Controversies in Endometriosis, Adenomyosis and Fibroids

Gynecologists have a great deal of knowledge about treating abnormal uterine bleeding and pelvic pain. However, the multiple disease conditions that contribute to these presentations remain perplexing and enigmatic for both patients and clinicians. In response to a clear need for continuing medical education focused on the diagnosis and treatment of gynecologic conditions related to endometriosis, adenomyosis and fibroids, Cleveland Clinic’s Ob/Gyn & Women’s Health Institute presents “Controversies in Endometriosis, Adenomyosis and Fibroids.”

The live webinar program is directed by Rosanne M. Kho, MD, and Tommaso Falcone, MD, and will be held March 19-20, 2021. By improving the knowledge, skills, and competencies of practitioners, this educational activity will help health care professionals ensure that they are providing the highest quality and up-to-date care for their female patients.

Addressing gaps in knowledge leads to improved outcomes and increased patient satisfaction

In general, gynecologists are challenged to stay abreast of a large volume of emerging research, to accurately assess the evidence, and to correctly analyze applications to clinical care. In addition, they need to be knowledgeable of new therapies and diagnostic technologies that are changing the direction of clinical practice. Addressing these gaps in both knowledge and practice will translate to improved outcomes and increased patient satisfaction.

“For this meeting, we have gathered a national and international group of experts who are prepared to share where the controversies lie and shed light on new treatment options,” says Dr. Kho, who is known for advancing the field of minimally invasive surgery for benign conditions.

Fibroids remain under-recognized

Uterine fibroids are the most common pelvic neoplasm in reproductive-aged women, accounting for 29% of gynecologic hospitalizations and 40% to 60% of hysterectomies.1,2 An estimated 20% to 50% of reproductive-aged women have fibroids, but only about one-third are diagnosed. Although most of these undetected fibroids are too small to be clinically identified, some evidence indicates that diagnosis of fibroids could be improved through better recognition and judicious use of imaging studies. Further complicating the recognition and diagnoses, not all fibroids require treatment, creating controversies regarding which to treat. Treatments also have changed with continued innovations in medical and surgical therapies.3.4 Additionally, innovations in morcellation have changed approaches to patients with fibroids.5 These factors point to knowledge and competence gaps regarding indications, malignancies, preoperative assessment, and surgical considerations regarding management of fibroids — all of which will be addressed in the webinar sessions.

Adenomyosis and fertility-related complications

Studies indicate that adenomyosis may affect fertility outcomes, which alters the selection of treatment options, both medical and surgical, especially in those who want to avoid hysterectomy to preserve fertility.6 However, many questions remain regarding the cause, diagnosis and treatment of this disease. This webinar will address a variety of questions, including: What are the best uses of imaging studies? What are the different types of adenomyosis? What are the effects on pain, bleeding and fertility?

Endometriosis and chronic pelvic pain

Endometriosis has an estimated prevalence rate of 1 in 10 reproductive-aged women in the U.S.7 However, there are documented delays in clinical practice from the initial presentation of pelvic pain to the diagnosis of endometriosis and appropriate treatment.8-10 This can be attributed, at least in part, to gaps in practitioners’ knowledge and competence to assess and diagnose the disease in symptomatic women. In turn, these gaps are influenced by the lack of clarity in the evidence. To provide some guidance, medical societies have developed consensus guidelines for the assessment of patients with chronic pelvic pain, including those suspected of having endometriosis, along with recommendations for diagnostic testing and empirical medical therapy.11-14 However, as with many guidelines, practitioners have gaps in knowledge of the guideline intricacies and their application in clinical practice. Faculty at “Controversies in Endometriosis, Adenomyosis and Fibroids,” will review the evidence and its implications for clinical practice.

Session designed to encourage interaction

“We designed a robust program to be as highly interactive as possible with time for discussion of complex cases with Q&A,” says Dr. Kho.

In addition to lectures, surgery videos and complex case scenarios, we will also have smaller workshops on how to use Imaging in the pre-operative diagnosis of endometriosis and fibroids, and on advancing skills in operative hysteroscopy and laparoscopy.

“If you are looking for a high-yield, efficient course that covers medical and surgical management of conditions that are commonly seen in the office, this will be an excellent course for you,” concludes Dr. Kho.

“Controversies in Endometriosis, Adenomyosis and Fibroids” will offer attendees a maximum of 15 AMA PRA Category 1 Credits. For more information on the course, or to register, please click here.

References

1. Pavone D, Clemenza S, Sorbi F, et al. Epidemiology and risk factors of uterine fibroids. Best Pract Res Clin Obstet Gynaecol. 2018;46:3-11.
2. Stewart EA, Cookson CL, Gandolfo RA, Schulze-Rath R. Epidemiology of uterine fibroids: a systematic review. 2017;124(10):1501.
3. Bradley LD, Gueye NA. The medical management of abnormal uterine bleeding in reproductive-aged women. Am J Obstet Gynecol. 2016;214(1):31-44.
4. Kho RM, Andres MP, Borrelli GM, et al. Surgical treatment of different types of endometriosis: Comparison of major society guidelines and preferred clinical algorithms. Best Pract Res Clin Obstet Gynaecol. 2018;51:102-110.
5. American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 770: Uterine morcellation for presumed leiomyomas. [Published correction appears in Obstet Gynecol. 2019;134(4):883.] Obstet Gynecol. 2019;133(3):e238-e248.
6. Mikos T, Lioupis M, Anthoulakis C, Grimbizis GF. The outcome of fertility-sparing and nonfertility-sparing surgery for the treatment of adenomyosis. a systematic review and meta-analysis. J Minim Invasive Gynecol. 2020;27(2):309-31.
7. Rolla E. Endometriosis: advances and controversies in classification, pathogenesis, diagnosis, and treatment. 2019;8:F1000.
8. Ballard KD, Lowton K, Wright JT. What’s the delay? A qualitative study of women’s experiences of reaching a diagnosis of endometriosis. Fertil Steril. 2006;86:1296-1301.
9. Falcone T, Lebovic DI. Clinical management of endometriosis. Obstet Gynecol. 2011;118(3):691-705.
10. Henry C, Ekeroma A, Filoche S. Barriers to seeking consultation for abnormal uterine bleeding: systematic review of qualitative research. BMC Womens Health. 2020;20(1):123.
11. American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 760: Dysmenorrhea and endometriosis in the adolescent. Obstet Gynecol. 2018;132(6):e249-e258.
12. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 114: Management of endometriosis. Obstet Gynecol. 2010;116(1):223-36.
13. Saridogan E, Becker CM, Feki A, et al; for the Working group of ESGE, ESHRE and WES. Recommendations for the surgical treatment of endometriosis–part 1: ovarian endometrioma. Gynecol Surg. 2017;14(1):27.
14. Dunselman GA, Vermeulen N, Becker C, et al; European Society of Human Reproduction and Embryology. ESHRE guideline: management of women with endometriosis. Hum Reprod. 2014;29(3):400-12.