IS IT ABOUT A DISEASE?
The endometrium is the lining of the uterus and responds to the action of hormones during the menstrual cycle.
At the beginning of the cycle, estrogen secreted by the ovaries causes the endometrium to thicken and, after ovulation, progesterone secreted by the corpus luteum makes it possible for the fertilized egg to implant.
This limits further growth of the endometrium before menstruation, which is caused by the rapid drop in estrogen and progesterone.
When the endometrium is outside the uterine cavity, it is called endometriosis.
Endometriosis is a common benign condition that is often detected by chance, but sometimes presents several and intense clinical symptoms.
WHY IS ENDOMETRIOS FORMED?
During menstruation, the endometrium flows back from the uterus to the abdominal cavity through the fallopian tubes.
In some cases, the endometrium can implant in the peritoneum (membrane that encloses the organs of the abdominal cavity) and spread into its superficial and deeper layers.
The inability to expel the endometrium in this form leads to the appearance of endometriosis.
WHERE DOES ENDOMETRIOS APPEAR?
Endometriosis appears as multiple small black or red foci or adhesions (membranes that stick the organs together).
The areas where endometriosis most often occurs are:
- In the peritoneum
- In the ovaries, forming cysts of variable size
- In the walls of the fallopian tubes
- Between bladder and uterus
- Between the uterus and the rectum, where they can penetrate deeply
In rarer cases, endometriosis can also appear in other organs (digestive tract, bladder, skin, lungs, etc.).
The degree of the disease is determined from the extent of the endometriosis foci.
SYMPTOMS-POSSIBLE INDICATIONS
1. PAIN
It can be caused in many ways:
- Dysmenorrhoea: is pain that occurs during and towards the end of menstruation with gradual worsening. It does not exclusively characterize endometriosis.
- Dyspareunia: is pain that occurs during sexual intercourse. It is usually concentrated in the depth and posterior part of the vagina and becomes more intense just before menstruation.
- Chronic pelvic pain: occurs in the lower abdomen and worsens during ovulation and menstruation.
- Pain during bowel movements.
- Dysuria: painful urination. The appearance of pain is related to the existence of peritoneal endometriosis, which during menstruation bleeds and develops deeply.
2. FERTILITY
The association of endometriosis/infertility is frequent, without however being able to determine which is the consequence of the other.
In infertile women, endometriosis is detected in approximately 30% of cases.
Many infertile women show no clinical evidence of endometriosis and the disease can only be diagnosed by laparoscopy.
Other clinical symptoms of endometriosis may include:
- Prolonged menstruation (menorrhoea)
- Manifestation of hematuria (endometriosis foci in the bladder) or enterorrhage (endometriosis foci in the digestive tract).
HOW IS THE DIAGNOSIS MADE?
Clinical examination may provide only clues to the presence of endometriosis.
- Examination of the cervix with a colposcope provides the possibility of finding bluish or reddish foci on the cervix or on the back surface of the dome of the vagina.
- Clinical examination usually causes tenderness on palpation of the cervix.
- Hysterosalpingography (X-ray of the uterus and fallopian tubes) performed by a radiologist at the beginning of the menstrual cycle can show adhesions around the fallopian tubes.
- Abdominal ultrasound (with a full bladder) and transvaginal ultrasound (with an empty bladder) allow finding ovarian cysts (larger than 3 cm).
Quite often, it is difficult to make a differential diagnosis from functional cysts.
Endometriosis can only be diagnosed by laparoscopy after a histological examination of the tissue (performed in an operating theater using general anesthesia in the context of same-day or one-day admission to hospital).
In addition, the degree of spread of endometriosis can be determined and the disease can be immediately treated surgically.
Other tests such as magnetic resonance imaging may be performed to more accurately locate the endometriosis.
TREATMENT – TREATMENT
Treatment for symptomatic endometriosis is mainly aimed at relieving the symptoms as well as reducing the possibility of recurrence or progression of the condition.
Even in case of effective treatment \, in 20% of patients the endometriosis can recur and appear in the same form as initially diagnosed or in some other form.
The treatment can be done:
- with drugs that interrupt the hormonal stimulation of the endometrium
- surgery at the same time as the diagnostic laparoscopy with the aim of eliminating and removing endometriosis foci from all the places where it is located (especially in cases of infertility)
- with a combination of the two previous therapeutic methods.
The choice of treatment method depends on factors such as the existence of infertility, the age of the patient and the severity and extent of the disease.
Medication usually lasts 3-6 months.
In cases of infertility and in advanced stages of the disease, it may be necessary to resort to in vitro fertilization.
