The endometriosis is defined as the presence and proliferation of endometrial tissue outside the uterine cavity (only physiologically endometrium is within the uterus).
There are two very different forms of endometriosis:
- Internal endometriosis or adenomyosis: when it is located in the thickness of the myometrium.
- External endometriosis or simply endometriosis: when it is located outside the uterus.
It can be located, therefore, in the uterus, ovaries, tubes, cervix, vagina, vulva and perineum, that is, in the entire genital tract.
It can also be located outside the genital tract, in the pelvis, rectovaginal septum, uterine ligaments, uterine peritoneum, and even in places far from the genital tract (intestines, navel, bladder, laparotomy scars, lung, pleura, and extremities).
The most frequent locations are:
- in the womb.
- in the ovaries.
- in the uterine ligaments.
Causes of endometriosis
The exact cause of endometriosis is not known, but there are a number of factors that may constitute a risk for this disease:
- Age: it is more frequent in the reproductive or menstrual stage of women (approximately between 15 and 45 years old), its appearance being rare before menarche or after menopause .
- Characteristics of menstruation: it appears more frequently in women who have had an early menarche (before 12 years) and in those who have short cycles (less than 27 days) or long menstrual flows (more than 7 days).
- Congenital anomalies of the genital apparatus: especially those of the obstructive type.
- Genetic factors: women with a family history of endometriosis are at higher risk of developing this disease.
- Injuries to the genital tract
- Other factors (not fully proven).
The mechanism of production of endometriosis is not clear, and various hypotheses have been formulated to explain it:
- Theory of proliferation: there would be a proliferation of the endometrium, which would penetrate the thickness of the myometrium. This theory explains adenomyosis.
- Metaplasia theory: consists of the production, by cells of a certain type, of tissue other than the one they normally produce (in this case, endometrium). This theory explains the location in the peritoneum.
- Implantation theory: it assumes that the cells shed during menstruation pass to the tubes (retrograde menstruation) and from there to the peritoneal cavity. This theory explains the location in the peritoneum.
- Propagation theory: it would consist of some endometrial cells being transported by the vascular or lymphatic route to places far from the endometrium. This theory explains the locations outside the genital tract.
Symptoms of endometriosis
The main symptom of endometriosis is pelvic pain, which can be accompanied by infertility.
There may be other associated symptoms that depend on the location of the endometriosis foci:
- Pelvic pain: it is the most characteristic symptom of endometriosis and often the only one. It is usually intense, deep, constant and is located on the sides of the pelvis. The moment of presentation is very characteristic; Although it can appear throughout the cycle, the usual thing is that it is premenstrual or perimenstrual, that is, that it begins at the beginning of the rule or about 2 days before, and that it persists or is accentuated during menstruation.
- Sterility: appears in 30% of cases of endometriosis.
- Dyspareunia (appearance of pain during intercourse).
- Menstrual disturbances: short menstrual cycles, prolonged duration of menstruation and small blood losses are often detected premenstrually. As we have said before, the period is accompanied by pain.
- Rectal pain and tenesmus : in cases of endometriosis in the rectum.
- Painful urination, urgency and hematuria: in cases of endometriosis of the bladder.
Bowel function disorders (diarrhea, constipation , obstruction pictures): in cases of endometriosis in the intestine.
Other times endometriosis does not produce any obvious symptoms, this form being called silent endometriosis.
How is it diagnosed?
Given the clinical suspicion of endometriosis, a clinical examination should be carried out, in search of foci of said disease.
- Simple inspection: Certain forms of endometriosis (vulva, perineum, laparotomy scars, umbilicus) can be seen as blue nodules.
- Speculum inspection: nodules with the same blue hue can be seen on the cervix and in the vagina.
- Vaginoabdominal or rectoabdominal examination: nodules of variable size, of a hard consistency and firmly adhered to the surrounding tissues in the uterine ligaments, ovaries or rectovaginal septum, and an enlarged and painful uterus in the case of an adenomyosis can be detected.
However, the data collected in the examination are not conclusive and, to reach a sure diagnosis, it is necessary to resort to complementary tests.
- Ultrasound: you can see the foci of endometriosis located in the genital tract and outside it.
- Laparoscopy: it is a very valuable method, since it allows to visualize the appearance of the lesions and, if necessary, it allows a biopsy in the suspicious areas for study under the microscope.
- Hysterosalpingography: it can be useful in certain cases for the diagnosis of foci located in the myometrium or in the tubes.
- Barium enema and rectoscopy: can be useful in the diagnosis of intestinal endometriosis.
- Cystoscopy and descending urography : can be useful for the diagnosis of endometriosis of the urinary system.
- Biopsy: from accessible foci, such as the vulva, cervix, laparotomy scar, and umbilicus.
The treatment of endometriosis is conditioned by the intensity of the symptoms, the location of the lesions, and the age of the woman and her desire for offspring. Hormonal treatment or surgical treatment can be used, depending on the case.
This type of treatment is based on the fact that foci of endometriosis respond to steroid hormones in a similar way to normal endometrium, and that during pregnancy there is a substantial improvement in endometriosis, and that this improvement persists once it is over. the pregnancy.
- Gonadotropin-releasing hormone (GnRH) agonists: it is a hormone that when administered continuously produces an inhibition of hormone synthesis in the ovary, suppressing ovulation.
- Medroxyprogesterone acetate: it is a progestin that acts by inhibiting the function of gonadotropic hormones, producing a suppression of ovulation; in addition, it induces atrophy of the endometrium. It has the disadvantage that, once the treatment is finished, there is a delay of several months in the onset of ovulation, so it is not indicated in women who want to become pregnant immediately.
- Danazol: it is a synthetic steroid similar to testosterone, which acts by multiple mechanisms, producing a decrease in estrogens and an increase in androgens, which causes a suppression of ovulation and atrophy of the endometrium.
However, it must be taken into account that these treatments inactivate the foci of endometriosis rather than cure them definitively, so that the definitive cure is only obtained with surgery.
- Conservative treatment: consists of the removal of the foci of endometriosis, but totally or partially preserving the uterus, tubes and ovaries. It can be performed by laparoscopy, which is the most widely used technique, or by laser vaporization. This treatment will be carried out in young women who show a desire to have children and only when hormone therapy has failed.
- Radical treatment: consists of removing the uterus, tubes and both ovaries, a technique known as hysterectomy with double salpingo-oophorectomy. This treatment will be carried out when the lesions are very extensive or if the woman is over 40 years old or does not want to have children. Regardless of the surgical technique used, hormonal treatment is indicated before and after surgery.
How can I avoid it?
It has been shown that the risk of endometriosis is greater in women who have not been pregnant than in women who have had several children, so pregnancy is considered as a measure that prevents the appearance of this disease.
Hello Readers, I am Nikki Bella a Psychology student. I have always been concerned about human behavior and the mental processes that lead us to act and think the way we do. My collaboration as an editor in the psychology area of Well Being Pole has allowed me to investigate further and expand my knowledge in the field of mental health; I have also acquired great knowledge about physical health and well-being, two fundamental bases that are directly related and are part of all mental health.