When we talk about endometriosis, we refer to the implantation of endometrial tissue (the endometrium is the tissue that grows every month inside the uterus with ovulation to prepare for the implantation of a possible embryo), outside the uterus. This tissue may be invading the ovaries, the ligaments that support the uterus, in the fallopian tubes and in the abdominal cavity, it can affect the intestine. As it is a foreign tissue, an inflammatory reaction occurs, triggering inflammation. This disease, feared by women, is frequent, occurs in up to 10-15% of women of reproductive age and in women with infertility it can be present in up to 30% of couples who consult for infertility. (Learn more about the treatments and consultations for endometriosis)
General
Frequency
Symptoms
Diagnosis
Treatment
Frequency
10-15% of women and 30% of women with fertility problems.
Symptoms
Pelvic pain (lower abdomen), Pain with menstruation and sexual intercourse.
Diagnosis
Transvaginal ultrasound, Diagnostic laparoscopy.
Treatment
Contraceptives, Anti-inflammatories, Progestogens. Laparoscopy and Fertility treatments.
Most Common Symptoms and Diagnostic Options
Pelvic pain or menstrual cramping “Dysmenorrhea” is the most frequent symptom. The characteristic of this pain is that it is usually associated with menstruation, it is “gravative”, this means that it increases over time. It is common to find patients whose pain initially gave way to common analgesics and over time they have to use more powerful, anti-inflammatory analgesics and sometimes consult an emergency department to receive venous treatment. This pain can be associated with pain during sexual intercourse, which will affect sexuality and sometimes generate “dysfunctions” in this area. At this time we must remind every woman of reproductive age that when presenting this type of symptoms, it is best to consult in time and a gynecologist to define whether or not the diagnosis is endometriosis.
In patients with severe endometriosis, endometrial implants may occur in the recto-vaginal septum (space between the vagina and the rectal blister). This type of compromise can trigger pain in the colon and alterations in intestinal transit (constipation and/or irritable bowel)
Transvaginal ultrasound
Transvaginal Ultrasound is an examination that allows the identification of lesions called “Endometriomas”, these are endometriosis cysts in the ovaries. The ultrasound image is very accurate and this allows an accurate diagnosis to be made.
Laparoscopy in Endometriosis
Laparoscopy is the most accurate test to diagnose the presence of endometriosis. The advantage of this intervention is that it becomes therapeutic as it allows endometriosis implants to be intervened, practicing “Fulguration”, which means vaporizing the visible foci with current. However, its repeated use can compromise reproductive function, so a second opinion should be requested in the event of the continued need for this procedure.
Treatments
Treatments in most cases seek to relieve the symptoms caused by endometriosis lesions. The most common symptoms are pelvic pain and infertility. In pelvic pain, in addition to the need most often for analgesics and anti-inflammatories in acute episodes, hormonal treatment should be instituted, which seeks to “block” the hormone-dependent development of these tissues. This group includes: Contraceptives, Progestogens, GnRH Analogues, etc. Each of these medications should be ordered by a specialist and should be properly monitored.
As for infertility caused by endometriosis, treatments will depend on the severity of the condition and the association of other pathologies. In these patients, then, treatments as simple as ovarian stimulation, Artificial Insemination, to Assisted Reproduction and Egg Donation can be indicated.
Finally, in addition to being an important tool in diagnosis, laparoscopy is essential in the treatment of endometriosis, especially in severe forms.
