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6 things a gynaecologist wants you to know about endometriosis

By Dr Nitish Narvekar, fertility consultant at King’s Fertility and consultant gynaecologist at King’s College Hospital NHS Foundation Trust

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Despite the fact that endometriosis affects an estimated one in 10 women and girls globally, the condition is still widely misunderstood.

This Endometriosis Awareness Month, Dr Nitish Narvekar, clinical director and consultant gynaecologist at King’s College Hospital NHS Foundation Trust, discusses why endometriosis goes undiagnosed for years and shares what you should know about the condition.

What is endometriosis?

Endometriosis is a chronic debilitating inflammatory condition affecting up to 10 per cent of patients in their reproductive (puberty to menopause) years which equates to approximately over 1.5 million in the UK and 176 million globally.

The disease, where endometrial-like tissue grows outside the uterus, costs approximately £8bn per year to the UK economy in healthcare costs and loss of amenity.

Whilst the classic symptom is pelvic pain of varying intensity, duration and location, it can present with a range of other symptoms and conditions.

Signs and symptoms of endometriosis
  • Pain before and/or during periods (dysmenorrhea)
  • Pain during or after sex
  • Pain on opening bowels
  • Pain on passing urine
  • More frequent or urgent need to open bowels especially during periods
  • More frequent or urgent need to pass urine or waking up many times at night to pass urine
  • Blood in stools
  • Blood in urine
  • Cyclical chest pain and/or cough
  • Fatigue
  • Infertility > 6 months, especially if any of above is also present

Diagnosis is often delayed by eight to nine years due to lack of awareness by patients and care providers in all settings. Therefore, it is not uncommon for patients to be first diagnosed often fortuitously when undergoing a pelvic USS (ultrasound scan) or MRI (magnetic resonance imaging) when investigating other conditions, for example infertility.

USS is type of scan which uses high-frequency sound waves to create images of internal tissues/organs, whereas MRI uses strong magnetic fields and radio waves to produce such images.

Endometriosis and infertility

Whilst endometriosis is found in up to 50 per cent of patients with infertility, it is usually causative in patients with active disease and/or involvement of the fallopian tubes or ovaries. Whilst medical hormonal therapies are effective, they are not compatible with fertility and therefore many patients with complex endometriosis have to resort to surgery to improve fertility outcomes.

However, surgery carries attendant risks of trauma to bowel and urinary tract (also known as complications), and moreover, patients may experience delays in resuming fertility whilst recovering fully from surgery especially if it is complex.

Laparoscopy and endometriosis

Laparoscopy is a type of surgery which allows a surgeon to use keyhole cuts and a camera for procedures inside the tummy or pelvis.  It is the “gold standard” test for diagnosis and treatment of endometriosis and although invasive in nature is highly safe and effective.

Robotic surgery and endometriosis

Robotic surgery is a type of keyhole surgery undertaken using specialised camera and instruments which are inserted through keyhole cuts but unlike in laparoscopy these are controlled by a surgeon who sits at an ergonomically designed console away from the patient but otherwise in the same theatre.

Robotic surgery has been successfully introduced for routine gynaecological use in selected NHS clinics, for example King’s Fertility, and given its advantages, which include reduced complication rates and blood loss and faster recovery, has revolutionised surgical care of patients including when compared with traditional laparoscopy.

Whilst robotic surgery should be available to all patients, its use is limited by higher costs and limited availability and therefore at present reserved for managing patients with complex surgical and anaesthetic needs.

Another lesser known and heralded advantage of robotic surgery over and above other forms of surgery, including laparoscopy, is the greater ergonomics and intuitiveness it provides which in-turn results in reduced surgeon fatigue especially for complex cases. This in the long-run will improve working life and retention of surgeons at a time of greatest need within the NHS.

The pros of robotic surgery 

  • Greater precision
  • Superior 3D HD vision
  • Minimum tissue trauma
  • Nerve sparing
  • Lower blood loss and complications
  • Less post-operative pain
  • Reduced hospital stay
  • Quicker recovery
  • More ergonomic for the surgeon and reduced surgeon fatigue

The cons of robotic surgery

  • Higher capital costs
  • Rigorous quality and safety controls
  • Only available in select clinics and hospitals
What should women do?

All patients, including adolescents, should familiarise themselves with symptoms and signs of endometriosis and seek a GP appointment accordingly.

Where appropriate, patients should seek a high-quality pelvic USS, but, equally be aware that a negative USS does not rule out endometriosis and therefore, in case of persistent symptoms, seek additional MRI and/or laparoscopy and/or empirical treatments.

Patients with endometriosis should seek referral to a fertility clinic to discuss the nature of their condition and its impact on fertility. Many, but not all, fertility clinics provide high quality pelvic USS during initial diagnostic work-up and therefore benefit from quicker and more accurate diagnosis of endometriosis including deep and/or complex endometriosis.

Women with ovarian endometriosis and even otherwise, should consider preserving fertility by recourse to egg/embryo freezing where applicable.

Patients with severe and/or complex forms of endometriosis should request referral to their local BSGE (British Society of Gynaecological Endoscopy) accredited endometriosis centre.  Where possible they should enquire about availability of robotic surgery in such centres.

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Everything you need to know about adenomyosis

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Adenomyosis, a condition that causes the lining of the womb to bury into the muscular wall of the womb, affects as many as one in 10 women of reproductive age in the UK. Here, we look at everything you need to know about it.

 

What is adenomyosis?

Adenomyosis is a condition where the lining of the womb starts growing into the muscle in the wall of the womb.

The displaced tissue continues to act normally — thickening, breaking down and bleeding — during each menstrual cycle, leading in some cases to enlarged uterus and painful, heavy periods.

The condition is more commonly diagnosed in women over the age of 30, but it can affect anyone who has periods.

What are the symptoms of adenomyosis?

Sometimes, adenomyosis causes no signs or symptoms or only mild discomfort. However, according to the NHS, common symptoms can include:

  • Heavy or prolonged menstrual bleeding
  • Severe cramping or sharp pelvic pain during menstruation (dysmenorrhea)
  • Chronic pelvic pain
  • Painful intercourse
What causes adenomyosis?

The cause of adenomyosis isn’t known. You may be more likely to get it if you are over the age of 30 and have given birth.

There have been many theories, including:

  • Invasive tissue growth. Some experts believe that endometrial cells from the lining of the uterus invade the muscle that forms the uterine walls. Uterine incisions made during an operation such as a cesarean section (C-section) might promote the direct invasion of the endometrial cells into the wall of the uterus.
  • Developmental origins. Other experts suspect that endometrial tissue is deposited in the uterine muscle when the uterus is first formed in the fetus.
  • Uterine inflammation related to childbirth. Another theory suggests a link between adenomyosis and childbirth. Inflammation of the uterine lining during the postpartum period might cause a break in the normal boundary of cells that line the uterus.
  • Stem cell origins. A recent theory proposes that bone marrow stem cells might invade the uterine muscle, causing adenomyosis.

Regardless of how the condition develops, its growth depends on the body’s circulating oestrogen.

How is adenomyosis treated?

Treatments include:

If these treatments do not work, women may need surgery. This could be a hysterectomy, or surgery to remove the lining of the womb, also known as endometrial ablation.

What is the difference between adenomyosis and endometriosis?

Adenomyosis and endometriosis are disorders that involve endometrial-like tissue. Both conditions can be painful. Adenomyosis is more likely to cause heavy menstrual bleeding. The difference between these conditions is where the tissue grows.

Adenomyosis occurs when endometrial tissue grows deep in the muscle of the womb, whereas endometriosis occurs when endometrial tissue grows outside the womb in places, such as the ovaries and fallopian tubes.

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Everything you should know about PCOS

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PCOS is one of the most common causes of female infertility, affecting six per cent to 12 per cent of US women of reproductive age but, according to the CDC, it’s a lot more than that. This lifelong health condition continues far beyond the child-bearing years. Here, we look at everything you should know about it.

 

What is PCOS?

PCOS is a condition in which the ovaries produce an abnormal amount of androgens, male sex hormones that are usually present in women in small amounts. The name polycystic ovary syndrome describes the numerous small cysts (fluid-filled sacs) that form in the ovaries. However, some women with this disorder do not have cysts, while some women without the disorder do develop cysts.

Polycystic ovaries contain a large number of harmless follicles that are up to 8mm (approximately 0.3in) in size.

The follicles are underdeveloped sacs in which eggs develop. In PCOS, these sacs are often unable to release an egg, which means ovulation does not take place.

The three main features of the condition are:

  • irregular periods
  • excess androgen
  • polycystic ovaries

If you have at least two of these features, you may be diagnosed with PCOS.

What are the symptoms of PCOS?

The symptoms may include:

  • Missed periods, irregular periods, or very light periods
  • Ovaries that are large or have many cysts
  • Excess body hair, including the chest, stomach, and back
  • Weight gain, especially around the abdomen
  • Acne or oily skin
  • Male-pattern baldness or thinning hair
  • Infertility
  • Small pieces of excess skin on the neck or armpits (skin tags)
What causes PCOS?

The exact cause of PCOS is not clear. Many women with the condition have insulin resistance. This means the body can’t use insulin well. Insulin levels build up in the body and may cause higher androgen levels. Obesity can also increase insulin levels and make PCOS symptoms worse.

PCOS may also run in families. It’s common for sisters or a mother and daughter to have it.

Genes, insulin resistance and inflammation have all been linked to excess androgen production.

What are the complications of PCOS?

Women with PCOS are more likely to develop certain serious health problems. These include type 2 diabetes, high blood pressure, problems with the heart and blood vessels, and uterine cancer.

Women with the condition also tend to have difficulty getting pregnant.

How is PCOS treated?

There’s no cure for PCOS, but the symptoms can be treated.

According to the NHS website, if you have PCOS and you are overweight, losing weight and eating a healthy, balanced diet can make some symptoms better. Medicines are also available to treat symptoms such as excessive hair growth, irregular periods and fertility problems.

If fertility medicines are not effective, a surgical procedure called laparoscopic ovarian drilling (LOD) may be recommended.

This involves using heat or a laser to destroy the tissue in the ovaries that’s producing androgens, such as testosterone. With treatment, most women with PCOS are able to get pregnant.

When should I seek help?

Experts recommend to see your doctor if your body has skipped periods, or you have other symptoms like hair growth on your face or body. Also, you should see a doctor if you’ve been trying to get pregnant for 12 months or more without success.

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Driving women’s health innovation: the launch of the Springboard Enterprise women’s health cohort

By Natalie Buford-Young, CEO of Springboard Enterprises

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Springboard founder Kay Koplovitz speaking at the Springboard Annual Gala

In the ever-evolving landscape of healthcare, addressing the unique needs of women has long been a neglected area.

However, with the emergence of initiatives like the recent announcement of White House Women’s Health Initiative and the ARPA-H Sprint for Women’s Health, there’s a promising shift towards fostering innovation and putting more resources towards advancing women’s health.

At Springboard Enterprises, we are proud to contribute to fuelling growth in this sector.

Springboard was founded in 2000 as the first official accelerator to mentor and accelerate the growth of women-led ventures. We have now officially launched our women’s health innovation program to identify and accelerate the growth of women-led companies innovating in health areas that uniquely, solely or predominantly impact women.

The announcement of the 2024 Women’s Health Innovation Program Cohort marks a significant milestone in the journey towards redefining healthcare solutions tailored specifically for women. This cohort comprises ten women’s health companies, each led by founders and CEOs committed to revolutionising women’s health. 

According to a report by Silicon Valley Bank, investment in women’s health has experienced an astounding 314 per cent growth since 2018, starkly contrasting with the overall healthcare investments. 

This incredible growth has really shown the abundance of opportunity, which was especially evident during our competitive process for our inaugural program. With countless innovative companies to choose from, we ultimately selected ten standout candidates after much deliberation.

  1. Navigate Maternity: Founded by Ariana McGee, Navigate Maternity has created a system that allows clinicians and care teams to remotely monitor prenatal and postpartum patients. The goal is to improve outcomes and avoid inequitable care through real-time data.
  2. Bone Health Technologies: Under the leadership of Laura Yecies, Bone Health Technologies (BHT) has developed the Osteoboost belt, the first and only safe and effective treatment for the 63 million people in the US with Osteoporosis or Osteopenia as well as a comprehensive digital therapeutic platform and services – a personalised digital health and telehealth solution for optimising bone health.
  3. Visana Health: Co-founded by Shelly Lanning, Visana Health pioneers a comprehensive virtual women’s health clinic, offering integrated care across various women’s health conditions. By adopting a holistic approach to healthcare delivery, Visana Health strives to empower women through personalised and longitudinal care.
  4. Herself Health: Founded by Kristen Helton, Herself Health is dedicated to addressing the unique healthcare needs of women on Medicare, ages 65 and up. Through a patient-centred approach, the company links women’s health goals with their life goals, taking into account a patient’s physical, mental, social, sexual, and spiritual needs and targeting common concerns like bone health, weight loss, and emotional wellbeing. The company hires top providers and trains them in the intricacies of person-centred geriatric and women’s care, delivering value-based care focused on patient outcomes.
  5. Marma: Co-founded by Meredith McAllister, Marma addresses critical gaps in maternal health by providing personalised nutritional guidance throughout the journey of motherhood. Marma works with patients to understand their unique needs and provide individualised, holistic nutrition advice at every stage of motherhood.
  6. Kegg: Founded by Kristina Cahojova, Kegg empowers women with accurate and personalised fertility tracking solutions. By harnessing cervical fluid data, Kegg enables women to make informed decisions regarding their reproductive health.  Already in the hands of 25,000 women in the US, the company now has the world’s largest dataset on vaginal health and the unique ability to use machine learning to help drive predictive healthcare for women at scale.
  7. Cntrl+ Inc: Founded by Karen Brunet, Cntrl+ Inc. is a pioneering life science firm specialising in female wellness. Their company has innovatively crafted an over-the-counter reusable solution addressing female stress urinary incontinence. They are dedicated to exporting and distributing this product globally, offering an effective and environmentally friendly solution for women.
  8. Multitude Health: Founded by Casey Langwith, Multitude Health alleviates the pain of irritable bowel syndrome (IBS) through an app-based clinical program that teaches members cognitive behavioural therapy skills, plus a tightly integrated therapist-led peer community to restore a healthy brain-body connection.
  9. Myri Health: Founded by Dr Pinky Patel, Myri Health introduces a comprehensive postpartum resource app, catering to the diverse needs of new parents. By providing personalised rehabilitation, evidence-based resources and a community platform, Myri Health seeks to support the postpartum journey.
  10. Ursamin: Founded by Shannon Aylesworth, Ursamin offers a SaaS-based care coordination platform for patients living with multiple chronic illnesses. By fostering a team-based approach to care delivery, Ursamin aims to improve outcomes and reduce administrative burden for providers and patients alike.

The diversity of solutions to advancing women’s health exemplified by the participants of the Springboard Enterprises women’s health cohort gives us a preview into the transformative potential of innovation in women’s health on various fronts.

At Springboard Enterprises, we play a pivotal role in catalysing innovation and driving meaningful change within the healthcare industry. By empowering women-led companies and amplifying their impact, we move closer towards achieving equitable and comprehensive healthcare solutions.

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