Still No Cure

Did you know that endometriosis was first microscopically discovered 159 years ago? However, there are recordings of endometriosis like disease processes in the Hippocratic Corpus, a serious of ancient Greek medical journals created over 2,500 years ago. In these medical journals endo was referred to as “strangulation of the womb.” So why is there so little understanding about a disease process we have known about for hundreds if not thousands of years?

Despite ancient records of disease affecting women’s reproductive tracts, women with endometriosis have been diagnosed with a myriad of obscenities. Throughout history women with endometriosis were accused of witchcraft, love sickness, hysteria, and immorality.  Endo sufferers were often imprisoned in mental institutions, excommunicated from communities, forced through exorcisms, hung upside down, and bled in order to “cleans them”.

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French psychiatrist Jean-Martin Charcot with one of his patients, a women supposedly suffering from “hysteria” on trial for insanity.

Finally a few medical professions started to realize that endometriosis was a physiological disorder. In 1815 the first vaginal hysterectomy was performed leading way to the first successful abdominal hysterectomy in 1853. In the mid 1800s an internist and  by the name of Armand Trousseau began to investigate endometriosis further. Dr. Trousseau became the first recorded physician to formulate a medical plan for endometriosis using opium extract, and belladonna (a poisonous plant that induces muscle relaxation). Not long after, it became customary for physicians to use alcohol, opium, morphine and leeches on woman’s cervix to help alleviate endometriosis related pain. Queen Victoria was recorded receiving monthly doses of cannabis to aid with her endometriosis related pain.

In the mid 1800s surgeons began attempting to “puncture” obvious endometriosis nodules but had limited success and the mortality rates for these surgeries were near 70%. In the 1870s surgeons were recorded using a technique were they would clawed out endometrial lesions with their fingernails. In the mid to late 1880s aseptic technique became more widely accepted and more patients lived through surgeries. It was then that the discovery was made that endometrial lesions where more complex to remove then simple fibroids and would often come back after removal. Due to complications and recurrence more doctors began to advise hysterectomies. Mortality rates still were quite high, staying above 50%. Because of this there was a push for less invasive treatment methods and the idea of transvaginal hysterectomy was revisited. By 1889 there were surgeons bosting vaginal hysterectomy mortality rates as low as 15%. With the discovery of antibiotics in the early 1900s mortality rates dropped between 2%-10%. Yet women were still having recurrence of pain.

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19th century transvaginal hysterectomy

In the early to mid 1900s multiple surgeons added in discovering that endometriosis was not limited to the ovaries and tissues immediately surrounding the uterus. In 1957 George Pinkus, developed and introduce a hormonal contraceptive. Many of the patients to try the earliest version of The Pill were women with endometriosis. In 1970 the first video-assisted laparoscopic excision surgeries began to take flight. In the 1980s a few mile markers showed up. The first successful laparoscopic removal of endometriosis on the bowels and the first successful laparoscopic hysterectomy were performed. In the following years methods for the laparoscopic removal of endometriosis of the bladder, ureters, diaphragm, liver, and lungs were performed. Sadly it was not until 2004, over 20 years later, that minimally invasive laparoscopy became wide accepted. Up until this point many surgeons were still resisting less invasive methods and performing unnecessary laparotomies. In 1986 non-pigmented endometrial lessons were first recorded. To this day many gynecological surgeons are unaware that such lesions can exist and continue to mislead patients into believing their pain is in their head. GnRH-agonists and prostaglandin inhibitors also began to undergo research and trials in the 1980s.

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Now here we are nearly 30 years later. What new finding have been made? Well not a whole lot. Laparoscopic excision is still the standard of care. Further research into preventing recurrence and methods for locating and treating non-pigmented lesions hasn’t really gone anywhere. There has been no solid answer in any research as to what causes endometriosis and how to prevent it. Also, non-surgical options are still limited to birth control developed in the 50s, hormone treatments with extensive side effects founded in the 1980s, and pain management similar to the ineffectively treatments used in the 1800s. So it has been over 4,000 years of documentation and research yet we still have no cure. We still suffer with the stigma that our pain is somehow psychological by many physicians. Professor and MD Ray Garry summed up our delima well stating that the current medical industry is in a state of “aetiological confusion and therapeutic anarchy” when it comes to the topic of endometriosis.

 

It is time for change. We must unrelentingly demand that more medical professionals research and learn about the condition that affects 1 in 10 women in the hopes that someday we will have a cure!

 

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