What is endometriosis? SYMPTOMS, CAUSES AND PREGNANCY
Endometriosis is a disease that occurs when there is endometrial tissue outside the uterus. This uterine change can affect the reproductive capacity of women who suffer from it.
Definition of endometriosis
Endometriosis is a disease caused by the presence of endometrial tissue, the layer that lines the uterine cavity, outside the uterus. Between 5 and 10% of the female population suffers from endometriosis, although in many cases it's undiagnosed.
Endometriosis is classified in four stages of severity based on the location, extent and depth of endometriosis implants; the presence and severity of adhesions; and the presence and size of ovarian endometrioma.
What are the symptoms associated with endometriosis?
The main symptom of endometriosis is pain associated with menstruation, although in some cases the discomfort can last the entire cycle. In fact, many women with endometriosis confirm that the worst time for them is during ovulation.
Endometriosis can also manifest by having pain during sexual intercourse or even by intestinal and urinary problems if the rectum or bladder are affected, in most severe cases.
In general, all these symptoms disappear when menopause arrives. Being a hormone-dependent disease, endometriotic foci disappear when the hormonal stimulus decreases.
Possible causes of endometriosis
The causes of endometriosis are still an unknown issue, although there are several theories. The best known is retrograde menstruation.
During each menstruation, most of the lining of the uterus and blood is expelled through cervix and eliminated via vagina. However, a portion of this tissue can migrate through fallopian tubes to pelvic cavity and implant in different places.
There are other theories for the cause of endometriosis, such as spreading through blood or lymphatic vessels, or transformation of cells of peritoneum into endometrial cells.
How is it diagnosed?
The diagnosis of endometriosis is usually based on clinical history and pelvic examination. Vaginal ultrasound helps us visualize possible endometriomas (ovarian cysts of endometriosis). Magnetic resonance imaging is also used.
The only confirming diagnosis of endometriosis is surgery (laparoscopy or laparotomy) with anatomopathological analysis of lesions.
Endometriosis and infertility
One of the major concerns of patients suffering from endometriosis is its association with infertility. The data are impressive: 30% to 50% of people affected by endometriosis will have infertility problems and between 35% and 50% of infertile women are diagnosed with endometriosis.
The association of endometriosis with infertility is due to several factors:
- Anatomic issue, especially in the fallopian tubes.
- Changes in ovarian reserve, that is, number of eggs and their quality.
- Inflammatory changes in the environment, which can influence fertilization.
- Changes in uterine implantation.
The treatment of endometriosis will depend on the symptoms, evolution of the condition and desire or not for pregnancy. It is mainly intended for the control of symptoms and especially for pain relief. Sometimes, a vigilant behavior can be maintained if the symptoms and evolution of the disease allow it.
Medical treatment can be analgesic, to control the associated pain, or hormonal, with contraceptives being most used, inhibiting ovulation and preventing the progression of endometriosis.
Surgical treatment is sometimes necessary when endometriotic cysts are large or pain severely limits daily activity. For the treatment of infertility, each case should be individualized and studied. However, the most used technique in women with endometriosos is In Vitro Fertilization (IVF).
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