Endometriosis – symptoms, treatment, diet, causes [WE EXPLAIN]

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Endometriosis, or heterotopic location of the uterine mucosa, is a troublesome, long-lasting and not entirely clear phenomenon. Despite many years of research and rapid progress in science, the etiopathogenesis of the disease remains unclear. We know, however, that the phenomenon of endometriosis affects about 10 percent. women. What are the symptoms of endometriosis and available treatments? How is the disease related to the diet?

Possible problems with the endometrium are a common cause of infertility. A special type of endometrial disorder is its growth outside the uterine cavity. This phenomenon is known as wandering endometrium – this is endometriosis.

The causes of endometriosis

Normally, the lining called the endometrium is located only within the uterine cavity, and wherever it occurs, it is a disorder. There are many theories about the causes and mechanisms of endometriosis, but none has been definitively and unquestionably accepted. For over 140 years, scientists have been studying how uterine cells appear in places sometimes as distant as the lungs. Among the reported cases, endometrial cells in the central nervous system have also been documented.

The underlying theories can be divided into three groups:

1. the theory of transplantation assuming the movement of menstrual blood through e.g. fallopian tubes to the peritoneal cavity, i.e. retrograde menstruation;
2. the theory of metaplasia, in which undifferentiated cells are attributed the ability to transform into endometrial cells under the influence of various factors;
3. induction theories linking elements of the above-mentioned hypotheses.

The influence of both genetic factors and the activity of the immune system seems to be significant, as its failure may be very important in the development of endometriosis. Unfortunately, despite many years of research and significant progress in science, the etiopathogenesis of the disease remains unclear.

Endometrial cells in some cases go to places even more distant from the genital system, in extremely rare cases even to the lungs or the brain.

Types and types of endometriotic changes

We distinguish the following types of endometriotic changes:

1. Deep infiltrating endometriosis – these are complex thickenings, in which there is endometrial, fatty and fibrous-muscular tissue.
2. Endometrial cysts- another name is chocolate or tar cysts. The walls of these cysts are lined with the endometrium, which exfoliates with the blood each month and becomes trapped within the cyst. This situation makes it look like tar or chocolate.
3. Superficial implants on the peritoneum and ovaries.

What are the characteristics types of endometriotic changes?

1. Adenomyosis -endometrium is located within the uterine muscle.
2. Caesarean scar endometriosis – an endometriosis focus located in the cutaneous scar after surgery. The incidence of caesarean section scar endometriosis is estimated at 0,03-0,4 percent. cases and so far it is not a high percentage, but taking into account the growing number of procedures performed, an increase in the frequency of this disease should be expected.

In the premenstrual period, the endometriosis area becomes swollen and sore. Any further enlargement during the menstrual period is due to the collection of blood and the inability to remove it, which causes additional pain due to pressure on the surrounding tissues. Therefore, a characteristic symptom is cyclical pain that occurs before and during menstruation.

Different location of endometriosis foci causes a wide range of symptoms, which may include:

1. pain during sexual intercourse;
2. chronic pelvic pain;
3. ovulatory pain;
4. chronic fatigue;
5. there may be less spotting or bleeding outside of the menstrual period, or excessive menstrual bleeding;
6. in the case of a bullous or intestinal form, hematuria or gastrointestinal bleeding may occur.

It should be emphasized that the intensity of pain often does not reflect the size or severity of endometriosis. It happens that endometriosis can also cause pain in the area of ​​the back (loins), or even pain in the thighs.

In many cases it is also observed asymptomatic course of endometriosis. If we are dealing with this form of disease, it is possible to detect it by accident. The absence of symptoms of ednometriosis does not mean that the disorder has no negative effects. The disease may be accompanied by fertility problems. Therefore, women who cannot become pregnant should be screened for endometriosis.

Endometriosis in the fallopian tubes – symptoms

Infertility is the most common symptom of endometriosis in the fallopian tubes. However, it should be remembered that not every woman with endometriosis has problems conceiving. Infertility is most often seen in the group of women in whom the disease affects the ovaries and fallopian tubes, causing adhesions. Adhesions close the path for the egg from the ovary, through the funnel of the fallopian tube, to its bulb, where it usually meets the sperm and fertilizes it. In such a situation, doctors recommend trying for a baby as soon as possible, as adhesions may increase in size. Symptoms of endometriosis lessen after pregnancy and disappear completely during the menopause.

Endometriosis can also cause other unpleasant ailments:

1. heavy menstruation;
2. constipation;
3. flatulence;
4. diarrhea;
5. nausea;
6. weakness of the body;
7. strong PMS;
8. gastrointestinal bleeding;
9. hematuria.

U women with endometriosis autoimmune diseases can also occur: systemic lupus (SLE), Sjögren’s disease, hypothyroidism, multiple sclerosis, rheumatoid arthritis (RA), as well as allergy and asthma.

Endometriosis – complications

Unfortunately, a complication of endometriosis, in addition to the pain syndrome, may be impaired female fertility, which is a result of the disease’s influence on many functions of the sexual organ. The consequence of inflammatory processes and changes in the area of ​​endometriosis foci are adhesions, often extensive, involving various organs, e.g. fallopian tubes.

Impaired mobility and patency of the fallopian tubes are not the only causes that can lead to infertility. It also includes disturbed hormonal production of the ovaries or abnormal immune responses within the uterine mucosa itself, preventing the proper implantation of the embryo. Miscarriages are significantly more common in these women. Their percentage reaches up to 40 percent. compared to 15-20 percent. in the entire female population.

Endometriosis increases the likelihood of miscarriage in the first trimester of pregnancy. Other possible complications of endometriosis in pregnancy is premature labor, as well as the occurrence of postpartum hemorrhage. Due to the increased risk of complications, frequent check-ups are necessary. Although the symptoms of endometriosis become milder in pregnant women, they worsen again after delivery.

1. Read more: How to recognize a miscarriage? Symptoms of miscarriage

It is not only fertility problems and pregnancy problems that result from endometriosis. Due to the fact that the disease is progressive, with time it leads to more and more severe destruction of the organs it affects. Recurrent and chronic inflammation contribute to irritation and anatomical changes, e.g. within the peritoneum. Endometrial cells in undesirable places such as the intestines cause adhesions to form, obstruct the intestines and disturb their peristalsis.

Endometriosis – difficult diagnosis

The stimulus to consider the presence of endometriosis are the patient’s complaints about cyclical permenstrual pain located in various places, most often in the small pelvis and / or problems with getting pregnant. A detailed medical history is very important, taking into account the presence of the above-mentioned symptoms. The next step is a clinical trial. It has already been mentioned that the location of endometriosis can be wide and may involve many different places, therefore, when looking for foci, a complete gynecological examination is necessary, including a thorough examination of the vulva and speculum examination of the genital tract.

Another element is the ultrasound examination, especially the vaginal and transrectal ultrasound. It is a way to detect endometrial cysts and other pathological changes characteristic of the disease. It is often useful to also perform other imaging tests, i.e. computed tomography or magnetic resonance imaging.

A key study in diagnosis of endometriosis is laparoscopy. It has both diagnostic and therapeutic significance. In specific cases, the doctor may also order a colonoscopy or cytoscopy. Biochemical tests are also used, although to a much lesser extent. One of the markers assessed is the non-specific CA-125 antigen. Its elevated level is observed in endometriosis, but it is also a neoplastic marker, the level of which is very often elevated in patients with ovarian cancer.

1. See also: Cancer markers for women – help in cancer diagnosis

If your doctor diagnoses endometriosis, he or she can determine the severity of the disease based on the ASRM classification. It distinguishes four stages of disease severity – from minimal (grade I) to severe (grade IV).

Endometriosis – treatment

Treatment of endomeriosis can be divided into surgical, pharmacological and combined treatment, and the choice of method depends on many elements, such as:

1. the age of the sick person;
2. desire to become pregnant;
3. the advancement of the disease;
4. worsening of symptoms;
5. location of disease outbreaks;
6. reaction to previous treatment.

The choice of procedure and its scope is difficult and it is always necessary to consider all the advantages and disadvantages of a given method and choose the best possible one for each patient.

1. Surgical treatment is divided into conservative and radical, depending on the scope of the surgery. The operation may involve removing only the foci and / or endometrial cysts, the entire ovary or even the uterus with appendages, which is a final and complete treatment. Operations are performed laparoscopically more and more often. The aim is to eliminate all visible endometriotic changes and adhesions, restoring the correct anatomical conditions.
2. Pharmacological therapy includes hormonal treatment and symptomatic treatment, mainly analgesic. Hormone therapy is aimed at suppressing the hormonal activity of the ovaries, which is to lead to the disappearance of ectopic endometrial foci. The main indications for hormone therapy are inoperable forms of endometriosis, insufficient surgery or recurrence of symptoms and recurrences. There are many groups of drugs that work at different levels of hormonal processes, and the choice should be made based on the individual needs of the woman and possible side effects of treatment.

A highly effective method of treating endometriosis has not yet been developed. In most cases, treatment is limited to relieving symptoms and inhibiting disease progression. Even with good results of therapy, recurrence of ailments is likely. The most invasive surgical intervention, that is, removal of the ovaries and uterus, leads to surgical menopause. This allows for effective elimination of symptoms, but not in all cases. Even a dozen or so percent of patients may still experience pain after this procedure.

Endometriosis – pharmacological agents

For starters, it is worth mentioning that hormone therapy is pointless when a woman is sterile! Hormones do not cure infertility.

1. Non-steroidal pain relievers such as ibuprofen.
2. Progestogens – have similar properties to DTA, they are not reimbursed.
3. Combined contraceptive pills (DTA), containing an estrogen and progestogen component. Recommended very often because they are effective and cheap. They completely inhibit the cycle, so the ovaries stop secreting estrogens and progesterone, and thus irritate the endometriotic foci. After discontinuation of the tablets, the cycle returns to its previous state.
4. Danazol – inhibits hormones produced by the ovaries, but carries many side effects, such as weight gain, water retention, high cholesterol, lowering good cholesterol.
5. Gonadoliberin (aGnRH) analogs, such as buserelin, nafarelin or goserelin, inhibit the ovaries. They are good at relieving endometriosis pain, but can have serious side effects: osteoporosis. It is not recommended to use them for a long time.
6. Aromatase inhibitors, reducing the conversion of androgens into oestrogens, i.e. anastrozole, letrozole.

Although endometriosis is a mild disease (because only a small percentage of the lesions become malignant), it is an extremely onerous disease. The diagnosis of endometriosis poses many difficulties, and the final outcome may be a laparoscopic and histopathological examination. Treatment does not always bring the expected results and, unfortunately, relapses are often observed. Despite many studies on the mechanisms of its formation, theories continue to grow without a definitive explanation of what makes endometriosis a cumbersome, long-lasting and still enigmatic phenomenon.

Endometriosis a dieta

Contrary to appearances, endometriosis has a lot to do with diet. What foods we eat can affect inflammation, the immune system and smooth muscle contractility. For this reason, diet is of great importance as a factor contributing to the alleviation of pain associated with endometriosis. Omega-3 fatty acids, which are found in, for example, walnuts, tuna or salmon, have a beneficial effect on the woman’s body. These products can even reduce the risk of developing endometriosis.

What is worth eating:

1. products containing antioxidants – help build the body’s immunity and maintain hormonal balance. We find antioxidants mainly in vegetables and fruits;
2. Brown rice;
3. apples;
4. lettuce;
5. turnip;
6. rhubarb;
7. carrot;
8. fatty fish;
9. Italian nuts;
10. Linseed;
11. olive oil;
12. linseed oil;
13. coarse-grained groats.

In addition, it is beneficial to take the following vitamins:

1. vitamin A – is involved in the formation of reproductive cells and has an anti-inflammatory effect. Taking it lowers the risk of endometriosis.
2. vitamin D – regulates cells of the immune system and regulates calcium homeostasis. Studies have shown that increased vitamin D intake lowered the incidence of endometriosis.
3. vitamin C – in addition to having a beneficial effect on the immune system, it regulates the level of the stress hormone and has antiviral and antibacterial properties.
4. vitamin E – studies have confirmed the effect of vitamin E levels on the reduction of the risk of endometriosis. Women with dysmenorrhea consuming vitamin E had shorter periods and less menstrual pain.

What is worth giving up / reducing to a minimum:

1. Red meat;
2. coffee;
3. fruit pesticides;
4. full-fat dairy products;
5. alcohol;
6. processed products;
7. white sugar;
8. if;
9. carbonated drinks;
10. black / red tea;
11. bread / wheat products;
12. animal protein.

Research by scientists shows that eating plenty of fresh fruit and green vegetables is associated with a 40 percent decrease in the risk of endometriosis. A comparative study of the eating habits of northern Italian women was conducted in 504 women with endometriosis and a control group. The risk of developing endometriosis has been shown to vary with diet. The risk was reduced by 70% in the surveyed women. in the group eating green vegetables, by 40 percent. among women who eat fresh fruit.

Bibliography:

1. Basta A, Brucka A, Górski J et al .; Team of Experts of the Polish Gynecological Society: Position of the Expert Team of the Polish Gynecological Society on the diagnosis and treatment methods of endometriosis. Ginekol Pol 2012; 83: 871-876.

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