Endometriosis is a benign pathology that consists of the appearance of endometrium outside the uterus and leads to the formation of cysts, plaques or nodules. It is estimated that up to 10% of women of childbearing age have endometriosis and that 20-40% of women with endometriosis may experience infertility.
Causes
There are several theories to explain the appearance of endometriosis:
- Retrograde menstruation. During menstruation, part of the menstrual tissue (endometrial) passes through the tubes by retrograde flow until it reaches the abdomen where it forms implants. Despite these, this is known to occur in many women who do not have endometriosis.
- Immunity defect responsible for the clearance of abnormal cells in the abdomen. In this case, the endometrial cells are not recognized as foreign within the abdominal cavity and may form implants.
- Genetic component. In some cases, endometriosis may involve a hereditary component.
What are the symptoms of endometriosis?
Endometriosis is a disease that can cause very variable symptoms from one woman to another. This is the main reason why the diagnosis takes about 7 years on average.
- Pain
This is the most frequent symptom and although it can also appear before menstruation, it manifests itself throughout the cycle. There may also be pain with defecation or when urinating. It is important to differentiate that menstruation can hurt and it is not necessarily endometriosis.
- Pain during intercourse
Vaginal penetration may compress an area affected by endometriosis and cause discomfort during sexual intercourse.
- Abnormal uterine bleeding
Most women with endometriosis have regular menses, but alterations of the menstrual cycle may occur with either menorrhagia (loss of a lot of blood in the period) or menometrorrhagia (loss of blood in the intermenstrual period).
- Reproductive problems
Approximately 50% to 70% of women with endometriosis will become pregnant spontaneously. However, endometriosis can cause infertility.
At this time, it is not known why, once pregnancy is achieved, women with endometriosis have an increased risk of miscarriage. It seems that this increased inflammation and the alterations of the defenses could be responsible for these gestational losses.
- Other
Fatigue, diarrhea or constipation, nausea and/or a feeling of fullness.
What is the treatment for endometriosis?
Treatment may be medical, surgical or other. The treatment for each patient must be individualized and will depend on several factors such as age, previous treatments used, number of previous surgeries and desire for genitalia, among others. Treatment should be a joint decision between the physician and the patient.
- Medical treatment
Medical treatment is based on the use of different therapeutic guidelines that include anti-inflammatory drugs such as ibuprofen, analgesics such as paracetamol and hormonal treatment. The most effective medical treatment is hormonal (combined hormonal contraceptives, progestogens and GnRH analogs).
When endometriosis is highly suspected but not confirmed by imaging tests, empirical (trial) treatment with combined hormonal contraception, progestogens, levonorgestrel-releasing IUD placement or GnRH analogues is recommended. It is possible for the patient to have endometriosis if symptoms decrease and her quality of life improves.
- Surgical treatment
When medical treatment is not effective, surgery (by removing the endometriosis lesions) can be an effective treatment to treat the pain associated with this disease.
The type of surgery to be performed will be individualized in each case and will vary according to the characteristics of the patient and the location of the disease: we will try to be conservative with the genital apparatus and restore the anatomy as far as possible if the patient has genital desire. However, if the woman’s genital desire is fulfilled and she does not wish to keep her uterus, a hysterectomy (removal of the uterus) may be reasonable.
- Other
Complementary therapies such as acupuncture and psychoneuroimmunology may be beneficial. Eating antioxidant and anti-inflammatory foods can also help you.
What surgeries can be applied for endometriosis?
The type of surgery will depend on the location of the disease:
- Cystectomy: if there is endometriosis in the form of ovarian cysts (endometriomas).
- Salpinguectomy: if there is endometriosis in the tubes.
- Resection of deep endometriosis nodules: when endometriosis forms deep nodules below the peritoneum.
- Discoid resection or rectal resection: if endometriosis invades the bowel.
- Ureterolysis or partial cystectomy: if the endometriosis is in the ureters or bladder.
- Radical surgery: in women who have already fulfilled their reproductive desire, hysterectomy with or without double adnexectomy (removal of the uterus, ovaries and tubes) may be recommended.
Endometriosis lesions can be resected (removed) or burned using a high-energy source, such as a laser (ablation).