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It can appear at any age. One of the main symptoms is pain.
In 2010, it was found in over 176 million women worldwide, including 10-15 percent. in childbearing age. So it is more common than AIDS or cancer.
Incredible as it sounds, in the case of endometriosis, microscopic fragments of the lining of the womb (endometrium) can travel throughout the body. They travel to other parts of the body through blood vessels (arteries or veins) or lymph vessels. Thus, endometrial cells can implant anywhere. They most often settle in the fallopian tubes, on the surface of the ovaries, in the intestines, bladder or pelvic wall, and sometimes in the pleura, airways and nervous system. These fragments respond to the monthly changes in hormones in a woman’s body, growing and bleeding during each cycle. As the blood does not drain out (as it does in the uterus), this leads to inflammation and scarring of the tissues.
The causes of endometriosis
Although endometriosis has been known for over a hundred years, it is still not fully known what causes it. It is presumed that a risk factor is a family history of this disease, early onset of the first menstruation (at the age of 10-11), a monthly cycle of less than 28 days, bleeding for more than one week, the first pregnancy after the age of 30, use of hormonal drugs ( estrogens and progestagens), anatomical structure or past inflammation of the reproductive organ.
Symptoms of endometriosis
Extravasation of blood, inflammation and adhesions cause pain: during menstruation (about 78% of sick women suffer from them, in the lower abdomen (38%), during sexual intercourse (32%). Another symptom is fatigue, ovulatory pains, pains in the intestines, bladder pain with periodic haematuria, abnormal vaginal bleeding, heavy menstruation with clots, rectal bleeding.
Due to the multitude of clinical symptoms accompanying endometriosis, the disease is often confused with:
– inflammation of the appendages,
– cysts,
– ovarian tumors,
– ectopic pregnancy, ovulation pains,
– inflammation of the urinary bladder,
– urinary tract infections,
– urolithiasis,
– irritable bowel syndrome,
– inflammation of the appendix.
Therefore, it takes about 5-8 years to correctly diagnose the disease after the first symptoms of the disease appear.
Disease detection
According to the latest findings, a thorough medical interview is very important, as well as a gynecological examination: through the vagina and rectum, transvaginal ultrasound. In some cases, when rectal bleeding occurs, colonoscopy or transrectal ultrasound is necessary.
Some patients (28%) diagnosed with endometriosis have elevated serum Ca 125 tumor marker. Usually, its increase occurs in the case of fibroids, ovarian cancer, as well as during pregnancy during menstruation and in inflammation of the small pelvis. Therefore, in the latest diagnostics of endometriosis, doctors check the level of the tumor marker Ca 125.
Treatment of endometriosis
It consists mainly in combating pain. They are administered non-steroidal anti-inflammatory drugs (NSAIDs), DTA (combined birth control pills) – mostly low-dose. A gonadoliberin GnRh antagonist is also used, this drug causes anovulation and inhibition of menstruation, which positively affects the reduction of symptoms related to the occurrence of endometriosis. An effective therapy is the intrauterine administration of levonorgestrel, which causes endometrial atrophy and amenorrhea in approximately 60% of patients. female patients.
The progestogens used in the treatment of endometriosis (the newest being Dienogesten) act directly on endometrial cells and reduce their activity.
Sometimes incorrectly located fragments of the mucosa are removed surgically or with a laser. Sometimes it is necessary to remove the uterus.
Fertility disorders as a complication of the disease
A serious complication of endometriosis is fertility disorders – they occur in over 80% of people. women. Difficulties with getting pregnant and possible infertility associated with endometriosis are caused by damage to the fallopian tubes and ovaries as a result of chronic inflammation and the formation of adhesions within them.
Late diagnosis, poorly treated or untreated disease may lead to intestinal perforation, which is very life-threatening.
Text: Hanna Mądra