Endometriosis – “Reproductive Health”

Endometriosis – “Reproductive Health” – It is one of the most common diseases in gynecological practice and causes significant changes in a woman’s body. The section will provide you with information on the incidence of the disease, clinical signs, complications, diagnosis and treatment methods. We will answer many interesting and topical questions related to endometriosis with an academic doctor of medicine, a reproductive gynecologist

– What is the disease endometriosis?

Endometriosis is one of the most common diseases in women. At this time, parts of the inner membrane of the uterus – endometrial tissue – are found in the form of small “islands” outside the uterus, in unusual places – the ovary, cervix, pelvis and undergo the same changes as the endometrium during the phases of the menstrual cycle. This form of the disease is called genital endometriosis, and these areas are called endometrial heterotopias.

Areas of endometriosis can be found in other organs as well – in the bladder, intestines, lungs, nasal mucosa, eyes. This form of the disease is called extragenital endometriosis.

Thus, we have two main forms of endometriosis: genital and extragenital. Genital endometriosis also includes adenomyosis and ovarian endometriosis.

– What does “adenomyosis” mean and what is “endometrioma”?

– Adenomyosis is one of the forms of genital endometriosis, in which the uterus

Areas of the inner membrane – the endometrium – are abnormally embedded deep in the wall of the uterus – in its muscular layer.

An endometrioma is called an endometrial cyst of the ovary. At this time, there is a cystic growth in the ovary, the inner wall of which is lined with endometrial-like tissue, and the contents are bloody, viscous, chocolate-like fluid. Therefore, they are also called chocolate cysts.

– How common is endometriosis?

– About 3 million women worldwide are affected by endometriosis, affecting 5-10% of women of reproductive age. The incidence of endometriosis is very high during painful menstruation – 40-60%, chronic pelvic pain – 75% and during infertility – 35-50%.

– What causes endometriosis?

– There is no unified theory about the development of the disease. It may be related to genetic factors and be determined from the time of pregnancy. There is a theory of retrograde menstruation, according to which menstrual blood from the uterus enters the pelvic cavity through the fallopian tubes and attaches to other organs in the form of “endometrial islands”. Areas of endometriosis with blood and lymph flow can spread throughout the body. There are other theories as well.

– What are the signs of endometriosis? When can we suspect the existence of this disease?

– The most characteristic sign of endometriosis is pain during menstruation, brown discharge before and after menstruation, chronic pain in the pelvis – in the lower abdomen, pain during sexual intercourse, prolonged and excessive menstruation. Endometriosis of the intestine and bladder may indicate pain during gastric emptying and urination.

A manifestation of endometriosis may be chronic fatigue syndrome.

– When can the first signs of the disease appear?

– The first signs of the disease can be detected in adults as soon as menstruation begins,

In the form of painful menstruation. This fact is not always given due attention as painful menstruation is considered a normal occurrence.

Sometimes newborn girls have a blood clot after birth, which is related to the hormonal changes taking place in the mother’s body. There is an opinion that the so-called Menstruation in newborns may be the first manifestation of endometriosis.

– Does painful menstruation always indicate endometriosis?

– Painful menstruation does not always indicate endometriosis. Menstrual pain can be of a functional nature, related to emotional background, hormonal changes and inflammatory processes.

– Can a woman have endometriosis but nothing to worry about?

– Yes, endometriosis can occur without any clinical signs. There are frequent cases when a woman undergoes surgery for another reason and accidentally discovers endometriosis.

– What changes does endometriosis cause in a woman’s body?

– Local inflammation is always observed around the areas of endometriosis, which leads to the development of healing. Endometriosis is also accompanied by hormonal imbalance. The disease has a significant impact on a woman’s psyche and character.

– What complications can endometriosis cause?

– Endometriosis is a chronic progressive disease, which means that without treatment it lasts a long time and gradually worsens.

Complications of endometriosis can be considered infertility, the development of severe healing, accompanied by severe pain and reduced ability to work. Because of this, endometriosis is named as the cause of a woman’s disability.

– Does endometriosis always cause infertility and by what mechanism?

– Endometriosis is considered to be one of the causes of infertility, especially some of its forms – deep endometriosis, adenomyosis.

Endometriosis is accompanied by hormonal disorders and, consequently, ovulation disorders. Endometrial cysts damage ovarian tissue and eggs. Concomitant inflammation around the areas of endometriosis promotes healing and can damage the fallopian tubes, causing their obstruction. During adenomyosis, it is difficult for the fertilized egg to attach to the uterus and maintain pregnancy.

– Is endometriosis a verdict that a woman will not have a child?

– It is not so. It is known that about 40% of women who have normal reproductive function and have children also have endometriosis at the same time.

However, today the problem of infertility caused by endometriosis is almost solved. Modern methods of highly effective treatment help a woman achieve pregnancy.

– How can we determine the presence of endometriosis? What are the methods of diagnosis?

– The diagnosis of endometriosis can be made on the basis of clinical signs. Ultrasound examination is informative, it allows us to diagnose endometrial cysts of the ovaries. Magnetic resonance imaging is performed to detect deep and extragenital endometriosis.

The gold standard in reproductive practice is diagnostic laparoscopy. At this time, a laparoscope is inserted into the abdominal cavity at a rate of one centimeter, on which a mini-video camera is attached and a direct view of the endometriosis areas is made. These areas can be excised and histomorphologically examined.

– How is endometriosis treated and how long does this process last?

– Endometriosis is treated with medical and surgical methods. Treatment should always be started with medication. There is a so-called Symptomatic therapy, when we try to alleviate the symptoms of the disease and the so-called. Pathogenetic therapy, when we influence the mechanisms of disease development, which ultimately results in reversal of the disease. Various hormonal medications are used for this purpose. Treatment is long, can last for several months, which is determined individually and depends on the patient’s complaints and the severity of the disease.

– What are the complications of hormone therapy during endometriosis?

– When prescribing hormone therapy, the risk and benefits for the patient are assessed in advance. This treatment is usually safe and does not involve any serious risks. A side effect of treatment may be the temporary cessation of menstruation, which returns to normal after the end of treatment.

– When and what kind of surgical treatment is performed during endometriosis?

– Surgical treatment of endometriosis is recommended for severe pain, large endometrial cysts of the ovary, infertility, when we can not get results with medical treatment.

Treatment is laparoscopic. In small areas of endometriosis they coagulate – burn, in deep endometriosis – they are excised, in endometrial cysts the contents of the cysts are aspirated and the capsule is removed. It is very important at this time not to damage the follicular apparatus, to maintain the healthy tissue of the ovary as much as possible.

– Is it necessary to excise endometrial cysts of the ovary?

– Unlike follicular cysts, endometrial cysts do not disappear on their own. The issue of surgical treatment should be resolved according to the size of the cyst and the patient’s complaints. When the endometrial cyst of the ovary is small (not more than 3 cm), does not prevent ovulation and does not cause pain, surgery is avoided, because the excision of the cyst is accompanied by a decrease in the supply of eggs in the ovary. This is especially true for older women who want to have children.

Thus, small endometriums are observed in dynamics, while large cysts, especially with accompanying complaints, are excised with maximum preservation of healthy ovarian tissue.

– How long can a woman get pregnant after the operation due to endometriosis?

– It depends on the form and severity of endometriosis. In small forms, when coagulation of the endometriosis areas takes place, a woman may be immediately allowed to become pregnant. In deep endometriosis, medical treatment is recommended after surgery, for an average of 3-6 months, which is determined individually.

– Is artificial insemination necessary during endometriosis and infertility?

Endometriosis is not an indication for in-vitro fertilization. This procedure is performed in cases when treatment with conventional methods does not give us results. Proper preparation of the patient is essential at this time. Pre-medication treatment increases the chances of pregnancy. Special protocols are used to stimulate the eggs.

It is a known fact that the quality of eggs during endometriosis can be reduced, which, in turn, should be given special attention.

– If endometriosis is transmitted from mother to child and what is the risk during pregnancy?

– There are family cases of endometriosis – If the mother had endometriosis, there is a risk that her child will also have the disease.

As for pregnancy, in the case of adenomyosis there is a risk of termination of pregnancy and the risk of other complications, especially if the woman had a problem with pregnancy. Therefore, such patients need proper preparation for pregnancy.

– What would you recommend to women with endometriosis?

– For women who have a confirmed diagnosis of endometriosis or suspect its existence, I recommend timely treatment. This is especially important for teenage girls. Mothers should pay attention to this so that their children do not face childbearing problems in the future.

No less striking is the fact that endometriosis progresses over the years, the pain intensifies and leads to impaired ability to work, depression. Consequently, the quality of life of a woman is reduced.

See also: Means for diagnosis and treatment of uterine fibroids and ovarian cysts