Endometriosis is a chronic disease, which consists of the appearance of endometrial tissue in any anatomical place different from its original location, which is the inner part of the uterus (endometrium) and which directly affects the fertility of the woman.
This endometrial tissue can be implanted anywhere in the human body, however, its appearance is more frequent in the uterine tubes, ovaries, vagina, rectum and pelvic wall or peritoneum.
The initial lesions have a red appearance and over time they develop into black implants, which can even form chocolate-like cysts inside. In the same way, endometriosis can generate adhesions or flanges of the pelvic organs, that is, they adhere to each other, generating pain and limitations of the normal function of these organs.
These injuries and adhesions can cause symptoms such as severe pelvic pain, heavy and painful menstrual periods, or difficulty achieving pregnancy.
It is important to clarify that it is a benign disease that is not related to cancer or other types of neoplastic disease, but it is one of the most frequent causes of pelvic pain and infertility. Hence the importance of discovering it in time and treating it properly, in order to avoid the appearance of the annoying symptoms that it can produce, as well as the interference that it can generate to achieve a natural pregnancy.
WHO DOES IT AFFECT AND WHY DOES IT OCCUR?
Endometriosis occurs mainly in young women who are in the reproductive stage and can affect 1 in 5 women in this age range. We can also find it in about half of women who have difficulty achieving pregnancy spontaneously.
The exact cause is not known, however, we do know that there are some genetic and hereditary factors that predispose certain women to develop this disease.
There are many theories about its exact cause, but apparently one of the most accurate is the retrograde flow of menstrual bleeding; that is, the material that should be expelled through the vaginal canal, returns through the uterine tubes, thus reaching the abdominal cavity and the internal pelvic organs.
It should be clarified that not all women who have this retrograde flow of menstrual bleeding have endometriosis and this can distort this approach a little.
Another important theory seems to be based on estrogen production. These hormones are released primarily by the ovaries and are necessary for many of a woman’s normal bodily functions. However, in some cases, these same estrogens stimulate the body’s cells to generate foci of endometriosis.
WHAT ARE THE SYMPTOMS THAT MAKE ENDOMETRIOSIS SUSPECTED?
The main symptom that a woman with endometriosis may present is severe pelvic pain.
This pain becomes stronger during the menstrual period and at the time of sexual intercourse, but it can also manifest itself with pain in the rectum, bladder, back and extremities. It is also common to find very heavy menstrual bleeding, however, in many women the first manifestation is the difficulty in achieving pregnancy spontaneously.
It is important to know that not all women who present these symptoms have endometriosis, but it should be within the main diagnostic options.
HOW DO WE DIAGNOSE ENDOMETRIOSIS?
Diagnosing this disease is not easy and on many occasions it is necessary to perform invasive procedures to confirm its presence.
The first indication of the disease is given by the symptoms reported by the patient, supported by a complete gynecological examination, which in patients who present the disease, can be more annoying and painful than usual. An ultrasound examination is necessary, preferably transvaginally, in order to detect lesions caused by endometriosis, such as cysts or organ retractions. Although endometriosis is frequent, it generates very small lesions that are not detected by this route.
The ideal method for diagnosing endometriosis is laparoscopy. This procedure involves inserting a camera through the navel and insufflating the abdomen with a gas (CO2), in order to directly observe the abdominal cavity and pelvic organs. This intervention not only allows us to diagnose the disease, but also to remove the lesions that are found at that time, such as red or black foci of the disease, ovarian cysts or release of adhesions.
In most cases, laparoscopy is enough to make the proper diagnosis of endometriosis, but in certain cases, it is necessary to take samples of abdominal tissue that may appear healthy, in order to send it to the pathology laboratory and thus confirm the presence or absence of the disease.
WHAT IS THE TREATMENT FOR ENDOMETRIOSIS?
Treatment can be divided into 2 main groups:
- Women with a desire for a near pregnancy:
In this case, treatment depends on the severity of the disease and the involvement of the pelvic organs. To begin with, it is advisable to perform a diagnostic and/or operative laparoscopy, in order to confirm the presence of the disease and treat the lesions found during the procedure. Depending on the type of condition and the degree of involvement in the reproductive system, treatments can be carried out to achieve pregnancy, from very basic treatments such as stimulation of the ovaries to ensure ovulation, to treatments that involve the manipulation of gametes such as in vitro fertilization, when the compromise due to endometriosis is greater.
The type of treatment depends in turn on the age of the woman, knowing that the older the woman, the lower the fertility and the longer the time of exposure to the disease, so that in patients diagnosed with endometriosis, the recommendation is to seek pregnancy at an early age or at least not to delay reproduction excessively. Age and the time of evolution of the disease are the factors that make it most difficult to achieve pregnancy.
In all cases, it is necessary to evaluate the quality of the couple’s sperm, in order to choose the most appropriate and effective treatment.
- Women without desire to get pregnant:
In this case, treatment is focused on improving the symptoms produced by the disease and preventing the progression of the lesions. In addition to laparoscopy as the main management tool, if there are no immediate pregnancy plans, the use of hormonal medications is indicated, whose main objective is to block the harmful effect of estrogen.
These medications can be oral contraceptives (preferably with progesterone compounds), injectable medications, hormone blockers and even some that induce a kind of “menopause”, which aim to reduce symptoms and prevent the progression of the disease, although they often have marked side effects.
Recently, an intrauterine device has been used that slowly releases hormones (progesterone), this being a comfortable, effective treatment with few side effects.
Pregnancy is the best natural treatment for endometriosis, due to the protective effect it exerts on the adverse effects of estrogens; substantially improves the symptoms caused by the disease and often returns the pelvic organs to their normal functioning.
Endometriosis is a disease that accompanies women throughout their reproductive life and can sometimes even affect them after menopause. Hence the great importance of its timely diagnosis and treatment.
Germán David Ospina
Fertility Specialist inSer Group
