Is it endometriosis? The gynecologist suggests

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– If you develop severe abdominal pain a few days before your period, you may start to suspect endometriosis. In some women, the disease manifests itself as premenstrual constipation and even bloody stools. And if it attacks the fallopian tubes, it often leads to infertility – says Dr. Tomasz Basta, gynecologist from Intima Clinic in Krakow. How to recognize and treat endometriosis?

1. There is a lot of talk and writing about endometriosis, unfortunately the information that appears on the Internet is often contradictory. That is why many women are confused when they suspect this disease
2. We all know that endometriosis is accompanied by pain. But almost every woman experiences pain before and during menstruation. – A disturbing signal is when severe pains appear a few days before menstruation – says Dr. Tomasz Basta, gynecologist at the Intima Clinic in Krakow.
3. Advanced and minimally invasive surgeries are now helping to fight the disease. – Unfortunately, endometriosis cannot be completely cured. The disease stops developing when ovulation stops. Fortunately, women today no longer have to wait for menopause to feel relieved. For several years, hormonal drugs have been available especially for patients with endometriosis – says gynecologist Tomasz Basta

Endometriosis is a condition that affects only women. It is caused by the fact that the tissue that lines the uterus, the so-called endometrium, implants and begins to develop elsewhere in the woman’s body – outside the uterine cavity. And it responds to the hormone cycle, so it exfoliates and bleeds – just like the uterus itself does during the menstrual cycle. The vast majority of women know very well how unpleasant and troublesome menstrual cramps can be. Their intensity varies widely, but those related to endometriosis are much more burdensome. So much so that they simply prevent the patient from living normally for a while. Apart from pain, there are also many other symptoms that indicate this ailment. What kind?

What might indicate endometriosis?

A woman may start to suspect endometriosis if she has severe pains a few days before menstruation, which is earlier than in a healthy and menstruating woman. – The non-pain symptoms of this disease are quite varied and are often associated with the location of endometriotic lesions. If endometriosis affects the fallopian tubes, infertility is often the result. If, on the other hand, the lesions are located near the intestines, then there are premenstrual constipation and even bloody stools – explains Dr. Tomasz Basta, gynecologist at the Intima Clinic in Krakow.

– There are also problems with painful premenstrual urination, when endometriosis is located close to the bladder and urethra – adds the doctor.

Women should watch their body carefully and carefully, paying attention to the signals it sends. It is important to be alert to any unusual pains in the abdominal area that we have not experienced before.

What causes endometriosis?

So far, specialists have been relying, unfortunately, mainly on assumptions. It seems most likely that the endometrium enters the abdominal cavity when it is difficult for menstrual blood to flow from the uterus into the vagina and then out. It can also be caused by various types of disturbances in the structure of the uterus.

Gynecologist Tomasz Basta talks about yet another type of ailment when it comes to the genesis of endometriosis. It is about endometriosis in the scars after cesarean section. – The endometrium may develop into scars following the procedure. This happens when, during stitching, the tissue that lines the uterus is inadvertently ‘pulled’ into the lining of the abdominal cavity. Such pathology in the cesarean scar is very painful for the woman and also requires removal – explains Dr. Tomasz Basta.

Does endometriosis affect fertility?

Unfortunately, endometriosis makes it very difficult to get pregnant. Paradoxically, it is pregnancy that can have a significant impact on slowing down the disease itself, even having a therapeutic effect on it.

Fertility problems in patients are the result of the formation of endometrial adhesions in the fallopian tubes, which causes their obstruction. This closes the way for the egg, so it does not fertilize or implant. Moreover, if endometrial changes occur in the genital area, especially in the ovary, inflammation develops in them, which also adversely affects the female fertility (it hinders the growth of ovarian follicles, causing degradation of the eggs). The disease also affects the hormonal balance, which – if it is disturbed – makes it difficult to get pregnant.

The patient’s fertility can be restored with the removal of the cyst. Unfortunately, when a patient decides to remove changes located in the ovary, she must be aware that the ovary will always be affected to some extent during the operation. As a result, it will weaken its functioning. A woman whose ovaries and fallopian tubes have been affected by endometriosis can only become pregnant if the ovary is not severely damaged. Thanks to this, he will still be able to produce eggs, endometriosis foci will be completely removed and the fallopian tubes will be opened.

Sometimes endometriosis is almost asymptomatic, and it turns out that a woman cannot get pregnant for unknown reasons. Then it is necessary to check whether this disease is not the cause of infertility. In addition, women suffering from this disease who want to have children in the future should decide to get pregnant as soon as possible. Then, when the outbreaks of the disease do not prevent it yet.

Is it endometriosis?

As soon as you notice the symptoms of the disease described above, you should first visit a gynecologist who should perform an ultrasound. As a rule, the disease can be pre-confirmed at this stage. The characteristic cysts filled with endometrial content are then noticeable. It is also necessary to test CA-125 (from blood). It is a neoplastic marker which may also be elevated as a result of the described disease. Although both of these help to check whether our assumptions are correct, the final diagnosis can be made only after a laparoscopic examination. The doctor then checks whether the cysts actually occur (and in what number). Then he removes them and submits to a histopathological examination to confirm whether we are actually dealing with endometrial changes.

How to fight endometriosis?

Although the current technology allows for the elimination of such pathologies in a less and less invasive way, unfortunately endometriosis cannot be completely cured. The disease stops developing in the body only when the ovulatory cycle stops, i.e. during the menopause. However, before this happens, we can try to stop or significantly slow down its further development.

For several years now, modern hormonal drugs have been available, designed specifically for patients with endometriosis

– They reduce the growth of the uterine mucosa, and thus also the size of endometrial cysts. Hormones contained in various types of intrauterine devices, vaginal rings, subcutaneous implants or tablets, i.e. hormonal contraceptives, also have a healing effect. It is because of the action of hormones that pregnancy has a beneficial effect on the disease. During this (as well as during breastfeeding) the ovaries do not produce estrogen (as in the menopause) and the disease is put into a state of dormancy. During this time, no new changes arise – the specialist explains.

However, it may turn out that hormone therapy is not enough and that surgery is needed. This is the case when a cyst has formed out of endometrial cells. As already mentioned, these types of lesions are now removed in a very advanced and practically non-invasive (laparoscopic) manner. Thanks to such equipment, the doctor can get inside the patient’s body through a few small, only a few millimeter incisions, see the organs on the monitor under magnification and perform the operation. The entire procedure is therefore minimally invasive, there are practically no complications after it, and even more importantly – it is very accurate and precise.

Bow. med. Tomasz Basta, specialist in gynecology and obstetrics. A graduate of the Collegium Medium of the Jagiellonian University, lecturer at the Polish Society of Plastic Gynecology (PTGP) and the Polish Society of Aesthetic and Reconstructive Gynecology. Author of many research and scientific publications. Founder of the Intima Clinic in Krakow (www.intimaclinic.pl), dealing in a holistic way with intimate health of women. The clinic specializes in gynecology and obstetrics procedures (including laser treatment of stress urinary incontinence, vaginal contraction), plastic gynecology, laser therapy, surgery, endocrinology, diabetes, angiology, dietetics, psychology and sexology.