Endometriosis

Overcoming Barriers, Improving Lives: MARCH Health’s Comprehensive Approach to Endometriosis Management 

Introduction 

Endometriosis is a chronic, inflammatory condition characterized by the presence of endometrial-like tissue outside the uterus. 

It affects an estimated 176 million women worldwide, or approximately 10% of women of reproductive age. (1) 

Endometriosis can have devastating effects on women’s reproductive health, causing pelvic pain, heavy bleeding, infertility, and other debilitating symptoms. (2) 

Despite its prevalence, endometriosis remains a poorly understood and often misdiagnosed condition. The average delay in diagnosis is 8 years, with many women reporting that their symptoms were dismissed or normalized by healthcare providers. (4) 

This delay can have serious consequences, as untreated endometriosis can lead to the formation of adhesions, scarring, and damage to reproductive organs. 

Challenges in Diagnosis and Treatment 

Endometriosis presents significant challenges in both diagnosis and treatment, impacting millions of women globally. The complexities surrounding the identification and management of endometriosis contribute to delays in diagnosis, suboptimal treatment outcomes, and a substantial burden on healthcare systems and individuals. (5) 

Challenges in Diagnosis  

Non-Specific Symptoms: Key symptoms of endometriosis, such as pelvic pain and heavy menstrual bleeding, are not specific to the condition, leading to challenges in accurate diagnosis. 

Lack of Screening Tools: Traditional imaging techniques like ultrasound or MRI are often insufficient for diagnosing endometriosis accurately, necessitating invasive procedures like laparoscopy for visualization. One of the biggest challenges in endometriosis is the lack of a reliable, non-invasive diagnostic test. Currently, laparoscopic surgery with histological confirmation is considered the gold standard for diagnosis. However, this procedure is expensive, carries surgical risks, and is not always accessible to all women. As a result, many women go years without a proper diagnosis. 

Lack of Awareness: Limited understanding and education on female health contribute to the dismissal of symptoms, delaying diagnosis and appropriate management of endometriosis. 

Additionally, endometriosis often recurs after treatment, leading to a cycle of pain and frustration. (8) 

Challenges in Treatment 

Limited Treatment Options: Treatment options for endometriosis are limited. Pain medications, hormonal therapies, and surgery can provide some relief, but there is no cure for the condition. Current treatment options for endometriosis primarily involve hormonal therapy, which may not be suitable for all individuals and may not effectively alleviate all symptoms. Many women report that treatments are ineffective or have unpleasant side effects. 

Recurrence after Treatment: Surgical interventions to remove endometriosis may not guarantee a cure, with the condition potentially recurring over time, leading to a cycle of pain and frustration and necessitating ongoing management and monitoring. 

Need for Personalized Care: Tailoring treatment to individual needs and preferences is crucial in managing endometriosis effectively, highlighting the importance of patient-centered care approaches. (5) 

Impact on Quality of Life 

Endometriosis can severely diminish a woman’s quality of life across multiple aspects – physical, emotional, and social. The chronic pelvic pain, heavy menstrual bleeding, and fatigue that often accompany endometriosis make it extremely difficult for many women to work, attend school, or engage in social activities. This can lead to feelings of isolation, as friends and family may not understand the severity of their symptoms. 

The condition also takes a major toll on mental health. Women with endometriosis face higher risks of depression, anxiety, and other psychological disorders. Having to constantly manage a chronic illness, compounded by the emotional impact of potential infertility, creates overwhelming stress and burden. 

Statistics on Endometriosis and Quality of Life 

  • A multicenter study across ten countries revealed a diagnostic delay of 6.7 years between symptom onset and surgical diagnosis of endometriosis, with a longer delay in centers with predominantly state-funded healthcare (8.3 vs. 5.5 years). (6) 
  • Women with endometriosis lost an average of 10.8 hours of work weekly due to reduced effectiveness while working, translating into significant costs per woman/week ranging from US$4 in Nigeria to US$456 in Italy. (4) 
  • A national prospective cohort study involving 3728 women born in 1973–78 found that endometriosis was associated with significantly worse reports of HRQoL over time, with adjusted odds ratios indicating worse physical functioning, bodily pain, mental health, and social functioning among women with endometriosis compared to those without the condition. (7) 

Impact on Physical, Mental, and Social Functioning 

  • Endometriosis impairs physical, mental, and social functioning, leading to reduced quality of life and well-being for affected individuals. 
  • Bodily pain emerges as a significant domain affecting HRQoL, with women with endometriosis reporting worse physical health, mental health, and social functioning compared to those without the condition. 
  • Women with endometriosis experience diagnostic delays in primary care, highlighting the need for a higher index of suspicion to expedite specialist assessment of symptomatic women and improve outcomes. (7) 

Barriers to Care 

Women with endometriosis face numerous barriers to receiving timely diagnosis and quality care, leading to significant delays in treatment and a substantial impact on their quality of life. Key barriers include: 

Societal normalization of women’s pain and stigma around menstrual issues 

  • Endometriosis symptoms are often dismissed or normalized, with many women being told their painful periods are “normal” or symptoms were dismissed or attributed to other conditions, such as irritable bowel syndrome or pelvic inflammatory disease. 
  • Stigma surrounding menstruation and painful sex can make women reluctant to discuss symptoms or seek care. 

Lack of knowledge and awareness about the disease 

  • Many healthcare providers lack training and awareness about endometriosis, leading to misdiagnosis or delayed referrals to specialists. (8) 
  • A survey found that 40% of women with endometriosis were told their pain was “normal” by their first doctor. (9) 

Absence of noninvasive diagnostics 

  • The lack of a reliable, non-invasive diagnostic test for endometriosis necessitates invasive laparoscopic surgery for diagnosis. 
  • This contributes to the average delay of 8-11 years between symptom onset and diagnosis. (8,9) 

Limitations of current treatment options 

  • Treatment options are limited, with no cure for endometriosis 
  • Many women report that treatments are ineffective or have unpleasant side effects 

Difficulties in accessing care 

  • Endometriosis specialists are often located in large cities or academic medical centers, making them inaccessible to many women. (9) 
  • The cost of care can be prohibitive, especially for women who are uninsured or underinsured. 
  • Women from certain regions, such as the Virgin Islands, may have to travel long distances to access care. 

Economic Burden 

The economic burden of endometriosis is substantial, with estimates ranging from $7.4 billion (about $23 per person in the US) (about $23 per person in the US) to $9.7 billion (about $30 per person in the US) (about $30 per person in the US) per year in Australia alone. 

The total cost per woman with endometriosis is estimated to be around $30,900 per year, consisting of: 

  • $25,800 for productivity costs 
  • $3,900 for total health costs 
  • $1,100 for carer costs  

Lost productivity due to endometriosis accounts for the majority (84%) of these costs. (10) 

Costs increase significantly with pain severity, with costs for women reporting severe pain being 6 times higher than those with minimal pain. 

Globally, the direct medical costs of endometriosis range from $1,459 to $20,239 per patient per year, with an increasing trend in secondary care costs over time. (11) 

Indirect costs, including productivity losses, range from $4,572 to $14,079 per patient per year. (11) 

The high economic burden of endometriosis is driven by several factors: 

  • Significant direct costs from hospitalizations, surgeries, and other medical care 
  • Substantial indirect costs from reduced work productivity and lost income 
  • Delayed diagnosis, with an average delay of 8 years 
  • Lack of effective treatments and high rates of recurrence after treatment 

Recommendations 

What is MARCH Health? 

MARCH Health is a comprehensive digital health platform that aims to revolutionize women’s healthcare by providing personalized, accessible, and holistic support. MARCH Health offers a multi-layered approach to addressing women’s health concerns. 

The platform begins with an intuitive mobile application that allows users to track their symptoms, medical history, and overall well-being. This data is then analyzed by MARCH Health’s AI-powered algorithms, generating personalized insights and recommendations. 

The next layer of support is the Health Coaching layer, where trained health coaches engage with users through messaging or video calls. These coaches delve deeper into the user’s symptoms, medical history, and potential health concerns, providing personalized guidance and support. 

As users progress through the layers, they gain access to virtual general medical sessions with licensed nurses, midwives, and general practitioners. These healthcare professionals offer comprehensive support, addressing treatment plans, medication management, and lifestyle modifications. 

For individuals with moderate to high-risk profiles or those requiring specialized intervention, MARCH Health offers virtual consultations with certified Obstetricians and Gynecologists (OBGYNs). These experts conduct thorough assessments, address concerns, and develop personalized treatment plans tailored to each user’s unique needs. 

The final layer of this model involves in-person OBGYN meetings for comprehensive physical examinations, procedures, and in-depth consultations. MARCH Health coordinates with local health services to ensure a seamless transition from virtual to in-person care, prioritizing the user’s comfort and well-being. 

MARCH Health Diagnostic Tools for Endometriosis 

At MARCH Health, we are committed to empowering women with the tools and resources they need to take control of their health. Our innovative diagnostic solutions are designed to revolutionize endometriosis care, offering a non-invasive and accessible approach to early detection and personalized treatment plans. 

  1. Cycle Tracking  

Our user-friendly cycle tracking app allows women to monitor their menstrual cycles, track symptoms, and identify potential irregularities. This valuable tool provides insights into menstrual patterns, enabling early recognition of endometriosis-related symptoms and promoting timely medical intervention. 

  1. Educational Quests 

Knowledge is power, and our educational quests equip women with valuable information about endometriosis. Through interactive modules and expert-led content, we empower individuals to understand their condition better, recognize early signs, and make informed decisions about their healthcare. 

  1. Diagnostic Test Kits 

At the core of our innovative offerings are our cutting-edge diagnostic test kits, designed to revolutionize endometriosis detection. 

Urinary Analysis Kit 

Our urinary analysis kit redefines the conventional urine test, providing a comprehensive evaluation of various health parameters. By conveniently collecting a urine sample at home and sending it for analysis, users can gain crucial insights into their overall health status, including indicators of endometriosis, without the hassle of clinic visits. (12) This kit enables swift intervention and personalized treatment strategies. 

Blood Test Kits 

Complementing our urinary analysis kit, we offer specialized blood test kits tailored specifically for endometriosis detection. These kits leverage the diagnostic potential of CA-125, a well-established biomarker linked to endometriosis, in combination with a panel of miRNA (microRNA) markers indicative of the condition. 

The combination of miRNAs and CA-125 has shown promising potential for improving the diagnosis and monitoring of endometriosis. Several studies have demonstrated that combining circulating miRNA expression profiles with CA-125 levels can enhance the diagnostic accuracy for endometriosis compared to using either biomarker alone. (13) 

By scrutinizing blood samples, our test kits deliver a comprehensive assessment of endometriosis risk, facilitating prompt diagnosis and customized treatment strategies. 

  1. Endometriosis Questionnaire 

In addition to our diagnostic test kits, MARCH Health has developed innovative medical questionnaires with exceptionally high accuracy in predicting endometriosis. These questionnaires utilize advanced algorithms and extensive data analysis to precisely identify symptoms and risk factors associated with these conditions. By leveraging sophisticated technology, our questionnaires enable: 

  • Early and accurate diagnosis of endometriosis 
  • Facilitation of tailored treatment plans based on individual symptoms and risk factors 

How Can MARCH Health Help? 

Improving Diagnosis and Awareness 

  • MARCH Health’s AI-powered symptom tracking, and analysis can help identify patterns associated with endometriosis, potentially expediting diagnosis. 
  • Educational resources and community forums within the app can raise awareness about endometriosis symptoms and the importance of seeking timely medical attention. 
  • Cutting-edge diagnostic test kits and innovative medical questionnaires with high accuracy offer a non-invasive and accessible approach to early endometriosis detection. 

Comprehensive Treatment Approach 

  • The app offers a multidisciplinary approach to endometriosis management, addressing mental health, diet, exercise, and lifestyle modifications. 
  • Personalized recommendations for anti-inflammatory diets, stress management techniques, and exercise routines can complement medical treatments. 

Enhancing Quality of Life 

  • Mental health support tools like mindfulness exercises, support groups, and counseling resources can help alleviate the emotional burden of endometriosis. 
  • Symptom tracking and analysis can identify triggers and enable personalized strategies to manage pain, fatigue, and other debilitating symptoms.  
  • The app’s lifestyle coaching, and habit-building tools can empower women to make positive changes for better overall well-being. 

Overcoming Barriers to Care 

  • Virtual consultations with health coaches and specialists can increase access to endometriosis care, especially for those in underserved areas. 
  • The app’s community forums and support groups can help combat the stigma and normalization of endometriosis symptoms. 
  • Educational resources within the app can improve knowledge and awareness among users and healthcare providers. 

Addressing Economic Burden 

  • By providing accessible virtual care and self-management tools, MARCH Health can potentially reduce the direct and indirect costs associated with endometriosis. 
  • Improved symptom management and quality of life may lead to increased productivity and reduced absenteeism from work or school. 

Overall, MARCH Health’s comprehensive approach, leveraging AI, personalized care, and a multidisciplinary model, has the potential to address various challenges faced by women with endometriosis, from diagnosis to treatment and quality of life improvement. 

Conclusion 

Endometriosis severely impacts the lives of millions of women globally. Diagnosing and treating it is very difficult. Social stigma and high costs make it even harder for women to get proper care. MARCH Health offers an innovative digital solution to address these challenges. 

The MARCH Health app uses AI to track symptoms and identify patterns that could indicate endometriosis. It provides education on the condition and offers non-invasive diagnostic tests like urine and blood analysis. The app connects women with healthcare providers virtually for personalized treatment plans. 

MARCH Health also offers mental health support and lifestyle coaching. This comprehensive approach aims to detect endometriosis earlier, improve treatment, reduce emotional distress, and lower the significant economic burden the condition causes. 

By making care more accessible, raising awareness, and empowering women, MARCH Health could revolutionize how endometriosis is managed. 

Reference 

  1. Zandi, N., Behboodi Moghadam, Z., Hossein Rashidi, B., Namazi, M., & Haghani, S. (2023). Reproductive health of women with endometriosis: an improving educational intervention based on the planned behavior theory. Middle East Fertility Society journal, 28(1), 4. https://doi.org/10.1186/s43043-023-00129-7 
  1. Moradi, M., Parker, M., Sneddon, A., Lopez, V., & Ellwood, D. (2014). Impact of endometriosis on women’s lives: a qualitative study. BMC women’s health, 14, 123. https://doi.org/10.1186/1472-6874-14-123’ 
  1. O’Hara, R., Rowe, H., & Fisher, J. (2019). Self-management in condition-specific health: a systematic review of the evidence among women diagnosed with endometriosis. BMC women’s health, 19(1), 80. https://doi.org/10.1186/s12905-019-0774-6 
  1. Pettersson, A., & Berterö, C. M. (2020). How Women with Endometriosis Experience Health Care Encounters. Women’s health reports (New Rochelle, N.Y.), 1(1), 529–542. https://doi.org/10.1089/whr.2020.0099 
  1. Frayne, J., Milroy, T., Simonis, M., & Lam, A. (2023). Challenges in diagnosing and managing endometriosis in general practice: A Western Australian qualitative study. Australian journal of general practice, 52(8), 547–555. https://doi.org/10.31128/AJGP-10-22-6579 
  1. Nnoaham, K. E., Hummelshoj, L., Webster, P., d’Hooghe, T., de Cicco Nardone, F., de Cicco Nardone, C., Jenkinson, C., Kennedy, S. H., Zondervan, K. T., & World Endometriosis Research Foundation Global Study of Women’s Health consortium (2011). Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries. Fertility and sterility, 96(2), 366–373.e8. https://doi.org/10.1016/j.fertnstert.2011.05.090 
  1. Gete, D. G., Doust, J., Mortlock, S., Montgomery, G., & Mishra, G. D. (2023). Impact of endometriosis on women’s health-related quality of life: A national prospective cohort study. Maturitas, 174, 1–7. https://doi.org/10.1016/j.maturitas.2023.04.272 
  1. Davenport, S., Smith, D., & Green, D. J. (2023). Barriers to a Timely Diagnosis of Endometriosis: A Qualitative Systematic Review. Obstetrics and gynecology, 142(3), 571–583. https://doi.org/10.1097/AOG.0000000000005255 
  1. Ye, L., Whitaker, L. H. R., Mawson, R. L., & Hickey, M. (2022). Endometriosis. BMJ (Clinical research ed.), 379, e068950. https://doi.org/10.1136/bmj-2021-068950 
  1. Armour, M., Lawson, K., Wood, A., Smith, C. A., & Abbott, J. (2019). The cost of illness and economic burden of endometriosis and chronic pelvic pain in Australia: A national online survey. PloS one, 14(10), e0223316. https://doi.org/10.1371/journal.pone.0223316 
  1. Darbà, J., & Marsà, A. (2022). Economic Implications of Endometriosis: A Review. PharmacoEconomics, 40(12), 1143–1158. https://doi.org/10.1007/s40273-022-01211-0 
  1. Chen, G., Guo, J., Li, W., Zheng, R., Shang, H., & Wang, Y. (2023). Diagnostic value of the combination of circulating serum miRNAs and CA125 in endometriosis. Medicine, 102(48), e36339. https://doi.org/10.1097/MD.0000000000036339  
  1. Dolińska, W., Draper, H., Othman, L., Thompson, C., Girvan, S., Cunningham, K., Allen, J., Rigby, A., Phillips, K., & Guinn, B. (2022). Accuracy and utility of blood and urine biomarkers for the non-invasive diagnosis of endometriosis: A systematic literature review and meta-analysis. F&S Reviews. https://doi.org/10.1016/j.xfnr.2022.12.001 

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