Endometriosis is a growth of the lining of the uterus that exclusively affects women due to the symptoms and disease confinement in the uterine area based on the determining anatomical features.
What is endometriosis?
Schematic diagram showing the anatomy and structure of female reproductive organs and the potential sites of endometriosis. Click to enlarge. In endometriosis, affected women suffer from a growth of tissue that manifests in the mucous membrane outside the uterus. Endometriosis affects the endometrium, the surrounding mucous membrane of the uterus. Endometriosis results from benign outgrowths of the mucosa that do not cause metastasis. Endometriosis is characterized by sometimes quite severe painful impairments. Endometriosis is not only typical for the areas around the uterus. Endometriosis can also occur on the peritoneum in the small pelvis, on the so-called retaining ligaments of the uterus and on the ovaries. Quite often, endometriosis is also found in the Douglas space. This area marks the deepest zone in the abdominal cavity behind the uterus. Endometriosis is a proliferative abnormality characterized by further growth if not treated.
Causes
Despite extensive research, the causes of endometriosis are not yet clearly known. Only numerous risk factors can directly influence the formation of endometriosis. It is believed that endometriosis is an expression of daughter tumors of another cancer site. In addition, it is acknowledged that cells from inside the uterus reach the outer mucous membranes and contribute to endometriosis there. The ovarian processes known as retrograde menstruation may possibly contribute to endometriosis by expelling cells from the endometrium. A weakened or altered immune system may also be a causative trigger for endometriosis.
Symptoms, complaints, and signs
Only half of all affected women have symptoms of endometriosis. The symptoms, experienced by the other half, depend on the location of the endometriosis in the body. The endometriosis lesions are subject to cycle-related changes, just like the regular mucosa of the uterus. Accordingly, symptoms occur mainly depending on the cycle. Whether and how pronounced the symptoms are varies from case to case and is not necessarily related to the size or number of the lesions. A large proportion of patients are completely symptom-free and endometriosis is merely an incidental finding. The main symptom of endometriosis is sometimes very severe cramping pain in the second half of the cycle before, during and after the period. These are referred to as dysmenorrhea. In addition, menstruation may be increased or there may be bleeding between periods. Depending on the location of the mucosal foci, other very different symptoms develop. These include pain during sexual intercourse and gynecological examinations, pain during bowel movements or pain during urination, cycle-dependent bleeding from the bladder or intestines, nausea and circulatory problems. Women who have endometriosis are much more likely to be infertile than healthy women. During a medical examination, patients may be found to have cysts, adhesions and scars in the affected tissue. Due to the large number of possible symptoms and the varying severity of symptoms, diagnosis is difficult and the disease is often discovered late.
Diagnosis and course
Because of the varied and sometimes severe symptoms and complaints of endometriosis, women go to a specialist who can perform an abdominal endoscopy to confirm the assumption. In addition, due to the rather non-specific symptoms of endometriosis, further diagnostic indications such as observation of menstruation in terms of a painful course, pain in the small of the back and during sexual contact, as well as disturbances of the menstrual cycle are useful. Laboratory tests of but and stool as well as the control by the gynecologist can be partial steps in the diagnosis.So-called imaging techniques such as ultrasound or a computer tomography serve as diagnostically relevant options to clarify endometriosis. In addition, tissue samples obtained during laparoscopy are examined. The course of endometriosis varies from individual to individual. Basically, in the majority of cases, removal of the endometriosis is necessary in order to achieve freedom from pain and discomfort and to eliminate the symptoms that occur. If left untreated, endometriosis can lead to infertility.
Complications
Since endometriosis is a chronic disease, the symptoms show up again and again. Without treatment, the symptoms usually intensify. The scattering of the endometrium can increase both with and without treatment. As a result, the symptoms increase and other parts of the body may also be affected. In addition to the cyclically recurring pain, the main complication is the possible link to female infertility. Although there is no scientific confirmation, studies show that the fertility rate of women suffering from endometriosis is significantly reduced. Without treatment, an existing desire to have children may remain unfulfilled. In most cases, the treatment is carried out by hormone administration. Complications can occur in many ways, since hormones control all bodily functions. The administration of estrogens can lead to weight gain and skin reactions. Likewise, the risk of thrombosis increases in affected women. Hot flashes and sweating, as well as reduced bone density, are also possible side effects of hormone administration. If the scattering of parts of the uterine lining is present over a large area, surgery is performed. Complications may occur during or after anesthesia, the risk of infection is increased, and scarring may occur. The adhesions of the interfaces can also cause pain. Without complications run alternative medical, supportive measures, such as mud packs, massages, as well as performing relaxation techniques such as yoga.
When should you see a doctor?
Women who experience severe menstrual pain or suffer from other menstrual symptoms should consult a doctor. If low back pain or pain during intercourse occurs, it indicates a serious condition that needs to be checked out. The doctor can determine whether this is endometriosis and, if necessary, initiate treatment directly. If there is an unfulfilled desire to have children, this must also be clarified. Possibly there is a previously undetected endometriosis, which has led to infertility. Rapid treatment may still be able to dissolve the growth and restore fertility. People who have already had cancer are particularly susceptible to endometriosis. A weakened or altered immune system can also promote a proliferation of the endometrium. If these risk factors are present, the gynecologist should be consulted quickly with the symptoms mentioned. Other contacts are internists or – in the event of a medical emergency – the emergency medical services. Infertility may need to be worked up with a therapist.
Treatment and therapy
Various methods and procedures are available to physicians for the treatment of endometriosis. However, treatment is not mandatory for every woman. The two pillars of therapy for endometriosis are medication and surgery. With surgery, women affected by endometriosis obtain definitive freedom from symptoms. Surgical intervention against endometriosis is based on laparoscopy or laparoscopy. This procedure can provide laser-assisted peeling of the endometriosis. In some cases, the endometriosis can be removed through the vagina. An abdominal incision is usually justified when the endometriosis cannot be reached in any other way. This method is not performed until family planning is complete, as the abdominal incision usually involves the removal of the ovaries at the same time. For the therapy of endometriosis with drugs, progestogens and the drugs called GnRh antagonists are administered. The prescribed drugs usually have to be taken for a longer period of time, usually for half a year, for an intended effect.
Outlook and prognosis
According to current medical knowledge, endometriosis is not completely curable and thus difficulties may occur throughout the life of an affected patient. Likewise, there are some cases of endometriosis in which the affected woman has no symptoms throughout her life. If an endometriosis focus spreads or a new focus develops, new symptoms or a worsening of already existing symptoms can be expected at first. Depending on the severity and suffering of the patient, surgical removal of the endometriosis focus may be necessary, which will stop the symptoms. However, this only lasts until a new problematic focus occurs in the body. Furthermore, problems occur when women with endometriosis want to become pregnant. Fertility is limited by endometriosis; in some cases, natural fertilization is even completely impossible. Affected women have the option of artificial insemination, but even then, pregnancy may not occur or may be terminated in the first days and weeks. On the other hand, if the pregnancy remains and the child is born, endometriosis may improve after birth and the woman may have to deal with less severe symptoms or none at all afterwards.
Prevention
To prevent endometriosis, there are no known ways so far. This would only be possible if the causative triggers could be sufficiently narrowed down. However, women are able to realize an early detection of endometriosis within the framework of a targeted self-observation. In the case of menstrual irregularities such as persistent and recurrent discomfort during or between periods, discussion with a gynecologist is recommended.
Follow-up care
Many women who suffer from endometriosis must undergo surgery to remove the painful endometrial growths. These can spread throughout the body under certain conditions. Depending on where the lumps were removed, an adhesion abdomen may develop. Alternatively, there may be other postoperative consequences. Both may require follow-up care. When cells from the lining of the uterus settle in the body, it causes pain. It is not always to an acceptable degree. In addition, endometriosis can lead to infertility. Nevertheless, there is no need for treatment if the endometriosis causes no or only minor discomfort. In this case, follow-up care is also not required. The situation is different, however, if endometriosis attaches to the intestinal wall, organs or even the eye. In this case, surgical options must be discussed. In addition, the resulting pain can be treated psychotherapeutically and thus alleviated. Treatment with painkillers or hormone preparations should be closely monitored in the sense of aftercare. Both can lead to consequences such as addiction and dependence or an increased risk of thrombosis or embolism. Therefore, the age of the woman plays a decisive role in the treatment and aftercare measures chosen. In advanced age, a hysterectomy may be indicated. Usually, this operation is followed only by postoperative follow-up.
What you can do yourself
In endometriosis, uterine lining forms outside the uterine cavity, which is often accompanied by tremendous pain for affected women. Patients cannot take self-help measures that address the problem causally. The most important self-help step is to work toward a prompt diagnosis and adequate medical treatment. Women who suffer from severe pain during menstruation should by no means accept this as “natural”, but should in any case consult a gynecologist. If endometriosis is indeed diagnosed, there are a number of treatment options. Patients should then seek comprehensive information from an expert about all possible treatment options. Gynecologists who specialize in the treatment of endometriosis can be researched on the Internet, and the medical associations and health insurance companies also provide information on this subject. During an acute attack, affected women should take it easy if possible and spend a day in bed. A hot water bottle on the abdomen often provides relief.On the road and at work, chemical hand warmers that can be placed discreetly under clothing are helpful. Naturopathy recommends intestinal cleansing for endometriosis, followed by a change in diet to a largely plant-based diet with a high proportion of raw foods. There are no scientific studies on the effectiveness of this treatment method for endometriosis. However, since a balanced plant-based diet is beneficial to overall health, there is nothing to be said against trying it.
