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Welcome ladies and gentlemen, best listeners.
Welcome to this podcast about endometriosis, a pragmatic approach.
My name is Femke Velpmann, and I'm on stage with Ingrid, Elfring and René Weersma...
...all at Kaderhuisarts Eurogynecology.
-Welcome. -Thank you.
Or welcome to your workplace.
We're going to talk about endometriosis. It's a great subject to take into account.
In this podcast, we'll answer your questions on the next prong questions.
When should you think about it?
Do you always need a laparoscopy for the diagnosis?
Or should you be sure of the diagnosis to start a treatment?
And when should you point out who it is?
How can we shorten the period of time and the dilemmas in the operating room?
We have a lot of questions to answer, but they're all coming up.
Let's start with endometriosis. What is it?
Endometriosis is a chronic inflammatory reaction...
...wherein endometriom-like tissue is found outside the uterus...
...and especially in the back, but sometimes it can also be in the other part of the uterus...
...and even very rarely outside the uterus.
And what else does it have to do with character?
Well, the diagnosis of endometriosis is thought over very differently.
But we do know that by taking the blood cycle...
...that there is a kind of inflammatory reaction, and the effect of it...
...is that the endometriosis can be created in different organs...
...or can even lead to lead formation.
And that's the effect of endometriosis, and that's why it's so important...
...that there's attention to it.
For example, you have to think about subtlety.
That's one of the big disadvantages.
It's not something that comes up a lot, but you have to think about it.
You see it more in a first-rate family member.
Then you have a high chance of seven times, roughly.
I have an example of a doubt in my practice...
...where one has a typical diagnosis, and the other has a high thinking.
The typical way of saying it is that it goes cyclically...
...and that's also our starting point when you ask for complaints...
...about women with endometriosis, but it lasts longer.
Unfortunately, there is a delay in both diagnoses.
Then it becomes a bit more chronic, then it gets the chronic character.
So at that moment, when the patients come with the procedure...
...it's even more difficult for us.
But the hope is that if you ask how it was in the beginning...
...and the patient knows that that can be the starting point for us.
Yes.
If I think of endometriosis, I think of it as doing something.
When you point out the laparoscopy that is necessary...
...still in my mind.
You write to me in this article, also the role of the laparoscopy.
In the past, that was the golden standard.
But nowadays, it's about a pragmatic approach...
...that can be very good in the household practice.
It sounds like a very nice improvement.
Soon we will talk about anemonesic, legal research and diagnostics.
But first, this change of laparoscopy...
...golden standard, to a pragmatic approach in the household practice.
Tell me.
In the past, laparoscopy was indeed a golden standard.
But it is now a bit abandoned in the second line...
...and no longer under the golden standard.
And there are a number of reasons for that.
One of the reasons is that the diagnosis...
...of the other diagnosis in the second line is better.
You have an advanced calligraphy...
...that can better represent the signs of endometriosis.
And besides, the emery has also become much better and much more specialistic in the past years.
Because of which the diagnosis can sometimes be set in that way.
And besides that, a laparoscopy also has disadvantages...
...because of its invasive character.
So it can cause complications on the organs, it can cause bleeding...
...and it can also cause a lot of adhesive formation.
So from there, in the second line, it is becoming more and more sustainable...
...to deal with that laparoscopy.
And now a laparoscopy is often used...
...if there are reasons to treat it.
So if they want to intervene immediately in a surgical procedure.
Yes, and we're going to come back to that right away.
That you also treat it as a home doctor, for example with an echo as a diagnosis.
But that you can also treat it very well within the home doctor's practice.
Yes, because the pragmatic approach that is in the second line...
...you can actually implement very well in the first line.
Yes, of course, I told in the beginning that endometriosis is...
...that it is in different places.
So you also have different types of endometriosis.
And we know that, in particular, the pyretinial shape...
...so the places that are on pyretinium...
...that it can be identified for the laparoscopy...
...and sometimes can also be treated.
So that's what it's meant for.
But you see, for example, the deeper endometriosis, you don't see it.
And there is, for example, an emery or an echo.
An echo where people do have attention for endometriosis.
So they have to have an eye for it, to be seen better.
And that is also one of the reasons why a laparoscopy...
...has come a little more to the background.
Okay.
Do you want to hear more about the figures that are known about endometriosis?
You often hear 10% that that is the estimated prevalence.
What is actually known about those figures here?
Well, actually, there are no Dutch figures available...
...how often that happens.
And in the past, based on the old figures, that was about 10%.
But that was from the second line.
And now we think that in the first line, about 4% comes forward.
And that is based on an Italian research in the first line...
...where they looked at women with an echo, with a question list...
...and with a laparoscopy.
And that was about 4% out.
Now, in the first line with us in the Netherlands...
...it is 1-2% known to the households with endometriosis.
So there is a discrepancy on it.
And furthermore, it is so that we, about three women a year...
...which is actually very little to see, see with dysmonerosis.
So there is also a discrepancy.
What do you think? How does that come about?
Yes, then we can immediately move on to the delay.
There is a research done on the delay of endometriosis...
...that is about seven years before the diagnosis is made.
And it is mainly in the household delay.
So that's a part of the patient.
You have a part in the second line, but the biggest part in almost six years...
...is in the household.
So from there, this podcast, where we are also going to handle...
... how can we shorten that delay at the household strike?
Yes, first of all about the patient delay.
What can we do about it?
Yes, we can certainly do something about it.
I think that should be known anyway...
...to women who have endometriosis with dysmonerosis...
...who mainly function daily.
That those women really come to our meeting room...
...to see what is on hand and how can we treat it.
And especially those young women we would like to see...
...because with that we can prevent a whole lot of misery...
...and progress of endometriosis...
...but also mentally dysfunctions through endometriosis.
Yes, there has been a Dutch online survey on women between the 14th and the 45th year.
And there it turned out that 85% dysmonerosis.
And of that group is a third who has endometriosis on a daily basis.
So that group, we are mainly interested in that they then report to the household...
...so that we can then see what the cause is.
Yes, then you will have a kind of reactionary bias of that 85%.
But 85% has painful menstruation, that is really very high.
One third of it will function daily, which then becomes a dilemma.
Again, I don't know how that bias is called, but...
...there will be a reactionary bias.
But that is a number that is higher than that 10% of the prevalence rate.
And you just said something about maybe 4% of the prevalence rate.
What's the difference between that? -That's a big difference.
Absolutely. It's super interesting that that online survey is much higher.
So we also think that the normalization of patients...
...and maybe mothers who have this kind of bias, who on the one hand say...
...but then I also had, and that fits in, can be in the negative sense...
...wherefore the daughter does not come with the bias at the household...
...can also be in the positive sense.
But that is, I think, something that we think is typical of the Netherlands.
It's part of it. And we just want to try to explain here a little bit...
...that dysmonerosis is a serious bias.
Yes, and then suddenly as an advocate of the devil...
...if you were to do such a call for patients...
...you would end up with a painful menstruation and that...
...you would function as a barrier, that would quite a lot of patients...
...who would be able to come with it.
I also hear voices from households and say...
...it would be a bit exaggerated, because all of that...
...could be seen as kind of endometriosis.
Yes, what is important is what is now serious dysfunctions.
That is, of course, nice to make a distinction.
I think that serious dysfunctions are, as women, several days a month...
...through menstruation complaints, not being able to go to school...
...or for work, but being serious and not being able to do normal things...
...that can be done in life.
Look, if you have pain, you can of course take some pain relief...
...but if it's okay, it's fine. Women don't have to see it for themselves.
But, above all, it doesn't function very well.
Yes.
Okay, we now have about the patient with the painful menstruation...
...that dysfunctions.
Well, Stel, she's coming with you on the talk. How do you take that on?
Well, I think that a number of things are very important.
And this is especially important, when has it started?
Does it take progress? When does it come into the family?
Those are all things you can think about.
Is there a promise of pain when you're free?
Because that also comes before the endometriosis.
Dysperin is not a very important complaint that comes with endometriosis.
Yes.
And, sometimes, when you hear about the pain relief...
...and that can be painful during menstruation...
...but it also feels like a painful mix during menstruation.
And now you say during menstruation, but there are also...
Renée, what you just said, that it's more chronic at the beginning of the cycle.
So those complaints, which you now call very specific...
...at the menstruation, pain relief, painful mix.
Would that also be possible during the month?
What you often see is that the cycle begins.
But what you see is that when the endometriosis is longer...
...you see that during the menstruation, the pain relief often becomes chronic.
So that keeps you warm, right?
But that's also one of the dilemmas you encounter in a room.
So looking back to how it used to be, how sick this pain relief was.
So, especially for women who already have long chronic pain reliefs...
...it's important to go back to how it was when you started menstruating.
Are there any more suggestions for endometriosis?
What's suggestive for endometriosis, but not very often...
...is cyclic-bond blood loss.
So cyclic-bond rectal blood loss, cyclic-bond hematury blood loss...
...and also cyclic-bond blood pressure.
So that's very suggestive for endometriosis, but it's the same thing.
What you can think of is, for example, dysentery or cyclic-bond obstepathy.
So those are also complaints you can think of when you think of endometriosis.
It's a difficult complaint, and then there must be cyclic-bond blood pressure.
But if it's chronic, it's quite difficult to make a call to think of endometriosis.
Yes, that's our dilemma. - Yes, for sure.
These ridges are found in the article, so that's very nice as a side work.
But now we're talking about endometriosis, possible causes of complaints.
But there are several causes of painful menstruation.
Yes, it's important to differentiate between the primary dysmenorrhage...
...the dysmenorrhage that takes place within 24 months after our first menstruation.
And then you have succidary dysmenorrhage, which often has a pathological cause.
For example, you can think of endometriosis as the most common cause.
But you can also think of adenomyosis, so that's an element in the spine...
...of the mother-in-law, or, for example, a PID, a pelvic inflammatory disease.
That's also a cause of succidary dysmenorrhage.
And how you can distinguish between primary dysmenorrhage, often after your 18th...
...of course, depending on when you're going for the first menstrual period...
...while the secondary dysmenorrhage often takes place, which is becoming more and more serious.
And why are you going to distinguish this?
Because that brings us to the track of endometriosis and diagnosis.
So it's not just a disease, but it's increasingly causing painful complaints.
Here's a message from us.
About primary versus secondary dysmenorrhage, because that's a bit too much.
Primary dysmenorrhage has no visible organical cause.
It often starts two years after the first menstruation.
And the pain is mostly related to the increased levels of prostaglandinous substances...
...which intensify the mother-in-law's contractions and cause such pain.
On the other hand, secondary dysmenorrhage happens mostly years after the menstruation...
...and is caused by organical causes, such as endometriosis, ovaries...
...or a back and on staking, for example, a pit.
Symptoms come before and during menstruation.
So that's the difference between primary dysmenorrhage and secondary dysmenorrhage.
And then a bit differently, because we'll talk about the deep endometriosis.
It's good to know that the upper endometriosis is about peritoneum.
And if you're talking about deep endometriosis, the endometriosis and noduli...
...can then be increased in surrounding organs, such as the bladder, urine, arm, and vaginoma.
Then we'll go back to the podcast.
There are even more differential diagnoses you have to think of.
Yes, a cheaper spiral can cause secondary dysmenorrhage.
Uterus myeloma is a much more common disease that you can see in the ego.
And uterus anonomaeum.
Uterus anonomaeum? Oh, yes, that's a good one.
And more?
PID is one of uterus myelomatosis.
A much more common disease that we see as a home is Prieke-Baard-Darm syndrome.
But the very important thing is the crown and the colitis ulcerosa.
Urine-veginfections, diverticulitis, or just ovaryal cysts.
So the differential diagnosis of ulcerosa or pain in the stomach area is pretty big.
I had a patient with a lot of news about the endometriosis.
And that patient was taken there. I think I did too.
And he went to the hospital. I thought I might not take it seriously as a home.
He had asked me for directions. And well, okay, that was okay.
But eventually there was a big crown to sit under, which he had.
What you want to focus on again is that you have to keep looking wide.
You have to look at the wide range of research.
If you think about it, do a study, et cetera.
As a home-career, we are very good at looking at the wide range.
So it's important to avoid vision of the patient as a home-career.
Yes, yes.
And I was also thinking that cyclism to chronics, that makes it very difficult.
That it can become chronically. So that's really a wave.
But do you use a diary when you look at the cyclists?
Because at the PMS, apparently, a lot of people think that it's PMS.
But if you fill in a diary, then it is quite a change
due to the month that people have complaints about a certain group of people.
Sometimes such a diary can give some extra clarity.
Sure, a diary is very useful, because it's convenient to keep the diary open
before you start a treatment.
And then, when you do the follow-up, we say that it's really important to follow-up.
Then you can also look at a diary by means of such a diary,
whether the complaints are really improved.
And whether the cyclists are burned or not.
Yes, and as an addition, if the cyclists are burned outside my complaints,
then you often see that it starts the day before the menstruation,
but then, while the cyclists get better.
And that's very typical for endometriosis and less typical for other causes of dysmenorrhea.
So that can, for you as a home doctor, and for the patient, such a diary.
And you called it progressivity in the cyclist itself.
But I think it's also important when you see that the complaints are increasingly progressive.
So when the cyclists get burned, the pain gets worse and worse.
How do you go further?
Well, the next step is the physical examination.
Because also the physical examination can give instructions that there are talks of endometriosis.
It is of course important to do the buccal examination, that can give a sensitive belly.
After that, it is also important to paper.
Sometimes you can choose an ovary, you can paper, so when you feel that,
then it can always be an indication for follow-up policy, follow-up diagnostics.
Further, of course, you look in speculo.
In speculo, you can sometimes also see complaints that can be shown on endometriosis.
And mainly in the Forenix posterior, you can see complaints, red, dark complaints,
that can be applied to endometriosis.
A few millimeters or so.
A few millimeters, yes.
And when you paper, that's why you have a forecast for the physical examination
during the menstruation, because then those complaints are the most sensitive.
So when you paper those complaints during the menstruation and they are very painful,
that can be an indication for endometriosis.
And then especially the deep endometriosis.
Yes, what you can also notice with the patient, is for example the tense back and bottom.
A tense back and bottom has different differential diagnoses.
But certainly if it is the deeper endometriosis,
it can also be applied to the upper surface of the pyrtonum, then they also have a back and bottom.
So this is not what a housewife herself would be able to do in terms of physical examination.
What kind of physical examination is followed?
Yes, the physical examination that you can do is of course testing whether there is an indication for a ZOA.
So that you can exclude Glamidia and Gonoreum as a cause of complaints.
You can ask for an echo and it is important to then show it to a center,
where they also have experience by looking at endometriosis through an echo.
Because endometriosis can be difficult to see on the echo.
So if it is not there, it does not mean that there is no endometriosis.
There are also some soft markers, so sometimes you can also see stains.
So they do not see spots themselves.
If a cheek is seen, it looks like a chocolate cheek or an endometrium on an ovary.
And then you have a diagnosis.
But we just noticed that endometriosis is often seen on the pyrtonum.
And you do not always see that on an echo.
But the deep endometriosis, where the marks and stains are seen,
is not an echo.
But that is what we can then hear, they can then see.
Yes, let's find out who can make good echoes in your network.
What happens to each gynecologist?
Well, there is also a list on the internet, at the endometriosis site and at the NVOG.
They have a two-part type of ability to prove people to do it.
Level one, that is a little more for the simple endometriosis.
And level two is for the complex endometriosis.
So that can be a handy thing to look at in your region,
or your hospital expertise.
Yes.
Well, the website you call that is handy to put it at the show notes.
Then we can look at home doctors, where they can do the right research in their network.
Those echoes are more advanced, but you also have MRIs.
So there are special MRIs.
Of course, you need an attention point when you ask the radiologist to do it.
Then you also need attention.
That is an attention point when you ask an MRI.
It is, I think, easier to prove someone to the gynecologist.
Okay, then you have everything ready.
The anemese, the scientific research and the intensive research.
Maybe it's still very unclear, for you as a home doctor.
Maybe it's very clear. How then?
Yes, well, if the home doctors and the mediatheists are probably eight,
then you don't have to prove it, but you can also set up a test treatment yourself.
And that is very easily applicable in the home practice.
First of all, you have to pay attention to equipment and lighting.
What would you say to me, if I had an endometriosis, for example?
Yes, well, it is important that there is a probability diagnosis,
especially in the first line.
So that is important, that there is a certain uncertainty in the diagnosis.
But that is often also in the second line.
And that has no influence on the policy, because you can actually just treat it.
It is important what is the nature of the operation.
We just talked about it, that it is a positive reaction,
that it can cause pain complaints and that it can also have a great influence.
On daily functions and how you can deal with it.
And there are of course a lot of treatment possibilities.
That is convenient to talk to the woman.
And of course, you can also talk to the woman,
that it has an influence on the fertility in the future.
It is important to know that most women with endometriosis can become just heavy.
So 65% of the women who have endometriosis can become just heavy.
But the chance of pregnancy is slightly reduced compared to women who don't have endometriosis.
So that can also be of importance for the future treatment,
that when they have children, they will come back to you on the right track.
Yes, indeed, it is important.
But if you already have over infertility, that fits in with endometriosis.
And then you are actually going to assume that they have endometriosis,
if you have over that risk.
So that makes you think, well, it's really a possible diagnosis.
So they just don't know if this is going to play for you.
No, that's right. But I understand your question that you went from
the probability diagnosis, but of course there are a lot of women.
Look, most women with dyspneuroe have primary dyspneuroe.
So you just treat them as dyspneuroe.
And then you gave the explanation, what do you do as treatment?
What do you do as a result?
Yes, the goal of medical treatment, because the next step is medical treatment,
is to suppress hormonal cycles.
Because of which endometriosis is a regressive or atrofeated,
and then the bleeding remains.
And that is achieved by breaking the ovulation with a sub-50 pill,
of the second generation in relation to trauma risk, and continue.
So you continue that.
The disadvantage is sometimes that you get a spotting if you continue it.
It's not serious at all, so you can easily stop the pill for a few days
and then go on again.
So the foreman has a sub-50 pill, but there are women who don't want that,
or can, because there is a contraindication,
then you also have progesterone alone, for example the hormone spiral,
or the implantation that you can do, or progesterone, the mini pill alone.
So that's what we want.
But some women don't want hormones, so you can do a pragmatic approach,
through painkillers, that is paracetamol, or an NSAID.
And the important thing with both is that you evaluate it after three months.
So that you're going to look at, take the pills off.
Because if you don't take the pills off,
then that's a reason to leave your diagnosis or the brain,
or to get those people out of it.
A question about the IUD. Does it work for eight years,
or is it only the first few years that it works well?
Because it still says that the ovulation is still a little better to suppress?
Yes, it's because you want to make someone aminereous.
So the hormone content of the spiral must have an added value,
that they are aminereous, so that you know that you have suppressed that protein.
So the patients who may not be aminereous for eight years in the spiral,
are advised to change it before that.
So do you have to suppress the ovulation with the spiral?
Or is it the reduction of the endometrium?
Yes, you have a good point there. It's about atrophy.
The endometrium makes it as thin as possible.
Because that's also the cause of the endometriosis.
That is your criterion. As long as someone is aminereous, they do it.
And if they are no longer aminereous, you can do better if patients want to change it.
Yes, okay.
And I can imagine that if you have a patient who is really overweight,
and you have the chance of infertility or subvertility,
what would you call that as someone who only wants pain killers,
and doesn't take the pill?
Yes, I think that's one of the things...
If you're too busy with your decision-making,
that you have to prevent the patient from having a progressive disease.
But that we don't know that, on the one hand, it has very serious complaints.
And on the other hand, it doesn't take any serious complaints.
Sometimes it can take off even more, as you get older.
But that would be one of the things that I would call a disadvantage.
Yes, because the use of the pill reduces the chance of infertility, right?
We see that the use of the pill probably goes further in the progression of the endometriosis.
But often, when you think of endometriosis and there are endometriosis spots,
they can influence fertility, so we don't know for sure if treatment with the pill
has influence on fertility, but at least on the progression of the disease.
And then you also have to think more than just about infertility or infertility.
It's also about growing in different organs, in the stomach,
which can be very inflammatory for patients.
I think that should be mentioned as well, because now we're very focused on fertility.
Why not the pill?
Because we know that the pill gives a high risk of osteoporosis,
that it takes off the blood pressure, increases weight, and has a different effect.
It's a long-term amenorrhea after the use of the pill,
which has an influence on the longer duration before you get an ice cream, if you want to get pregnant.
So that's the reason why a pill is not in the uterus.
Outside the hormones, the pain, the quietness, and the light, what else can you do?
Apart from treating psychosis, and pain, of course,
you can also treat other disciplines, of course.
All of them are aimed at functioning as well as possible with endometriosis.
In dysparenia, for example, you can think of an introduction to a sexologist.
You can also treat a breast therapy, if there's a talk of breast hypothermia,
or problems with the mix, and then you have the defecation.
Psychologists can treat it, if there's a talk of mental complaints as a result of endometriosis.
And there are a number of complementary therapies,
such as acupuncture, homeopathy, and osteopathy,
where many women still go in search of it,
but there's a lot of scientific evidence that it works.
And the pain specialist?
Yes, if there's a lot of talk of pain, you can also talk about the pain specialist,
and we know that, for example, Tent is a very good treatment for painkillers and endometriosis.
That works well.
I think it's about recognition, and that patients are able to stick to it,
and have control over their complaints, and these are beautiful, satisfying treatment options.
Yes, because you are actually aimed at functioning as well as possible with complaints.
And then, of course, there's also an introduction to the second or third line.
Yes, there are actually four reasons to introduce the gynecologist.
Of course, you've been to that woman, you thought that there could be possible talks about endometriosis,
and you've started with a test treatment of NSIDs and hormonal treatment,
and you're evaluating that well.
If it turns out that after three to six months you're evaluating that,
and the complaints are not sufficiently accepted,
then that's really an obvious reason to point out women.
Because it turns out that this woman, if you point out women with this indication,
is about 70% talking about endometriosis.
Here I'd like to add something, because after the recording, there was a question.
In the podcast, it was said that if complaints are not sufficiently accepted after the test treatment,
then there is an obvious reason to point out women.
At 70% it turns out there are talks about endometriosis in that group.
But how does this work? Because successful treatment is precisely an assessment of the diagnosis.
And now we say that if there is not a successful treatment, there is also often endometriosis.
We have presented this question to the speakers, and here is the answer from Ingrid.
A large part of women with dysmenorrhage and therefore possible endometriosis
will have an improvement after treatment.
A small minority will react sufficiently to the test treatment.
Indeed, it turns out that 70% of them still have endometriosis.
And these are often women with a serious form of dysmenorrhage
who do not come out with normal treatment.
So after the diagnosis, it is often deeper or a serious form of endometriosis.
So you can actually say that despite the failure of the test treatment,
70% of the endometriosis still has endometriosis.
And these women can have a serious treatment with the gynecologist.
I hope this question is answered correctly.
And that you have not only brought more confusion.
We are going back to the podcast, namely to the second reason
that Ingrid is going to give to the gynecologist to prove it.
Further, it is of course important if you have ever made the diagnosis
or if there are words of current children with a possible endometriosis,
that that is also important to prove, to prevent,
that women are going through a very long path of fertility,
to prevent that unnecessary path.
A third reason is cyclical plagues of the dharmes, of the urines or of the airways.
These are reasons for deep endometriosis or extra-abdominal endometriosis.
And we say to them, well, you should actually prove those women
to an expertise center for endometriosis,
because they have a multidisciplinary treatment team there,
and are specialized in that.
So that is actually the third reason to prove it.
And the fourth reason you can prove it is if you still have the patient,
or you as a home doctor, a clear doubt about whether or not to speak of endometriosis.
You can of course consult the gynecologist for that,
that you have a telephonic contact with him, if it makes sense to prove it,
and what would you do then?
Or that there is something uncertain about the woman who needs more confirmation,
and who finds it difficult to deal with such uncertain closures.
And what will the gynecologist do next?
Yes, that is an important question.
The gynecologist does full research, as far as it is still not done,
so he advances in echography, and sometimes in emery,
because you can therefore get the confirmation of whether or not to speak of endometriosis.
Sometimes a laparoscopy, so that's up to the gynecologist if he finds it necessary.
And the gynecologist also has more medicated treatment options than we as a home doctor.
The gynecologist can, for example, be a GNRH agonist,
give it to suppress the cycles even further.
And the reason that it is in the second line and not in the first line,
because it has a lot of side effects,
is that the cycles are even more quiet,
which can lead to flyers, dry vaginas, mood swings,
high chance of osteoporosis.
And of course that happens at the second line at home.
And sometimes, if the complaint is very serious, it is important to operate,
but of course that is also up to the gynecologist.
Correct. And you want to fill in?
Yes, I want to fill in, because I also looked at my own patients in this podcast.
And what I see very often is that they do a pragmatic approach in the second line,
and a laparoscopy only do that patients who experience serious complaints.
So it is actually more a sort of shared decision making between the patient and the gynecologist,
or if they want to be sure about the diagnosis.
Yes. And to be able to do that during the laparoscopy?
Yes, that is an added value.
That is more the motivation, I think, also from the gynecologist,
that they can also take spots away when they see it.
Because it is not always seen at the laparoscopy.
That could also be a way for the gynecologist to do a comprehensive procedure,
like a laparoscopy.
Yes, and for example, the increase in chances of osteoporosis.
That can also be a reason to intervene in operation.
Well, then we know in principle from the beginning to the end what we should be able to do with endometriosis.
Are there any further tips about the home doctor's delay to be able to prevent that?
To be able to shorten that?
Yes, certainly. We have a number of advice for the home doctors.
Of course, the difficulty is of course to be able to proceed in various ways.
So it is important that home doctors also think about endometriosis.
Certainly at Bui Klachten.
After that, it is important, but there is this podcast for, and also our article,
that the knowledge of endometriosis at home doctors is great,
so that they also know what they can ask,
what kind of research they have to do and when they can prove it.
Further, it is important that the home doctor, especially with dysmonerosis,
takes seriously, takes the time to come to the table,
in order to see if eventually endometriosis could be a cause for dysmonerosis.
And besides that, it is important to point out the time.
And of course, we have already talked about that.
And it is of course important, that we can't push enough to really do that follow-up,
with treatment, because if women don't come back, because the treatment doesn't work,
then you lose them.
And then we will go to the "Falkeulen", the dilemmas that can be presented in the speech room.
Yes, we have indeed thought about it today, and the only thing that comes to mind is,
that women don't want hormones, and that is indeed a dilemma.
Because you really want to make those patients amnere, so give them continued hormone therapy.
So I really think that is a dilemma.
And other people can be, that patients already come in and read about it,
and have heard, well, I know for sure that endometriosis is there.
We just mentioned in the podcast what the differential diagnosis is.
You also don't want to see a coliseum rose or crown over your head.
So you have to stay broad, think about it.
I think that is also a part of the dilemma with the diagnosis endometriosis,
that you have to point out different disciplines,
before you come to the diagnosis endometriosis once.
You have to learn to live with the uncertainty of the diagnosis.
As a home doctor and as a patient.
And then do a pragmatic approach through the means of the medical treatment.
And that these interventions are so diverse.
Yes, and can you give the listener some tips on how to deal with these different dilemmas?
What do you do if someone doesn't want to have hormones?
Is it a good suggestion to take the patient in there?
Try to do something, see how life can improve?
Yes, yes, so really a certain decision making, education of the patient.
And then say, Jo, let's try that for three months.
If there's no contraindication for that, and then it's going to be experienced...
...or you're going to get complaints, and if they really don't want that...
...then you still take the means of pain relief, and that's also okay.
It's not at all to say that all endometriosis become so serious.
I think that you can also hear that calmness as a listener.
Yes, and even more things that you've come across in practice...
...how you can deal with those dilemmas?
Yes, it's actually that you have to think about endometriosis...
...and you can ask yourself, how was your cycle at the beginning?
When did it start? How long did you have the pain relief?
Or how much time did you start getting the pain relief?
So you're actually leaving from the current complaints...
...but you're going back to the state of the complaints.
And that can keep you stuck in those diagnoses.
Yes, then you can try to get it back to the pure beginning of the complaint.
Yes, yes.
So it's already in my head when people complain about back pain relief...
...or complaints that come in the back...
...that I actually do all kinds of anemonesis...
...that when was your day, how did it look at the beginning of the year?
Did you already have some hormones? How did you react to that?
That I take that with me when I see patients with gynecological complaints...
...but that's definitely also important for endometriosis.
Yes, and in the end dilemmas also remain for you dilemmas in the chat room.
Is there not an answer to some difficult moments?
But for the listeners, there may be a call.
Imagine that you come across some nice things in the chat room...
...how to handle it yourself. And that can also go to
[email protected].
And we can do that. In the next podcast, people can read it on the website.
Yes.
René and Ingrid, there is a lot to say.
From start to finish, I now have a very good image of endometriosis.
It is always an challenge to be able to do it in the chat room as well.
But we can, as an employee, happily take over the article...
...to take the slides. But dilemmas remain for the listeners...
...and for all of you dilemmas. It's just difficult.
What are your final take-home messages before we close?
I think it's very important that home doctors...
...as women take this with a serious mind.
In addition, it is important to start a test treatment with medication...
...and see where you come from.
-Nice and pragmatic. -Nice and pragmatic.
And if the treatment has an insufficient effect...
...and the patient has children's clothes...
...or if you have signs of type endometriosis, point it out.
Yes. Well, ladies and gentlemen, thank you very much.
Ingrid Elfring, René Weersma, about endometriosis...
...and a much more practical approach.
Thank you for this podcast recording.
-You're welcome. -Thank you.
Don't forget, the next podcast...
...is about the kidney and the g-standard "fracture prevention".
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