Contents
Why is endometriosis so often referred to in connection with infertility? How to catch endometriosis symptoms that are almost indistinguishable from menstrual symptoms? And is non-surgical treatment of endometriosis possible? We will answer these and other questions related to endometriosis with the help of leading experts!
Menstruation, accompanied by severe pain, should alert a woman, as this may be one of the signs of the development of endometriosis. True, the disease can be asymptomatic. As a result, the woman does not receive the necessary treatment, endometriosis progresses and can lead to infertility.
Endometriosis: the causes of the disease and the main symptoms
Today, and these data are absolutely reliable, in the world about 16% of women of reproductive age suffer from endometriosis. A frightening figure! Among all gynecological pathologies, this disease is among the top three along with inflammatory diseases and uterine myoma, leading to significant reproductive disorders, persistent pain syndrome and infertility.
Endometriosis used to be called nun’s disease because the disease was most common in women who had never had sex. And now the symptoms of endometriosis are diagnosed even in very young girls. According to the results of a study by the International Association of Endometriosis, in which 40000 sick women took part, 50% of respondents showed the first signs of the disease before the age of 24 years, in 21% – before 15 years, in 17% – between 15-19 years.
In essence, endometriosis is a benign proliferation of tissue, similar in properties to the endometrium – the layer lining the uterine cavity.
Alexander Popov, Doctor of Medical Sciences, Professor, Director of the Moskvorechye Medical Center, Head of the Department of Endoscopic Surgery of the Moscow Regional Research Institute of Obstetrics and Gynecology:
“During menstruation, in almost most healthy women, menstrual blood flows outside the vagina. Also, blood is thrown into the abdominal cavity through the fallopian tubes. Normally, these brought in endometrioid cells must be killed by killer cells that are in the body of every person. But for some reason this does not happen. This is how endometriosis begins. “
And then the endometrial cells with the blood flow are carried throughout the body and develop in places where they should not be. For example, in the fallopian tubes, ovaries, intestines, kidneys, peritoneum and other organs.
Having attached themselves to an atypical place, the endometrial cells begin to perform the same functions as in the uterus, that is, to menstruate. These bleeding leads to inflammation in the surrounding tissues, the formation of adhesions, which contributes to the appearance of the main symptoms of endometriosis:
pulling pain in the lower abdomen and in the lumbar region throughout the month, worsening on the eve of menstruation;
pain during intercourse (dyspaurenia);
bloody spotting, dark “chocolate” color before and after menstruation;
prolonged and profuse bleeding during menstruation;
insomnia, headaches, nervousness, mood deterioration, decreased performance.
In some cases, the first and only symptom of endometriosis is infertility. About a third of women with endometriosis cannot get pregnant. The resulting adhesions disrupt the patency of the fallopian tubes and the anatomy of the small pelvis, and also interfere with the normal ovulation of the ovaries.
There are many theories for the occurrence of endometriosis, but none of them has been proven. The background for the development of the disease can be frequent infectious diseases in childhood, hormonal disorders, inflammation of the appendages. The “starting point” for the development of pathology can be abortion or diagnostic curettage. Recently, genetic factors have become increasingly important.
According to Alexandra Popova, science has proven that unfavorable environmental factors, for example, poor ecology, can provoke the development of endometriosis. That is, the pathological process has not yet started, and if there were no harmful effects, and this enhances the proliferative activity of endometrioid cells (their multiplication by division), then the woman would not get sick with endometriosis.
Endometriosis: diagnostic methods
The insidiousness of endometriosis is that it still needs to be detected. There are many forms of the disease, the manifestations are varied, which complicates the diagnosis. A gynecological examination and a questioning of a woman at a doctor’s appointment only suggest the presence of a disease. With the help of ultrasound, it is also not always possible to diagnose the disease. For example, with the initial degree of endometriosis, when there are few foci of the disease.
The most reliable method for diagnosing endometriosis is laparoscopy – examination of the pelvic organs using a special instrument – a laparoscope, which is inserted through a small incision on the anterior abdominal wall. During the examination, the surgeon can take a piece of tissue and send it to the laboratory for further analysis.
Today, surgery remains the main treatment for endometriosis. Laparoscopy is most often used to remove foci of the disease. As a rule, the operation is performed for chronic pelvic pain (pain in the lower abdomen) and infertility, as well as for the formation of endometrioid ovarian cysts.
So, the main thing that should alert a woman if endometriosis is suspected is the cyclical nature of severe pain during menstruation. In severe cases of the disease, pain can also be chronic. And here both the activity of the woman herself and the professionalism and attentiveness of the doctor are important.
According to an international survey, in which 14000 women aged 16-45 from 13 countries took part, 80% of women suffering from painful menstruation do not associate unpleasant sensations with any disease and simply take painkillers. While endometriosis is found in 75% of women who visit specialists for pain in the lower abdomen.
Surprisingly, doctors sometimes do not attach much importance to this main symptom of endometriosis and do not prescribe adequate treatment on time.
Endometriosis: the treatment is simple and complex
Today, surgery remains the main treatment for endometriosis. As a rule, laparoscopy is used to remove foci of the disease.
Other types of technologies are also used (laser, electrical, cryo-, ultrasonic and plasma). However, during surgery, especially with advanced endometriosis, only visible and accessible foci are removed, and microscopic ones can go unnoticed. This can lead to further relapses of endometriosis.
As a rule, the operation is performed with chronic pelvic pain (pain in the lower abdomen) and infertility, as well as with the formation of endometrioid ovarian cysts – one of the most dangerous types of disease for women. The fact is that several surgical interventions on the ovaries reduce the number of eggs in a woman that can be used for fertilization. Thus, the chances of getting pregnant on their own and giving birth to a biologically native child are reduced.
When sending for an operation, not all doctors, unfortunately, take care of a woman’s reproductive potential. But several operations on the ovaries may well lead to the fact that at the age of 30 a woman comes to menopause. It is sterile, since the entire egg supply has been destroyed during surgery. That is why it is very important to consult a reproductive specialist before the operation, who can “preserve” the eggs for use in the IVF program (if necessary).
The good news is that if the disease is detected early, surgery may not be necessary. You can stop the development of endometriosis and relieve pain with drugs. For example, as is widespread in France, where hormonal contraceptives are prescribed as the first line of treatment for endometriosis, which introduce the body into a state of pseudopregnancy.
One of the effective methods of drug treatment of endometriosis is the appointment of hormonal contraceptives, which suppress the menstrual function of a woman, as a result of which the growth and spread of endometriotic foci stops. The disease does not develop.
Actually, the best treatment for endometriosis is pregnancy and cessation of menstruation. Against this background, the risk of developing the disease is zero. However, a modern woman plans her life herself and it is impossible to force her to be always pregnant, so contraceptives in this case are the only alternative. It is important that the course does not need to be interrupted, it is better to take the drugs for a long time, since the peaks that occur when the drug is canceled are very risky with a sharp increase in the disease.
In addition, drug treatment is used after surgical confirmation of endometriosis and removal of visible foci of the disease – as prevention of its recurrence, as well as for the treatment of relapses to reduce the risk of reoperation.
Hormonal contraceptives are not a sentence, as many believe. It is a safe and effective treatment for endometriosis. The main thing is to choose an individual course of therapy together with a doctor.
Vera Vyacheslavovna Korennaya, Candidate of Medical Sciences, Associate Professor of the Department of Obstetrics and Gynecology of the Russian Medical Academy of Postgraduate Education, Leading Gynecologist of the Swiss University Clinic:
“It is important to understand that endometriosis is a chronic disease, it cannot be completely cured, but modern medicine is able to offer a woman adequate therapy that will stop the development of endometriosis, relieve the main symptoms of the disease, postpone surgery or completely abandon it. And the most important thing is to preserve a woman’s reproductive function and give her the opportunity to become a mother without resorting to assisted reproductive technologies. “
Interview
Do you experience severe pain in the lower abdomen during your period?
Yes, during menstruation it is the lower abdomen that hurts me very much.
I feel pain and discomfort, but not much.
My lower back hurts a lot, but not my stomach.
I do not experience any painful sensations at all during menstruation.