19:30-21:00 Endometriosis NZ Symposium

Transcription

1 Ms Miriama Kamo Dr Guy Gudex Director Repromed Professor Neil Johnson Gynaecologist and REI Subspecialist Auckland Gynaecology Group and Repromed Auckland Dr Fiona Connell Gynaecologist North Shore and Auckland City Hospitals Auckland Ms Deborah Bush Co-founder and Chief Executive Endometriosis New Zealand Auckland 19:30-21:00 Endometriosis NZ Symposium

2 Early Intervention for dysmenorrhoea and why it matters Deborah Bush MNZM QSM Dip Tchg LSB Chief Executive Endometriosis New Zealand Director EPP Coaching and Consulting World Endometriosis Trust Board Endometriosis NZ 2018 ALL RIGHTS RESERVED

3 Dysmenorrhoea: painful periods or menstrual cramps prevalence estimates vary from 45% to 95%. the most common gynaecological condition in women regardless of age and nationality usual onset occurs around the time that menstruation begins symptoms typically last less than three days pain is usually in the pelvis or lower abdomen associated with a restriction of activity and absence from school or work (5% to 51% women) few women with dysmenorrhoea seek treatment as they believe it would not help BMJ May 13; 332(7550): doi: /bmj Proctor M, Farquhar C. Endometriosis NZ 2017 ALL RIGHTS RESERVED

4 Primary dysmenorrhoea Secondary dysmenorrhoea Differential diagnosis of primary & secondary dysmenorrhoea Onset shortly after menarche Onset can occur at any time after menarche (typically after 25 years of age) Lower pelvic or abdominal pain is usually associated with onset of menstrual flow and lasts 8-72 hours Women may complain of change in time of pain onset during menstrual cycle or in intensity of pain Back and thigh pain, headache, diarrhoea, nausea, and vomiting may be present Other gynaecological symptoms (such as dyspareunia, menorrhagia) may be present No abnormal findings on examination Pelvic abnormality on physical examination Endometriosis NZ 2017 ALL RIGHTS RESERVED

5 Literature Review on Prevalence of Dysmenorrhoea in Adolescence Turkey 8 Mexico 7 Nigeria 6 Sudan 4 Ethiopa 5 India 1,2 Singapore 9 Brazil 3 Salient points Prevalence of dysmenorrhoea reported 25 93% School absence due to dysmenorrhoea 20 31% 5 33% seek GP advice Australia 10 New Zealand Rani et al. (2015) Practices and perceptions of adolescent girls regarding the impact of dysmenorrhea on their routine life: a comparative study in the urban, rural, and slum areas of Chandigarh. Int J Adolesc Med Health; aop 2. Dambhare et al. (2012) Age at Menarche and Menstrual Cycle Pattern among School Adolescent Girls in Central India. Global Journal of Health Science 4( ) 3. Pitangui et al. (2013) Menstruation Disturbances: Prevalence, Characteristics, and Effects on the Activities of Daily Living among Adolescent Girls from Brazil. J Pediatr Adolesc Gynecol 26 ( ) 4. Ali et al. (2011) Age at menarche and menstrual cycle pattern among schoolgirls in Kassala in eastern Sudan. Journal of Public Health and Epidemiology 3( ) 5. Zegeye et al. (2009) Age at menarche and the menstrual pattern of secondary school adolescents in northwest Ethiopia. BMC Women s Health 9(29) 6. Nwankwo et al. (2010) Menstrual Disorders in Adolescent School Girls in Enugu, Nigeria. J Pediatr Adolesc Gynecol 23 ( ) 7. Ortiz et al. (2009) Prevalence and impact of primary dysmenorrhea among Mexican high school students. Int J Gynecol and Obst 107 ( ) 8. Erylimaz et al. (2010) Dysmenorrhea prevalence among adolescents in eastern Turkey: its effects on school performance and relationships with family and friends. J Pediatr Adolesc Gynecol 23 ( ) 9. Agarwal et al. (2009) Questionnaire Study on Menstrual Disorders in Adolescent Girls in Singapore. J Pediatr Adolesc Gynecol 22( ) 10. Parker et al. (2009) The menstrual disorder of teenagers (MDOT) study: determining typical menstrual patterns and menstrual disturbance in a large population-based study of Australian teenagers. BJOG ( ) 11. The New Zealand me program research

6 abdominal pain mental health PMS cramps PANDORA S BOX Prevalence v incidence misdiagnosis underreporting stereotyped diagnostic delay unresolved aetiology investigations hit and miss treatments the scale of the problem not being believed taboos, myths repeat visits to doctors bad surgery multiple surgeries only about surgery

7 The young patient with dysmenorrhoea s role This is a part she never auditioned for She faces grave consequences should she get her part wrong Triage classifications diagnosis referrals characteristics endo profiling She is encouraged to take control and responsibility regarding an incurable complex disease of uncertain aetiology. WHAT? Access and variances in care. Endometriosis NZ 2017 ALL RIGHTS RESERVED

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9 Endometriosis doesn t discriminate 120,000 New Zealanders 176 million girls and women from all races and cultures 1-in-10 girls and women all around the world

10 Why early intervention? age onset of symptoms diagnostic delay fertility down stream costs (fiscal, personal, human) current evidence potential to develop into chronic pelvic pain now recommended in the literature OBLIGATION TO PROVIDE A DUTY OF CARE Grace, V.M. and Zondervan, K.T. (2004) Chronic pelvic pain: prevalence, pain severity, diagnoses and use of the health services in NZ Australian and New Zealand Journal of Public Health, Vol 28(4): Adolescent endometriosis J Sanfilippo June MDOT Study Parker, ACT 2005 Consensus on the Management of Endometrosis (2013) NICE guideline Endometriosis NZ 2017 ALL RIGHTS RESERVED

11 Adolescent females with severe dysmenorrhoea (period pain) Disrupted cognitive development Interrupted education and academic performance Missed career opportunities Poor emotional, psychosocial, physical and mental health outcomes Moradi, et al (2014). Impact of endometriosis on women s lives: a qualitative study. BMC Women's Health. Agarwal A, Venkat A (2009). Questionnaire study on menstrual disorders in adolescent girls in Singapore. Journal of Pediatric and Adolescent Gynecology. Parker, et al. (2009). The menstrual disorder of teenagers (MDOT) study: determining typical menstrual patterns and menstrual disturbance in a large population based study of Australian teenagers. BJOG. Dorn, et al (2009). Menstrual symptoms in adolescent girls: association with smoking, depressive symptoms, and anxiety. Journal of Adolescent Health. NICE guideline 2017 Endometriosis NZ 2017 ALL RIGHTS RESERVED

12 The me programme Menstrual Health and Endometriosis An overview Endometriosis NZ 2017 ALL RIGHTS RESERVED

13 Quality education: an effective and acceptable tool to raise awareness of endometriosis in young people What we know empower a population and improve health seeking behaviours avoids potential compromised fertility / quality of life downstream minimises the chances of a complex persistent pain condition developing GLOBALLY school absence due to dysmenorrhoea 20 31% MDOT Early recognition of symptoms and timely intervention is crucial Education is the best screening tool available Multi-disciplinary treatment me 27% of girls often / always miss school due to dysmenorrhoea 25% marked menstrual disturbance Endometriosis NZ 2017

14 Has this translated to the clinical setting? Are we seeing young women presenting earlier? Endometriosis NZ 2017 ALL RIGHTS RESERVED

15 96% went to laparoscopic review 98% diagnosed with endometriosis 49% stage I endometriosis Presenting symptoms? dysmenorrhoea, lower back pain, bowel symptoms, bloating fatigue

16 Stage of endometriosis diagnosed in patients under 20 years (2006) Endometriosis and Pelvic Pain Clinic, Oxford Clinic Women s Health, Christchurch, NZ. 7% 16% 28% Treatment laparoscopic excision of endometriosis + / - Mirena placement and/or other management multi-disciplinary holistic approach specific management for this age group 49% Grade l Grade ll Grade lll Grade lv Endometriosis NZ 2017 ALL RIGHTS RESERVED

17 Endometriosis NZ 2017 ALL RIGHTS RESERVED Stage of endometriosis diagnosed in patients years (2006) EPP Clinic, Oxford Clinic Women s Health, Christchurch, NZ. 18% 23% 31% 28% Grade 1 Grade 2 Grade 3 Grade 4 More women with stage III and IV endometriosis and infertility

18 We need to: listen does the story and the history stack up? treat appropriately in primary care focusing on outcomes which really matter to her address relevance and encourage patient involvement what treatment is preferred? inter-disciplinary management follow up at intervals if she s doing well watch for new clinical pathways educate CME PHO DHB Patient resources from ENZ? Free downloadable ebook Communities HOPE Refer Gynaecologist with special interest and expertise.

19 e Stage I endometriosis 15 yrs old Presentation? dysmenorrhoea Can we stop this Endometriosis NZ ALL RIGHTS RESERVED

20 Stage IV endometriosis 33 year old Infertility & CPP becoming From this? Endometriosis NZ ALL RIGHTS RESERVED

21 YOU BET WE CAN! Early intervention is crucial to STOP the harm and significant impact Endometriosis NZ 2017 ALL RIGHTS RESERVED

22 strength through support mä te tautoko, ka whai kaha, ka ora Endometriosis New Zealand acknowledges the organisers of the Rotorua GP CME conference Particularly: Dr Peter Chapman-Smith and Leon Olsen