ETHICAL CHALLENGES IN THE DIAGNOSIS AND TREATMENT OF ENDOMETRIOSIS

Endometriosis is a chronic disease characterized by the ectopic presence of endometrial-like tissue, which mainly affects women of reproductive age and generates symptoms that can have great impact on their physical, mental and social well-being. In Romania, more and more women are being diagnosed with endometriosis due to increased addressability to gynecologists for chronic pelvic pain and to increased possibilities of diagnosis by ultrasonography and laparoscopy. Therefore, gynecologists must be prepared to manage and counsel such patients. It is the doctor’s duty to establish a diagnosis as early as possible and to inform the patient about the possibility of recurrence and the associated infertility. The chronic pelvic pain associated with endometriosis must not be considered a trifling symptom, because it is invalidating and it significantly affects the quality of life. A symptomatic treatment for strictly relieving the pelvic pain should not be recommended without considering the possibility of endometriosis and without further investigating the patient. After achieving the diagnosis, which most often occurs quite late, it is necessary to pursue a treatment protocol that sometimes raises difficult ethical dilemma due to the high risks and side effects on one hand and the limited benefit on the other hand. In some cases, pain is so invalidating that the last resort is total hysterectomy. Affected women are usually nulliparous, and recommending radical surgery to remove all endometriosic implants (thus abolishing the pain) would make it impossible for the patient to ever conceive a child. In this article the authors discuss the ethical challenges raised by endometriosis in terms of diagnosing and treating the disease and illustrate the gynecologists ’ dilemmas through clinical cases.