suggestions. Endometriosis is estrogen dependent, progesterone resistance, and it is an inflammatory disorder. This is a fact. The other fact, unfortunately from the time of the first symptom to diagnose it, it takes 8 to 11 years, so we are behind
in assessing the endometriosis.

You’ve heard all of these diagnoses that it could be retrograde menstruation, coelomic metaplasia, immune dysfunction, environmental triggers. We know dioxin, we know DES patients who have been exposed with DES 80% chance they have endometriosis, congenital anomalies. Almost all women have retrograde menstruation sometime in their life, but why do not all of them have endometriosis?

If you look at all the symptoms, cyclic pain is the most common symptom associated with endometriosis. Look at history, all these paintings from the 17th century shows the adolescents, the teenagers, the young women disabled because of the pain. They were bedridden, either praying for
them or having a house care by the doctor.

You would see the natural remedies and herbs and the massage were used to treat endometriosis historically. Today, we have acupuncture and physical therapy, so when you look at the treatment, all the summary of all these talks that you have heard, medical therapy, all of them, surgical therapy removing excision. Excision, unfortunately, is taken beyond the proper utilization and then sequential therapy. The success rate for medical, it works for a little bit then it stops working, the side effects are high for surgery. There is no cure for endometriosis, there is only cure endometriosis on Internet. We don’t know what it is? We don’t have a cure for it. Surgical excision in two to five years, you have 50% recurrent, why is that? When we look at the infertility, endometriosis could affect all the factors who could contribute to the pregnancy, peritoneum factor, ovarian factor, tubal factor, and endometrial factor. It’s a toxic inflammatory organ. In the past, getting pregnant was a treatment for endometriosis. They said, if you do not get pregnant, the uterus wanders around the abdomen and causes more trouble.

In 2011, we had the world symposium in endometriosis in Atlanta. 55 leaders of the world came. We talked about immunology, mechanical treatment, but the conclusion is at today’s expertise, the surgical excision without compromising function of the organ and restoring of the anatomy is the answer, no
answer is left behind. We all allot with laparoscopy when it comes to the knowledge of endometriosis not only on treatment but diagnosis. If you look at even in general surgery, urology, the way that we are started treating endometriosis by laparoscopy expanded to the other disciplines.

Donna Vogel who worked at the NIH in the 80s said, “Endometriosis is a difficult disease to live with and difficult to understand. It’s like nailing Jello to a tree.”

We are here today. We think we are doing something about endometriosis.