Current Research on Endometriosis: An Interview with Kevin Kuan

Teresa Götz: Could you please introduce yourself briefly?

Kevin Kuan: My name is Kevin Kuan. I am a final-year medical student at the University of Edinburgh but originally from Toronto, Canada. My work is mainly about endometriosis and chronic pelvic pain.

Teresa Götz: How did you come to do this research?

Kevin Kuan: I first encountered endometriosis when I shadowed a laparoscopic surgeon in Toronto during my second year of medical school. I noticed a lot of patients with endometriosis but I had never heard of that before. I started asking questions like, “What causes this?” For many diseases, we know what the cause is. However, for endometriosis which seems to affect so many people, there was no cause that we could determine. There were just so many questions, and I became very curious. During my third-year dissertation, I integrated a project and looked at IVF treatment options for endometriosis. When I began working with the Edinburgh EXPPECT team, Professor Andrew Horne and Dr. Lucy Whitaker have been excellent mentors for me, providing many opportunities to work on exciting projects. Since then, you could say that I became obsessed with endometriosis research!

Teresa Götz: What would you say is your main motivation?

Kevin Kuan: I’ve always been interested in obstetrics and gynecology as a specialty, but as far as my research drive, it’s really working with patients and being able to talk to them and see their feedback on that.

Teresa Götz: In your opinion, what is the greatest challenge in the field of endometriosis now?

Kevin Kuan: I’m not sure about that. There are just so many aspects that we don’t know yet, whether some people are really interested in fertility, the cause of endometriosis, new non-hormonal treatments, or even a cure. Right now, it’s still very difficult, at least for me, because I’m still exploring different avenues of endometriosis research. We recently just closed an international survey about fatigue and endometriosis. We wanted to find out because a lot of treatments are often aimed at treating pain symptoms, but whether these treatments are also effective in the fatigue aspect of endometriosis is under-researched. I think that’s exciting for me right now.

About Kevin Kuan

  • final-year medical student at the University of Edinburgh
  • specializing in research related to endometriosis and chronic pelvic pain
  • Part of the Edinburgh Endometriosis and Pelvic Pain Team (EXPPECT)

Teresa Götz: At the Congress, you presented other work. Could you summarize your research or describe your research?

Kevin Kuan: The project looked at comparing inpatient management of episodes of pelvic pain before and after the COVID-19 pandemic. There were quite a few outcomes that we looked at.

Our primary outcome was to determine whether COVID-19 had an impact on the number of admissions for patients with relapses of pelvic pain. At the same time, we compared the number of opioids or types of investigations that patients with chronic pelvic pain received compared with patients without chronic pelvic pain. Interestingly, there was no significant difference in the absolute number of patients admitted for chronic pelvic pain or for chronic pelvic pain episodes.

In terms of examinations, we found that the types of examinations were quite similar in patients with chronic pelvic pain and in patients without chronic pelvic pain.

In terms of the opioid treatment aspect, we found that women with chronic pelvic pain were significantly more likely to be receiving opioids at discharge to treat their pain. We know that prescribing opioids for endometriosis may be helpful in the short term to manage a pain crisis, but not in the long term. There is a risk of increasing dependence on opioids and requiring higher doses to achieve a similar effect. This has many negative consequences including increased difficulty controlling these episodes along with their associated side effects.

I would also acknowledge that this is a study that looked at a single center in Edinburgh in terms of the management of chronic pelvic pain, which may vary from region to region. To our knowledge, this is at least one of the first studies that quantified the management of chronic pelvic pain flares. We don’t have clear guidelines for managing these episodes, which are also very common. More than 90 percent of patients with chronic pelvic pain have been previously admitted with a flare. This remains an ongoing challenge and we must find a better way to manage these flare-ups to prevent them from recurring.

Teresa Götz: You said opioids can be helpful in the short term, but in the long term they have a lot of side effects, and you can become dependent on them. They should be used carefully, and some patients don’t even know that. How can your work improve women’s lives in the long term?

Kevin Kuan: Since I am still studying medical school and haven’t had my full training yet, it’s hard for me to say right now. However, I believe that adopting the multidisciplinary approach for long-term management will best capture the complexity of endometriosis and chronic pelvic pain. The first point of contact might be the physician at the clinic who offers medical/surgical management, but also the specialist nurse, physical therapist, psychologist, and dietician, because each has their own role in treatment. The nurses might also be a good first point of contact within the community. You can also go to physical therapists who offer different exercises that may benefit myofascial pelvic pain. One of the innovations that centers are beginning to adopt is also incorporating the mental health aspect into management because there is an overlap between mental health and exacerbation of symptoms.

Teresa Götz: I fully agree that a multidisciplinary approach to endometriosis is very important. We see that as well. Everything works differently for every patient, so we need many people. You mentioned the project about fatigue. What are your future research goals or another project on the horizon?

Kevin Kuan: As for my projects, I would say that our fatigue survey is currently my main project, and we are in the process of analyzing results. At the moment, I’m still balancing research with medical school. In any case, I would love to participate in research that involves patients, whether it’s developing questionnaires, improving diagnostic techniques for the disease including advanced ultrasound, or designing randomized controlled trials. Again, I feel like it’s a little early to decide, but it’s exciting. I think that’s why I like endometriosis research so much because there are so many different avenues and topics for me to continue exploring.

Teresa Götz: I have a fitting question. Is there something you would like to share with people with endometriosis? A message for the patients?

Kevin Kuan: One thing I would say is don’t be afraid to speak up for yourself when you have the symptoms.

However, it is equally important for healthcare workers to do a better job listening and believing patients, and finding ways to have these conversations. If we don’t listen, then patients just get tired. It’s very difficult and I have a lot of sympathy for the patients.

Teresa Götz: That’s a great message. It’s sad that women have the same experience with the healthcare system in Germany, Scotland, and everywhere else. Now we come to my last question. What do you think about digital self-help in general?

Kevin Kuan: Digital health is very exciting. At the World Congress, I met so many people working on this field, and it seems like a great way for patients to get more involved in their own care and be able to access and monitor things. I haven’t had a chance to look at the Endo-App yet, but I think if people want to track their pain or notice changes in their diet or exercise, digital self-help is a great way to move forward. As researchers, we can analyze different patterns in a patient’s life, figure out what might help them, and develop an individualized management plan. Again, there is also no magic formula for treating this disease.

Teresa Götz: This is a good way of looking at it. Thank you very much for the informative interview.

Teresa Götz