What we know about endometriosis
ENDOMETRIOSIS: IS IT A DISEASE?
Endometrium is called the mucous membrane of the uterus which is connected with the hormone activity during the menstrual cycle. At the beginning of the cycle, the oestrogens secreted from the ovaries result in thickening of the endometrium whereas after ovulation the progesterone secreted from the corpus luteum enables implantation of the fertilized ovum. This limits further thickening of the endometrium before the appearance of the menstrual flux which is caused by a dramatic fall in oestrogens and progesterone. When the endometrium lies outside the uterine cavity the condition is called endometriosis. It is a frequent but benign disease which is often detected accidentally, though at times it can cause diverse and intense clinical symptoms.
WHAT IS THE CAUSE OF ENDOMETRIOSIS ?
During the menstrual flux the endometrium flows retrogradely from the uterus to the abdominal cavity via the fallopian tubes. In some cases the endometrium may implant in the peritoneum (a membrane in which the abdominal organs are enclosed) and spread to the superficial and deeper layers of the latter. Inability to shed the endometrium in this form leads to endometriosis.
APPEARANCE OF ENDOMETRIOSIS
Endometriosis appears whether in the form of multiple black or red spots, small in size or as adhesions (membranes binding organs with one another).
Areas of frequent appearance
- In the peritoneum
- In the ovaries where cysts of variable size are formed
- In the walls of the salpinges (fallopian tubes)
- Between urinary bladder and uterus
- Between uterus and rectum where endometrial tissue can implant deeply
On rarer occasions, endometriosis can appear in other organs (digestive tube, urinary bladder, skin, lungs, etc.)
The degree of endometriosis is positively correlated with the extension of the areas of the disease.
SYMPTOMS AND POSSIBLE INDICATIONS
PAIN: It can appear in various instances
- Dysmenorrhea: Pain not exclusive to endometriosis. It appears during menstruation and may progressively deteriorate towards the end of it.
- Dyspareunia: Pain during sexual intercourse. It is usually located in the deep part of the vagina and becomes more intense just before menstruation.
- Chronic pelvic pain: It appears in the abdominal area and deteriorates during ovulation and menstruation.
- Pain during intestinal evacuation.
- Dysuria: Painful urination. Pain is associated with peritoneal endometriosis which develops deeply and causes bleeding during menstrual flux.
Endometriosis is often associated with subfertility but it remains uncertain which one is the cause of the other. In subfertile women endometriosis is detected in about 30 percent of the cases, yet a lot of them have no clinical indication of endometriosis and the disease can only be detected by laparoscopy.
Other clinical symptoms of endometriosis may be the following:
- Prolonged menstrual period (menorrhagia)
- Haematuria (foci of endometriosis in the urinary bladder) or enterorrhagia – intestinal haemorrhage- (foci of endometriosis in the digestive tube).
WAYS OF DIAGNOSIS
Clinical examination can only provide indications of the presence of endometriosis.
- Examining the vagina and the cervix uteri during a simple gynaecological examination with a bivalved vaginal speculum gives the possibility of locating bluish or reddish foci on the cervix or on the back surface of the vagina.
- Clinical examination can often cause sensitivity during palpation of the cervix.
- Hysterosalpingography (x-ray of the uterus and fallopian tubes) is conducted by a radiologist at the beginning of the menstrual cycle. It can show adhesions around the salpinges (fallopian tubes).
- Abdominal ultrasound (with a full urinary bladder) and transvaginal ultrasound (with an empty urinary bladder) permit to locate cysts -larger than 3cm- in the ovaries. Quite often, differential diagnosis from functional cysts can be difficult.
- Endometriosis can be diagnosed only by laparoscopy following a histological examination (it is carried out in an operating theatre with general anaesthesia during a same or one-day stay in hospital). What is more, laparoscopy can determine the extension of endometriosis and the disease might be treated surgically right away. Besides, with a view to better locating the foci of endometriosis, other examinations such as magnetic resonance tomography may further be done.
TREATMENT AND CURE
In the case of symptomatic endometriosis treatment aims mostly at providing relief from symptoms as well as at reducing the possibility of recurrence or evolution of the disease. Even in the case of effective treatment, 20 percent of the patients may relapse into the disease which can recur in the form in which it was originally diagnosed or in some other form.
Treatment can include:
- Medicine that blocks hormonal stimulation of the endometrium.
- Surgical operation during diagnostic laparoscopy with a view to eliminating and removing all foci of endometriosis wherever it appears (especially in cases of subfertility).
- A combination of the aforementioned therapeutic methods of treatment.
The choice of treatment depends on criteria such as subfertility, the patient’s age as well as the gravity and extension of the disease. In case of pharmaceutical treatment, it usually lasts 3-6 months. In instances of subfertility or advanced stages of the disease in vitro fertilization may be considered necessary in order to achieve pregnancy.