What is endometriosis

What Is Endometriosis

At first glance, pain in the lower abdomen during menstruation or during sex seems harmless. "It will pass, - you think. - Probably, this is how my body works." Even if the pain torments a woman often or regularly, many are in no hurry to see a doctor. And in vain, because one of its possible causes is endometriosis.


Endometriosis is a common gynecological disease that is still poorly understood and still difficult to diagnose and treat. It develops over the years and can turn your life into sheer anguish.

The essence of the disease lies in the fact that cells of tissue, similar to the endometrium (the lining of the uterus), go beyond the uterus, become fixed and grow in other organs. Doctors speculate that endometrial cells can spread through the lymphatic and circulatory systems.

It is important to understand that endometriosis is not cancer, not a virus, it cannot be infected from another person.

Foci of endometriosis are found in different parts and organs of the small pelvis: on the surface of the peritoneum, ovaries, in the fallopian tubes, in the uterosacral ligaments, in the recto-vaginal septum, in the Douglas space. Less commonly, they are found in postoperative scars after cesarean section, laparoscopy and laparotomy, on the surface of the bladder, small and large intestine, colon, appendix and rectum. In extremely rare cases, foci of endometriosis can be in the vagina, bladder, skin, lungs, spinal cord and brain.

According to statistics, about every 10th woman in the world suffers from endometriosis [1,6]. But medical science does not yet have a definite answer why endometriosis occurs. The reasons can be different, and in addition, there can be a combination of several risk factors. This disease does not depend on nationality, social status or lifestyle.

Many experts believe that endometriosis is possible only with regular menstruation and the body's readiness for childbirth (during the reproductive period). But life only partly confirms their guesses. Sometimes the disease is found in adolescents and postmenopausal women, that is, before and after the cessation of menstruation. These data suggest that the mechanisms of the onset of the disease are more complex.

Among the common signs of endometriosis

lower abdominal pain painful and / or heavy periods painful sensations during sex infertility

The disease lasts a long time, often has a progressive course, so over time, rare pains can become chronic. And this means that the earlier the treatment is started, the faster the improvement of well-being will come and it will be possible to avoid serious consequences in the future.

Disease facts

Approximately one in 10 women of reproductive age suffers from endometriosis. This is more than 170 million women worldwide. The disease does not depend on nationality, social status and lifestyle [1,6]:

- Endometriosis ranks third among gynecological diseases, after inflammatory diseases and uterine fibroids [18]

- According to the results of a study by the International Association of Endometriosis, in which 4000 patients with endometriosis took part, 50% of respondents showed the first signs of the disease before the age of 24 years, in 21% - before 15 years, in 17% - between 15-19 years [18]

- In many women, the main symptom of endometriosis is infertility (30-40%), while other symptoms may not be present [2]

- The most common symptoms of endometriosis include chronic pain in the lower abdomen, painful periods, unstable discharge, pain during intercourse [15]

- 71-87% of patients have persistent pain syndrome. The pain caused by endometriosis affects both the physical and emotional state of a woman, and can affect her life in general [5]

- About 80% of respondents experiencing severe pain during menstruation do not associate them with any disease and continue to take pain relievers. While endometriosis is found in 70% of women who visit specialists for pain in the lower abdomen. [3,4,9]

- Instead of treating endometriosis, many women receive therapy for inflammatory diseases of the uterus or appendages. The diagnosis of endometriosis is usually made only 7–12 years after the first symptoms of the disease appear. [10]

- Pregnancy does not cure endometriosis. Symptoms of the disease may temporarily disappear, but after the birth of the baby, when the menstrual cycle and hormones are restored, they may reappear.

- Early treatment of endometriosis will help avoid serious consequences of the disease, such as infertility and chronic pain syndrome

Endometriosis causes

Keeping health and protecting yourself from disease is the desire of every woman. Therefore, the questions naturally arise: why does endometriosis develop and how to protect yourself from its development?

Unfortunately, science cannot yet fully explain the mechanisms of this disease. [7] Today, there are several hypotheses, which are adhered to by certain specialists. And yet, modern researchers still need time to collect and analyze more scientific data on its course in different patients.

Current theories for the development of endometriosis include the following

Heredity (there are cases of familial endometriosis) [11-13]
Congenital malformations of the body
Autoimmune disorder (production of antibodies that infect cells in your own body)
Retrograde menstruation (reverse flow of menstrual blood with fragments of the mucous membrane of the uterus - endometrium - through the fallopian tubes back into the abdominal cavity) [10]
Spread of endometrial tissue through the lymphatic or circulatory systems
Impaired function of the immune and endocrine systems under the influence of external adverse factors

However, most likely, the disease is caused by a combination of several causes.

Endometriosis symptoms

How to understand that you have endometriosis? This is not an easy task. According to statistics, only every 6th gynecologist, whom a woman turns to with complaints of pain in the lower abdomen, makes a diagnosis of "endometriosis" [19]. This is due to the complexity of its diagnosis. It often happens that instead of endometriosis, a woman is treated for a long time and without much effect from a similar inflammation of the uterus and / or appendages.

In many patients, the main symptom of endometriosis is infertility, and other signs may be absent altogether. Often, doctors accidentally discover endometrial lesions during surgery. However, there are a few signs that you need to pay special attention to.

The main symptom of endometriosis is lower abdominal pain. It can occur:

before, during or after menstruation;
on other days of the menstrual cycle or be chronic for at least 6 months;
during intercourse. [15]
The pain can be felt not only in the pelvic organs, but also in the intestines during bowel movements, in the anus during menstruation, as well as in the lower back.
Painful sensations are so heavy and debilitating that they affect the general physical and emotional state of a woman and force her to change her usual way of life.

Other signs of endometriosis include

diarrhea or constipation, especially during menstruation
bloating, also associated with menstruation
profuse bleeding
chronic fatigue [16]

 
After listening to you and comparing the symptoms, the specialist may prescribe studies such as:
gynecological examination
Ultrasound
MRI (magnetic resonance imaging)

Unfortunately, none of these studies are able to unambiguously confirm or decisively refute the diagnosis. To date, the most accurate method for diagnosing endometriosis is considered to be surgical excision and then examination under a microscope of tissue samples taken from the foci of endometriosis.

This difficulty in diagnosing the disease often leads to the fact that between the appearance of the first signs and the diagnosis is 7–12 years [19]. Therefore, be attentive to yourself. Don't let pain become your faithful companion!

Consequences and prevention of endometriosis

It is important at any age to feel healthy, energetic and happy. And if, besides, you are young, then the time will come when you want to start a family and have children. Endometriosis can interfere with these plans.

This disease is chronic and progressive. The fact is that foci of endometriosis lead to the formation of adhesions that change the anatomy of the pelvic organs and make it difficult for normal fertilization and the advancement of a fertilized egg into the uterus. According to statistics, in 21–47% of women with endometriosis, attempts to become a mother end in failure. [20]
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It is important to know that the earlier endometriosis is diagnosed, the greater the possibilities for non-surgical, non-drug treatment. The likelihood of a relapse of the disease in this case is lower, and the period of possible relapse is longer.

 
Since medicine is not yet able to completely cure endometriosis, modern treatment has three goals:

• reduce the intensity of pain;
• stop the progression of the disease;
• exclude relapse.

Together, this will give you the opportunity to have a baby and avoid future surgery.
However, the doctor can decide on the operation at the initial stage. Treatment always depends on the individual characteristics of the patient. Therapeutic and diagnostic laparoscopy (introduction of an endoscope through a small incision in the abdominal wall) is needed in order to confirm the diagnosis and remove foci of the disease: with a scalpel, laser, electric current or liquid nitrogen. Long-term drug therapy begins after the operation. It is needed in order to make microscopic foci of endometriosis inactive, which could remain in the body after surgical treatment.

References

1. Eskenazi B, Warner EL. Epidemiology of endometriosis. Obstet Gynecol Clin North Am 1997; 21: 235-258.

2. Winkel C. Evaluation and Management of Women With Endometriosis. Obstet Gynecol. 2003; 102: 397-408.

 
3. Farquhar C. Endometriosis. BMJ 2007; 334: 249-253.

4. Mounsey AL, Wilgus A, Slawson DC. Diagnosis and management of endometriosis. Am Fam Phys 2006; 74: 594-600.

5. Ballard K, Lowton K, Wright J. What's the delay? A qualitative study of women's experiences of reaching a diagnosis of endometriosis. Fertil Steril 2006; 86: 1296-1301.

6. Hummelshchj L, Prentice A, Groothuis P. Update on endometriosis. Women's Health 2006; 2: 53-56.

7. Allen C, Hopewell S, Prentice A, Gregory D. Nonsteroidal anti-inflammatory drugs for pain in women with endometriosis. Cochrane Database Syst Rev 2009; (2): CD004753.

8. D'Hooghe T, Bambra C, Raeymaekers B, Koninckx P. Increased prevalence and recurrence of retrograde menstruation in baboons with spontaneous endometriosis. Hum Reprod 1996; 11: 2022-2025.

9. The Practice Committee of the American Society for Reproductive Medicine. Treatment of pelvic pain associated with endometriosis. Fertil Steril 2008; 90: S260 – S269.

10. Nnoaham et al . Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries. Fertil Steril 2011; 96: 366–73.

11. Nouri K, Ott J, Krupitz B, Huber JC, Wenzl R. Family incidence of endometriosis in first-, second-, and third-degree relatives: a case-control study. Reprod Biol Endocrinol 2010; 8: 85-91.

12. Bischoff FZ, Simpson JL. Heritability and molecular genetic studies of endometriosis. Hum Reprod Update 2000; 6: 37–44.
13. Kennedy S, Bennett S, Weeks D. Genetics and infertility II: Affected sib-pair analysis in endometriosis. Hum Reprod Update 2001; 4: 411-418.

14. Taylor MM. Endometriosis - a missed malady. AORN J 2003; 77: 298-303.

15. Sinaii N, Plumb K, Cotton L et al. Differences in characteristics of 1,000 women with endometriosis based on the extent of disease. Fertil Steril 2008; 89: 538-545.

16. Kennedy S, Bergqvist A, Chapron C, et al. ESHRE guideline for the diagnosis and treatment of endometriosis. Hum Reprod 2005; 20: 2698-2704.

17. Gorgan S., Turley E., Cole J. 'So many women suffer in silence': a thematic analysis of women's written accounts of coping with endometriosis. Psychol Health. 2018 Nov; 33 (11): 1364-1378.

18. Endometriosis: Diagnosis, Treatment and Rehabilitation. Clinical guidelines for the management of patients. Ed. L.V. Adamyan. 2013.S. 11-37.

19. Nnoaham KE, et al. Fertil Steril. 2011 Aug; 96 (2): 366-373

20. Practice Committee of the American Society for Reproductive Medicine. Treatment of pelvic pain associated with endometriosis: a committee opinion. The Practice Committee. Fertil. Steril. 2014; 101 (4): 927-35.