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It occurs in every tenth woman of reproductive age. The World Bank has even estimated that 176 million women are struggling with it during the best years of their lives. What’s worse, in some of them the disease is not diagnosed and treated at all. What are we talking about? About endometriosis still not fully known to doctors.
The causes of endometriosis were first dealt with in 1927. It was then that JA Sampson published the results of his observations on the phenomenon of the retrograde transport of menstrual blood through the fallopian tubes to the peritoneal cavity, proposing that they were the cause of the formation of endometrial implants. Over time, however, along with subsequent research, many arguments refuting this thesis appeared. Even though it’s been years, doctors and scientists still don’t quite know why the mucosa that normally lines the walls of the uterus grows outside of it.
Mysterious disease
Today, endometriosis is called a hormonal and immune disease dependent on sex hormones. Presumed causes include increased estrogen sensitivity and / or progesterone resistance. It mainly affects women of childbearing age, but also affects over 30% of teenagers, mainly complaining of painful periods. The name endometriosis comes from the Latin word endometrium, which means the endometrium. This tissue, which lines the uterine cavity, grows and peels off every month during the menstrual cycle. In endometriosis, mucosal cells migrate and develop in other parts of the body – on the ovaries (endometrial cysts), the fallopian tubes, the walls of the vagina, bladder, large intestine, and even in the airways, forming specific types of growths, tumors and implants. Scientific reports describe women who suffered from persistent nosebleeds due to endometriosis. However, the primary symptom of the disease is pain. When it hurts more than usual
Pain is usually localized in the lower abdomen, begins even before menstruation and continues throughout the period of bleeding. Women who suffer from endometriosis say the pain is much stronger than normal contractions, and it often appears even after years of completely painless periods. When the endometrium covers the Douglas sinus, the vaginal-rectal septum or the sacro-uterine ligaments, women also experience pain during intercourse, although doctors note that their intensity does not have to be related to the degree of disease development. In addition, endometriosis is often manifested by heavy menstrual bleeding, vaginal spotting before or after intercourse, and sometimes also during urination (usually with pain). Symptoms of the disease may also include: painful bowel movements and low back pain, persistent diarrhea or constipation, fatigue. Symptoms of the disease usually appear just before your period, so keep a close eye on your body. Is something strange happening, hurting us more than usual? Let’s take a closer look at our body, especially since it is already known that many women with endometriosis also suffer from immunological diseases – allergies, asthma, eczema and struggle with infertility (20-50% of infertile women in the world have endometriosis). Recent studies also show that women and girls suffering from endometriosis are more likely to develop cancer, especially of the ovaries and breasts. And this is probably reason enough to fight pain not only with home methods.
Diagnosis? Difficult case
Unfortunately, there is no single test by which a gynecologist can tell if we have endometriosis. The disease can occur in different places, and while there are areas where it is more likely to occur (e.g., the ovaries), the doctor is often unable to locate all the lesions. So what to do? First of all, choose an experienced specialist who will not ignore our ailments, and then prepare for a detailed medical interview, incl. be able to describe and locate the places of pain and its intensity, bleeding time, additional symptoms of the disease, and even our well-being during menstruation. If the gynecologist suspects endometriosis, he will definitely perform a basic gynecological examination, and then vulvoscopy (non-invasive, painless examination of the genital epithelium – vulva, perineum, anus, etc.; vulvoscope is a stereoscopic microscope that allows you to view changes in magnification magnification) and an ultrasound examination. They may or may not be helpful in diagnosis. Therefore, the doctor often orders blood tests and determination of cytokines, hormones, immunoglobulins or glycoproteins, e.g. determination of CA 125 antigen, useful for the detection of third and fourth degree endometriosis. He may also recommend a cystoscopy, especially if he suspects endometriosis has attacked the bladder. However, the most reliable method for diagnosing the disease is laparoscopy and performing a biopsy from a sample of the changed tissue. This procedure is sometimes called “the only reliable test”, except that women are simply afraid of it because it is invasive. Therefore, at the beginning, it is worth looking for a doctor specializing in ultrasound. It is not without reason that gynecologists are increasingly boasting on the international forum that they are successful in correctly diagnosing the disease in this way.
Treatment methods
There are several of them – from the use of painkillers, including non-steroidal anti-inflammatory drugs, through hormone therapy to surgery. However, gynecologists emphasize that the method is always selected individually for the patient, and often combined therapies are used. Recently, the American Society for Reproductive Medicine even issued a message stating: “Endometriosis should be considered a chronic disease that requires a lifelong treatment plan to maximize drug treatment and avoid repeated surgery.” It turned out that surgical treatment, during which the doctor cuts out endometriotic lesions, removes cysts or adhesions, is often ineffective. Official data show that after a few years endometriosis recurs in 40–50% of patients. Therefore, hormonal therapies that inhibit estrogen synthesis and thus lead to the disappearance of endometrial “implants” are becoming more and more popular. The simplest method of treating pain with painkillers or non-steroidal anti-inflammatory drugs (NSAIDs) is now being abandoned. Reason? Side effects including stomach ulceration. In hormone therapy, gynecologists use e.g. progestogens, danazol, GnRH analogues and oral contraceptive pills. In each case, the side effects of the treatment are taken into account – weight gain, nausea, vomiting, headaches, problems with the digestive system, decreased libido, hot flashes. However, do not worry in advance when the doctor mentions them, because these effects may or may not occur. Every body reacts differently to drugs. It is only important not to ignore the symptoms and inform the gynecologist about them, especially if they persist for more than three months. Then the method will most likely need to be changed.
Relaxation – a way to health
Although endometriosis remains a challenge for scientists and doctors, women struggling with the disease increasingly find ways to deal with bothersome symptoms. In addition to pharmacological methods, they also use natural methods – antispasmodic herbs (Note! Always ask your doctor whether they can be combined with hormone therapy), exercise, yoga, dance and everything that relaxes them, and a proper diet (it has been proven that, for example, eating large amounts of fresh fruit and green vegetables is associated with a 40% decrease in the risk of endometriosis, while eating large amounts of red meat increases the risk by as much as 80%). When the impact of stress on a woman’s psyche and the incidence of intimate diseases and endometriosis were examined, it turned out that stressed women (among Polish women, they are 41–45 years old, with higher education and working in managerial positions) statistically more ill. That is why every gynecologist will tell us that in addition to starting treatment, it is worth doing everything to minimize stress and learn to relax. Let the “happiness hormones” that mobilize the immune system to fight disease do their job.
Disease degrees
Doctors distinguish four stages of endometriosis:
• Grade I – lesions less than 5 mm. In the fallopian tubes and ovaries there are non-vascular adhesions and free hyphae of the fallopian tubes.
• Grade II – initially the disease foci are less than 5 mm. In the fallopian tubes, non-vascularized adhesions and free hyphae of the fallopian tubes are observed, and in the ovaries, cysts smaller or larger than 5 mm (sometimes they rupture). With time, between the so-called wide ligaments and ovaries, adhesions appear. Strong adhesions that cannot be removed by endoscopy develop in the fallopian tubes. In the ovaries, there are adhesions with a broad ligament and lesions larger than 5 mm in diameter. Numerous foci of endometriosis are observed in the recto-uterine cavity.
• Stage III – the broad ligaments are in adhesions with the ovaries or fallopian tubes. Adhesions also occur in the hyphae of the fallopian tubes. There are no or present foci of endometriosis in ovarian adhesions. Numerous lesions in the recto-uterine cavity.
• Stage IV – the uterus is immobile, adnate in retroflexion, and filled with adhered intestine or displaced posteriorly. The intestines are in adhesions with the peritoneum of the recto-uterine cavity, the recto-uterine ligaments, or the endometrium. The appendix is affected by the disease process. There are foci of endometriosis in the bladder. (Based on data from www.endoendo.pl – the first portal about endometriosis.)
A complex problem
Gynecologists claim that endometriosis limits the ability of women to be fully active in life, impairs their professional functions and even in many cases prevents them from working. When the health care costs and loss of productivity associated with the disease in the United States were summed up, endometriosis was found to be a far more complex problem than previously thought. The costs were much higher than for Crohn’s disease or migraines.
Text: Anna Niewiadomska