1. What is Endometriosis disease?

Endometriosis disease is a chronic disease that usually comes back.

The endometrium is the tissue that lines the uterus. Under the effect of hormones (estrogen), the endometrium thickens for a potential pregnancy during the cycle, and if there is no fertilization, it breaks down and bleeds. These are the menstruation. In almost all women, cells will move up, migrate through the tubes, and disperse in the abdomen. This is the menstrual reflux theory. However, the immune system works to destroy these cells, which are not where they are needed.

However, in 10% of women, the endometrial tissue that develops outside the uterus is not destroyed and is grafted onto the organs and then causes lesions, adhesions, and ovarian cysts (endometriomas). This is where it becomes "endometriosis."

This "colonization," though it mainly occurs on the genitals and peritoneum, can frequently extend to the urinary, digestive, and more rarely pulmonary (diaphragm) systems. There are also very rare cases of endometriosis in the brain.

2. Location of endometriosis and extent of lesions

Endometriosis disease presents in the form of:

- Peritoneal implants in the form of multiple small lesions or millimeter granulations:

  • Either bluish or black in color (content with old blood);
  • Either red active and hemorrhagic, at the level of the sub-peritoneal plane or at the surface of the peritoneum; this type of lesion is seen especially during menstruation and during episodes of bleeding;
  • Or white fibrous, scarring, and surrounded by a retracted, tight, indurated, and fibrous peritoneum.
  • Peritoneal endometriotic implants, often develop on the peritoneum of the small pelvis:
  • On the posterior layer of the broad ligament,
  • On the path of the uterosacral ligament,
  • On the surface of the ovaries,
  • On the horns of the uterus and the proximal portion of the tubes,
  • On the peritoneum of the anterior cul-de-sac,
  • On certain uterine lesions (sub-serous fibroma ...) and then on the digestive organs surrounding the small pelvis (sigmoid, rectum, appendix ...).

These implants are call points for the formation of adhesions, often very fibrous, in the form of membranes or impulses bringing the organs together.

- Ovarian cysts (endometriomas) of varying size and containing a liquid resembling melted chocolate (due to the accumulation of blood in the cavity of this cyst); sometimes, the endometrioma can be multiple, on one or both ovaries at the same time.

3. What causes Endometriosis disease?

The exact cause of endometriosis is uncertain. In endometriosis, a few small pieces of endometrial tissue that should be flushed out of the body with the menstruation may instead travel up to the fallopian tubes. One of these small pieces might even move inside the belly and start to grow.

Endometriosis can have a familial character.

4. What are the symptoms of Endometriosis disease?

The symptoms of endometriosis disease include:

  • Pelvic pain;
  • Pain during intercourse;
  • Changes in menstruation;
  • Pain and cramps during menstruation;
  • Painful urine or bowel movements during menstruation;
  • Infertility.

Many of these symptoms are also associated with other medical conditions. The severity of the symptom is not necessarily with the amount of tissue present outside the uterus. Some women who have endometriosis throughout the pelvis have no particular sensation, while others with very limited symptoms experience excruciating pain.

Period pain that has been bearable for years, but increasing in intensity, may be a sign of endometriosis.

Sometimes cysts and scar tissue form around the vagina in the pelvis, making sex painful. These pains sometimes indicate a case of endometriosis, but this symptom can also be due to other conditions. In women with endometriosis, endometrial tissue often ends up reaching one or even both ovaries. It may then form cysts called endometriomas.

5. Endometriosis disease: at what age?

Endometriosis affects women of childbearing age, usually between 25 and 50 years old, although this disease can also affect adolescent girls. It mainly affects young women up to 35 years old. As the endometrium is under the influence of sex cycle hormones, endometriosis will also be subject to these changes, which explains some of the symptoms.

6. Diagnostic

The doctor will usually start with a medical history and do a pelvic exam. During the examination, he checks the patient for symptoms of endometriosis and then feels the internal organs for the presence of lumps and growths. This procedure may be followed by an ultrasound of the pelvis to check for the possible presence of cysts in the ovaries. Often the ultrasound does not reveal anything in particular.

Sometimes an MRI (magnetic resonance imaging) or a laparoscopy which involves examining the abdominal cavity using an endoscope. Laparoscopy has two considerable advantages: the formal identification of endometriosis and the possibility of eliminating foci of endometriosis during exploration.

Related: In which way can progesterone prevent miscarriage?

7. Treatment of Endometriosis disease

Endometriosis treatment maybe with medication, laparoscopic surgery, or traditional surgery. The choice of treatment depends on the person, and some factors, including the woman's age, the severity of her symptoms, and whether or not she wants to have children.

7.1 Hormonal treatment

Therefore, the basis of treatment is hormonal, and the first of these is the pill, prescribed continuously. By blocking the menstruation, it avoids pain. When this is not enough, it is advisable to start a treatment which will induce artificial menopause (injection of GnRH agonists), for a period limited to "18-24 months ". This treatment has the effect of stopping the cycle. This normally resumes within two to three months after stopping the treatment. The doctor may also prescribe a treatment of non-steroidal anti-inflammatory drugs (NSAIDs) as part of the management of pain associated with endometriosis.

7.2 Surgical treatment

Laparoscopy and minor surgery are sometimes done to remove endometrial tissue from places where it should not be forming, such as the pelvis. During laparoscopy, the doctor uses an electrical device or a laser to burn the endometrial tissue. Laparoscopy is a less invasive technique than traditional surgery (e.g., hysterectomy). It is an outpatient surgery (without the patient hospitalization). Larger, more encapsulated growths sometimes require traditional surgery.

Women who do not want to have children may opt for a hysterectomy and complete oophorectomy (the removal of the uterus, ovaries, and fallopian tubes). Combined with medication, this procedure eliminates the production of female hormones and therefore relieves symptoms associated with endometriosis. However, it does not guarantee pain relief. Removal of the ovaries leads to estrogen deficiency. Women undergoing this procedure will take hormone replacement therapy. Before accepting it, it is important to discuss the risks and benefits of this treatment with the doctor.

Originally published on Live Positively.