Endometriosis is defined as the growth of endometrial tissue outside the uterine cavity. This growth can take place in several parts of the body, such as the ovaries, the Fallopian tubes, behind the uterus, on the uterine ligaments, in the pelvic cavity, and also but rarely in other areas, such as the bladder.
Endometriosis is a common illness in women in fertile age, it is painful, and the pain increases during menstruation. It’s estimated that it affects 15% of women in Spain and between 10%-20% of women in America.
It’s an important cause of sterility, since 30%-40% of women that suffer from it have, subsequently, problems to achieve pregnancy. Different severity levels can be distinguished, depending on the location, deepness, quantity and size of the tissue.
The causes why this kind of growth takes place outside its common position are not completely known. It is believed that it can be due to some fragments of the endometrium that aren’t expelled during menstruation. They ascend along the Fallopian tubes and get adhered to some organs of the pelvic cavity, where the tissue develops forming bulges or cysts, named implants or tumours that are completely benign.
Other causes may be due to genetic factors, which means this affection could be inherited, thus having certain predisposition to suffer from it. It could also be provoked by immunological or endocrine causes, but all of them are being studied.
Recently, an enzyme related with the development of endometriosis, telomerase, has been identified.
As if it was a normal endometrium, the implants found in several parts of the body respond to the hormonal changes in progesterone and estrogenic hormone during the menstrual cycle. They bleed too, just like the uterine endometrium, the difference lies in the fact that this blood is not expelled outside of the body, hence provoking the inflammation of the tissues that surround them and scars in those tissues (adherences).
The most common symptom is a mild to intense pain in the abdomen, pelvis and lower back. Generally, this pain increases during the period and it’s not related to the quantity of endometriosis that a woman can have.
Other symptoms are:
- Pain in the intestine and intestinal disorders, such as constipation or diarrhea.
- Pain during and after sexual intercourse.
- Pain when urinating during the period, or even hematuria – blood in urine.
- Longer periods, in which there’s an increase in the expelled blood.
- Expelling blood between periods and before them.
In order to diagnose endometriosis, a complete physical examination with special attention to the pelvic area must be performed. The obtained information, along with the medical history, will help when it comes to reaching a diagnosis.
Other tests that can be carried out are an ultrasound, in which the images of the genital organs are obtained, or in some cases, a magnetic resonance imaging to obtain a picture in two dimensions of some organ.
Nevertheless, the doctor will only be sure of the diagnosis when a laparoscopy is performed. It is a minor surgery with general anesthesia, in which through a tube equipped with a lens and a light, the inside of the abdominal cavity can be observed.
Recent researches are trying to find endometriosis markers that allow a diagnosis by carrying out a simple blood or urine analysis. These markers would be substances created by our body in response to the illness or created by the illness itself.
Endometrial markers in the endometrial fluids have been discovered so far, which means an analysis of the endometrial fluids would allow detecting the illness.
These are some of the risk factors that are related with the development of this illness in women:
- Having a close relative that suffers from it.
- Not ever having had children.
- Having children for the first time after 30.
- Having an abnormal uterus.
- Enduring hymen problems.
- Frequent menstrual cycles and periods lasting more than seven days.
- Having had the period at an early age.
Endometriosis can’t be cured nowadays. Its treatment consists on relieving the pain of the woman that suffers from it, so that she can carry a normal life. Since it depends on hormones, endometriosis is present during all her fertile life, and sometimes even longer.
The treatment can be hormonal or surgical depending on the severity of the illness. In the mildest cases, the treatment will consist on painkillers and in the most severe cases, when chronic pain is experienced, surgery can be a good option.
We can find some alternative treatments such as folkloric remedies, homeopathy and traditional Chinese medicine.
The patient must be informed of the advantages and disadvantages of every treatment, since some of them, such as the hormonal, may not be compatible with the idea of having children.