Endometriosis is a chronic gynecological condition where tissue similar to the lining that normally lines the inside of the uterus (the endometrium) develops outside of it. This ectopic tissue can be found on the ovaries, fallopian tubes, the outer surface of the uterus, the peritoneum, or even in more distant areas such as the bowel or bladder.
1. Mechanism and location:
- Abnormal growth: Endometrial tissue outside the uterus reacts in the same way as endometrial tissue inside. It thickens, breaks down, and bleeds with each menstrual cycle.
- Inflammation and pain: Unlike normal tissue, displaced endometrial tissue cannot be flushed out of the body. This leads to inflammation, the formation of cysts, scars (adhesions) and often pain.
- Common location: The most commonly affected areas are the ovaries, fallopian tubes, the ligaments that support the uterus, and the outer surface of the uterus. Less commonly, endometriosis can affect the bowel, bladder, or other organs in the pelvis.
2. Symptoms:
- Pelvic pain: This is the most common symptom. The pain is often severe, especially during menstruation (dysmenorrhea), but can also occur before and after menstruation, during ovulation, or during sexual intercourse (dyspareunia).
- Heavy and irregular periods: Affected women may have heavier menstrual bleeding or irregular periods.
- Infertility: About 30-40% of women with endometriosis may experience difficulty conceiving. Endometriosis can affect fertility by damaging the fallopian tubes or impairing ovulation.
- Fatigue: Chronic fatigue is common in women with endometriosis.
- Other symptoms: Endometriosis can also lead to gastrointestinal symptoms such as diarrhea, constipation, bloating, and pain during bowel movements or urination, especially during menstruation.
3. Causes and Risk Factors:
- Exact unknown causes: The precise cause of endometriosis is not well understood, but several theories exist:
- Retrograde menstruation: One theory suggests that during menstruation, blood containing endometrial cells flows back into the fallopian tubes and into the pelvic cavity, where these cells implant and proliferate.
- Cell transformation: Some cells in the pelvic cavity could turn into endometrial cells.
- Immune and genetic factors: Immune system abnormalities and genetic predisposition may play a role.
- Risk factors:
- Family history: Having a mother or sister with endometriosis increases the risk.
- Short menstrual cycles: Cycles of less than 27 days with heavy and prolonged bleeding increase the risk.
- Early onset of menstruation: Starting your period at an early age is also a risk factor.
4. Diagnosis:
- Clinical Assessment: Diagnosis begins with a symptom review and physical exam, including a pelvic exam.
- Medical imaging: Pelvic ultrasound and magnetic resonance imaging (MRI) can be used to visualize cysts or other abnormalities associated with endometriosis.
- Laparoscopy: This is the most definitive method of diagnosis. It involves inserting a thin tube with a camera into the abdomen to directly view endometrial tissue outside the uterus and possibly remove samples from it for a biopsy.
5. Treatment:
- Medicaments:
- Analgesics: To relieve pain, nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen are often prescribed.
- Hormonal therapies: Hormonal contraceptives, GnRH agonists, progestins, and progesterone-based intrauterine devices (IUDs) can reduce or eliminate menstruation, which helps decrease the symptoms of endometriosis.
- Surgery:
- Laparoscopy: To remove endometrial implants, adhesions, and cysts, especially in women with severe pain or infertility.
- Hysterectomy: In severe cases where other treatments have not worked, a hysterectomy (removal of the uterus) may be considered.
- Long-term management:
- Regular follow-up: Endometriosis is a chronic condition that often requires ongoing management. Regular follow-up with a health professional is essential to adapt the treatment.
- Psychological support: Due to the impact on quality of life, psychological support or therapy may be beneficial.
6. Impact on quality of life:
Endometriosis can have a significant impact on the quality of life of women who suffer from it, due to chronic pain, fertility challenges, and effects on daily activities and professional life. Medical and psychological support is essential to help manage this condition.
In summary, endometriosis is a complex disease that requires a multidisciplinary approach to its diagnosis and treatment, with options tailored to the individual needs of patients.
