子宫内膜异位症（Endo）
Endometriosis is a leading systemic, debilitating disease that has a wide range of physical and mental symptoms, affecting the quality of life of women all over the world.
Pain, menstrual cramps
- Endometriosis is a disease where tissue similar to the lining of the uterus grows in other places in a woman’s body, causing pain, an increased risk for infertility, and chronic inflammation.
- It is a very heterogeneous disease in terms of symptoms, treatment responsiveness, and the presentation of endometriotic lesions, making the timely diagnosis and treatment extremely challenging.
- Retrograde menstruation is the most broadly adopted theory for disease cause, but there is no definitive evidence, while many other competing theories also exist.
Current Management & Patient Flow
Disease / Symptom Onset
Diagnosis
Initial Treatment
Major medical treatments include NASID/pain medications, progestins, estrogen/progestin combo, and GnRH (agonists/antagonists), and all should be considered suppressive rather than curative; the goal of hormonal treatments is to induce a local hypoestrogenic state by suppressing ovulation.
Surgery is indicated for failure or intolerance of medical treatment or the purposes of diagnosis and immediate treatment; laparoscopic surgery could effectively manage the pain in short-term, but with a high recurrence rate and limited data to show fertility benefit; hysterectomy is the definitive treatment but highly invasive and leads to permanent fertility loss. Without hormonal suppression, the 5-year recurrence risk post-surgery is ~50%,[4] multiple surgeries are not recommended but are not uncommon in this population.
Disease / Symptom Onset
Diagnosis
Initial Treatment
Both pharmacologic treatment and surgical intervention are available.
Major medical treatments include NASID/pain medications, progestins, estrogen/progestin combo, and GnRH (agonists/antagonists), and all should be considered suppressive rather than curative; the goal of hormonal treatments is to induce a local hypoestrogenic state by suppressing ovulation.
Surgery is indicated for failure or intolerance of medical treatment or the purposes of diagnosis and immediate treatment; laparoscopic surgery could effectively manage the pain in short-term, but with a high recurrence rate and limited data to show fertility benefit; hysterectomy is the definitive treatment but highly invasive and leads to permanent fertility loss.
Without hormonal suppression, the 5-year recurrence risk post-surgery is ~50%,[4] multiple surgeries are not recommended but are not uncommon in this population.
Unmet Needs
Disease Onset/Seeking Care
Disease Stigma
Societal normalization of women’s pain and stigma around menstrual issues result in delayed disease diagnosis and management.Diagnosis
Late/Mis-diagnosis
Diagnostic gold standard is an invasive surgical procedure and clinicians are left with empiric treatment and patients with years of misdiagnosis; ave. 6-12 years of diagnosis delay.[6]Treatment
Siloed Approach
Endometriosis is a chronic systemic disease, but current products are treating it as a pelvic-only issue.[5]缺乏创新
All available treatments still focus on the hormone pathway or pain management, leaving many patients with inadequate symptom management and ineffective at halting the course of the disease.Limited Fertility Improvement
Surgery has not been correlated with improvements in fertility, patients cannot get pregnant when using hormonal treatment.Safety Concerns
Limited options for long-term treatment without side effects, patients need to take extreme measures to manage symptoms: laparoscopy or hysterectomy surgery, which are invasive and not without risk.
Disease Stigma
Societal normalization of women’s pain and stigma around menstrual issues result in delayed disease diagnosis and management.Late/Mis-diagnosis
Diagnostic gold standard is an invasive surgical procedure and clinicians are left with empiric treatment and patients with years of misdiagnosis; ave. 6-12 years of diagnosis delay.[6]Siloed Approach
Endometriosis is a chronic systemic disease, but current products are treating it as a pelvic-only issue.[5]缺乏创新
All available treatments still focus on the hormone pathway or pain management, leaving many patients with inadequate symptom management and ineffective at halting the course of the disease.Limited Fertility Improvement
Surgery has not been correlated with improvements in fertility, patients cannot get pregnant when using hormonal treatment.Safety Concerns
Limited options for long-term treatment without side effects, patients need to take extreme measures to manage symptoms: laparoscopy or hysterectomy surgery, which are invasive and not without risk.Sources
[1]. Taylor HS, et al, Endometriosis is a chronic systemic disease: clinical challenges and novel innovations. Lancet. 2021 Feb 27;397(10276):839-852.
[2]. Falcone T, Flyckt R. Clinical Management of Endometriosis. Obstet Gynecol. 2018 Mar;131(3):557-571.
[3]. Agarwal SK, et al. Rethinking endometriosis care: applying the chronic care model via a multidisciplinary program for the care of women with endometriosis. Int J Women’s Health. 2019 Jul 23;11:405-410.
[4]. Falcone T, Flyckt R. Clinical Management of Endometriosis. Obstet Gynecol. 2018 Mar;131(3):557-571.
[5]. China Endometriosis Treatment Guideline (2021).
[6]. Van Oostrum N, De Sutter P, Meys J, Verstraelen H. Risks associated with bacterial vaginosis in infertility patients: a systematic review and meta-analysis. Hum Reprod. 2013 Jul;28(7):1809-15.
