Gynecologist Velja Mijatovic is the first professor of Endometriosis in the Netherlands. This condition, in which the endometrium ‘gets lost’ outside the uterus, mainly affects young women. They have a lot of stomach pain and often fertility problems. The new professor is committed to more research and better treatment of this condition. “There are hopeful innovations in the treatment of endometriosis.” This week he will deliver his inaugural lecture.
In endometriosis, tissue that resembles endometrium is located outside the uterine cavity. It settles on the peritoneum and on the organs in the abdomen. The tissue can also manifest itself outside the abdomen, such as in the lungs. There is a risk that affected organs function less well. Women with this condition have a lot of pain and therefore function less well. They are often incapacitated for work at a young age. The disease also brings fertility problems, for which many women seek help.
Velja Mijatovic wants to gain more insight into the development of endometriosis. “There are indications that vaginal bleeding in newborn girls is a possible explanation. Endometriosis stem cells are carried along with the bleeding to the baby’s abdominal cavity and may contribute to the development of endometriosis years later.
Painful blood loss
Women with endometriosis need tailor-made care for a long period of time. Attention is paid to emotional, sexual and social aspects of the disease. Mijatovic: “In Amsterdam UMC we work in a multidisciplinary team on the diagnosis and treatment of this disease. In addition to gynecologists, 17 other medical specialties are involved in the treatment, including radiologists, intestinal surgeons, pain specialists and psychologists. The patient association also advises us on how best to organize this complex care. Treatment aims to combat this condition and the monthly ‘bleeding distress’, the painful blood loss during menstruation. ”
Innovative treatments
Velja Mijatovic sees opportunities to improve care for patients with endometriosis. For example, the tissue outside the uterine cavity is often surgically removed. The new professor calls for evaluation research into this complex endometriosis surgery. Here you have to weigh the risk of complications from the procedure against possible health benefits: reduction of pain complaints and improvement of fertility.
Extra attention is also needed for chronic pain in endometriosis. Innovative treatments can offer a solution here. For example, digital pain training using ‘virtual reality’ that teaches women how to deal with pain better.
In addition, Mijatovic wants to gain more insight into the mechanisms responsible for reduced fertility. “The well-known hormone progesterone may play a role in this. The endometriosis tissue can be insensitive to progesterone. This insensitivity therefore applies to the uterus and thus affects fertility. We will investigate how we can influence this insensitivity. ”
Impact corona
In this corona year, appointments with patients were often canceled and planned surgeries or fertility treatments postponed. This certainly had an impact on the quality of life of these patients. Mijatovic: “Together with the patient and professional association, we investigated the impact of the first lockdown on our patients. More than half of them reported an increase in their complaints. The replacement video calling with their healthcare provider did provide some support. But above all they missed the reassurance of physical contact with possibilities for additional examinations, such as an ultrasound scan. Fortunately, there are also positive opinions about, among other things, medication use. We are now forced to prescribe medication more often because surgical care was scaled down and the medication seems to work well for many. ”
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