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– It is not true what grandmothers used to say to their grandchildren that if you are a woman you must suffer. When menstrual complaints force you to use painkillers, you need to consult a gynecologist, because it may be a symptom of endometriosis – says Prof. Krzysztof Szyłło head of the Surgical Gynecology Clinic of the Polish Mother’s Memorial Hospital – Research Institute in Łódź.
Halina Pilonis: – Most women suffer during menstruation and therefore do not go to the doctor.
Prof. Krzysztof Szyłło: – And this is a mistake. It is not true what grandmothers used to say to their grandchildren that if you are a woman you must suffer. When menstrual complaints force a woman to use painkillers, she should consult a gynecologist as such pain may be a symptom of endometriosis.
– How else is endometriosis manifested?
– Apart from painful menstruation, this disease sometimes causes pain during intercourse, during bowel movements or when urinating. Moreover, it is often manifested by heavy menstrual bleeding, vaginal spotting before or after intercourse, and sometimes also during urination. Symptoms may also include low back pain, persistent diarrhea or constipation, fatigue. Symptoms usually begin right before and during your period. Inability to get pregnant can also be caused by endometriosis.
– Do many women ignore these symptoms and see a doctor with an already advanced disease?
– Unfortunately. It takes even 10 years from the first symptoms to be diagnosed. For example, if endometriosis affects the ovaries, a cyst may form during this time and some patients may need to have the entire ovary removed, which may lead to problems with pregnancy in the future. Therefore, the sooner we start treatment, the lower the risk of such serious complications. I would like to express my great joy that during the XXXI Congress of the Polish Gynecological Society held in Katowice, apart from many problems that are extremely important for women’s health and life, endometriosis occupies one of the leading places, as several sessions will be devoted to this subject. We will be able to share the latest research results in the diagnosis and therapy of women, the more so that for a year now a new drug has been reimbursed for the treatment of ailments related to this disease. Such a rich program of the Congress will result in increased awareness of the disease among gynecologists, and thus faster diagnosis and more effective treatment. The conclusions of the proceedings should also reach the society, especially women, and make them sensitive to the first disturbing symptoms.
– What time of ineffective efforts for a child should force a woman to see a gynecologist?
– Until not long ago, people were talking about two years. Today, the recommendations require starting diagnostics after one year. It is a pity for valuable reproductive time. In addition, untreated and developing endometriosis reduces the chance of a baby.
– Medicine cannot cure endometriosis completely. Do we know the cause of this disease?
There are many theories trying to explain the mechanisms that trigger endometriosis, but none explains all the details. One of them tells about the passage of menstrual contents into the peritoneal cavity. However, many women do, and not all develop endometriosis. Immune system disorders are one of the causes of the disease.
– How many women are affected by this disease?
– In the population of women of childbearing age, 5 to 10% suffer from endometriosis. It must be remembered that the disease can develop even in adolescents. If we narrow this group down to women receiving treatment for infertility, endometriosis may be as high as 50%.
– The disease is difficult to diagnose and treat.
– There is no single test that clearly shows endometriosis. In the first stage of diagnostics, the doctor should interview the patient in detail, as the presence of characteristic symptoms may suggest endometriosis. Then you will need a gynecological examination and ultrasound examination. Often, the doctor will also order blood tests. However, the most reliable method for diagnosing the disease is laparoscopy and performing a biopsy of the changed tissue.
– How is this disease going?
– There are three forms of endometriosis. The first is the formation of endometrial foci on the peritoneum, the second is the ovarian changes, and the third is deeply infiltrating endometriosis.
– Is it true that pregnancy heals this disease?
– No, but the pregnant woman’s hormonal status stops the progression of the disease. In the case of less advanced endometriosis after pregnancy, a reduction in symptoms can be expected. Although the disease tends to renew itself.
– How is endometriosis treated?
– Treatment of endometriosis depends on the stage of the disease, the patient’s age, the severity of symptoms and problems with becoming pregnant. There are two basic methods: surgical, which means removing endometriosis foci, and conservative, which means administering hormonal drugs. The younger the patient is, i.e. the lower the advancement of the disease, the greater the chance of a less radical surgery. Many scientific societies recommend that patients whose doctor suspects endometriosis based on their medical history should start hormonal treatment. And such conduct may cause the symptoms to subside. However, it is often necessary to use both methods simultaneously, because surgical procedures, during which the doctor removes endometriosis foci, removes cysts or adhesions, are sometimes ineffective and the disease recurs after several years. The hormonal treatment used may lead to the disappearance of endometrial foci.
– When should a doctor suggest laparoscopy?
– When the attempt of hormonal treatment does not eliminate pain or when the patient does not become pregnant.
– Can we talk about the prevention of this disease?
– The most important thing is the awareness of women that endometriosis should be diagnosed and treated as early as possible. We should also remember that physical activity and maintaining a healthy body weight are allies in the fight against this disease. Regular visits to the gynecologist are also important. During follow-up visits, we perform a Pap smear and breast examination, but you should also ask about any pain symptoms.
Text: Halina Pilonis