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Endometriosis

What is endometriosis?

Endometriosis is a common gynecological problem. Its name derives from the endometrium, the uterine cavity. In women with endometriosis, there is tissue that looks like and behaves like endometrium in areas outside the uterus. These lesions are called endometriosis nodules or implants of endometriosis or foci.

We can find lesions of endometriosis: Above or within the ovaries (endometrioma). Behind the uterus, on the ligaments that keep the uterus. On the peritoneum that binds the abdominal walls and organs and on the intestine, bladder or rectum.

Endometriosis can rarely develop in areas far away from the uterus. This ectopic tissue creates inflammation, pain, infertility and heavy menstruation.

Symptoms

Pain is one of the most common symptoms of endometriosis. Usually women have low abdominal pain during mestruation. Some women have no pain and yet endometriosis is scattered in many and large areas.

However there are patients with important mestrual pain and/or pain during sexual intercourse.

Symptoms include:

  • Dysmenorrhea

  • Chronic pelvic pain

  • Pain during sexual intercourse

  • Gastrenteric symptoms

  • Gastrenteric and urinary pain during mestruation

  • Heavy menstruation

  • Loss of blood between menstruations

  • Infertility

Women often present intense gastrenteric symptoms during menstruation like diarrea and bloating.

Which women have it?

7 to 10% of women suffer from endometriosis. The gold standard for diagnosis is laparoscopy.

Women with endometriosis

  • Have a regular cycle

  • Median age 27 years old

  • Present some symptoms already 2 to 5 years before the diagnosis

In menopause endometriosis symptoms disappear. This happens because the reproductive hormones stop circulating.

How can i suspect that i suffer from endometriosis?

It is possible a woman suffers from endometriosis if:

  • Menstruation begins early in adolescence

  • There is dysmenorrhea

  • Period lasts for more than 7 days

  • There is a small menstrual cycle (25 days or less).

  • There is somebody in the family with endometriosis

How can I reduce endometriosis?

You suffer less than endometriosis when you:

  • You exercise regularly

  • Follow a healthy diet

  • Avoid alcohol

How is it created?

Endometriosis is a benign disease (not carcinogenic). However it can create many problems. Every month, the hormones that affect the endometrium increase its thickness. This happens, in order to receive the fertilized egg and keep it safe during in the first days of its life.

If the egg is not fertilized the endometrium falls using the natural route, uterus, cervix, vagina, vulva and creates menstruation. The foci of endometriosis respond in the same way during hormonal changes.

They grow every month and if the woman is not pregnant, the extra tissue that is created bleeds, but there is no way for this tissue and blood to escape.

Thats why endometriosis gets worse and heavier every year that passes. The tissue and blood that remain in various parts of the body cause inflammation and pain. As the ectopic tissue grows it can cover the ovaries and walloping tubes creating infertility.

Thats why endometriosis gets worse and heavier every year that passes. The tissue and blood that remain in various parts of the body cause inflammation and pain. As the ectopic tissue grows, it can cover the ovaries and walloping tubes creating infertility.

Endometriosis creates inflammation and inflammatory lesions can be found on organs such as intestine and bladder.

Is it important for a woman to know that she has endometriosis?

The pain of endometriosis can affect a woman’s life. Studies have shown that women with endometriosis are often missing from school, work or social events. It is a problem that can affect relationships with partner, friends, children, colleagues

Finally, endometriosis can affect a woman’s fertility.

When a woman knows that she has endometriosis, she realizes the reason why she feels discomfort. The treatment doctors give, can control the symptoms and relieve the pain. It can also reduce the spread of endometriosis and maintain the woman’s fertility.

Diagnosis

The doctor will get a history of suspected endometriosis. Fertility specialists can diagnose endometriosis by the gynecological examination in which they can palpate endometriotic foci. The ultrasound taken during the examination often reveals endometriosis cysts in the ovaries.

There is a biochemical marker, CA 125, which is increased in case of endometriosis. It is not an absolute indicator since it is not always increased. If the doctors do not find endometrial foci during physical examination or ultrasound, MRI can be helpful.

Laparoscopy is the only sure and precise way to diagnosticate and treat endometriosis.

Therapy

Actually there is no farmaceutical therapy that eradicates endometriosis. That can reduce and help the patient. The only definite solution is surgery. Among the farmaceutical solutions there are:

For some women with mild symptoms, the doctor may prescribe painkillers such as ibuprofene or naproxene. If these do not work then we recommend stronger painkillers.

Hormonal therapy ( for example decapeptyl which stops period for 3 to 6 months)

When painkillers don’t reduce the pain, then the doctor usually recommends hormone therapy. This treatment can be taken by women who don’t plan to get pregnant. Hormone therapy is best for small foci that do not have severe pain. A woman can take these hormones in many forms (such as pills, injections or nasal sprays).

We suggest hormones like:

Contraceptives reduce the natural hormones that affect the endometrium. They reduce the menstrual period in quantity and duration. They have the same effect on the endometrial cysts. This reduces the amount of blood and tissue that is retained each month in the ectopic foci.

Progesterone reduces endometrial thickening in the uterus and ectopic foci. It’s a new treatment in which 2mg of dienogest only (a type of progesterone) promises high effectiveness in reducing pain and endometrial foci. Its results are almost equal to gonadotrophines.

Gonadotrophines reduce all hormones and put a woman in a ‘pseudo-menopause’ by stopping her period. During the treatment the ectopic endometrial cysts reduce and disappear. When stopping the treatment, the woman’s period and fertility return.

Danazole is not used anymore today.

Doctors usually suggest surgical treatment to women with severe endometriosis, severe pain or fertility problems. There are two surgical methods that specialists use.

It’s the most painless method. Doctros use it for women with no severe endometriosis.

They use  laparotomy in very extensive cases of endometriosis. For instance, when the organs in the pelvis have formed many adhesions and laparoscopy is impossible. We also do it in case of a total hysterectomy, when the woman does not want to get pregnant and is over 45 years old.

According to scientific studies, the laparoscopic treatment of endometriosis offers a better chance of conception in women.

One in 3 women gets pregnant in the first nine months after the laparoscopic treatment of endometriosis. On the contrary, the number of women who conceive without surgery is much smaller.