For those who do not know it yet: Endometriosis is a chronic disease that affects more than one in ten women. It occurs in various forms and can be more or less severe. Unfortunately, it is often diagnosed too late and there are only a few treatment options to combat it. Here you will learn everything you need to know about this gynecological condition, which is still little known to the general public.
Endometriosis, what is that?
Endometriosis is a disease that is closely related to menstruation. The uterine lining, known as the endometrium, thickens during the menstrual cycle due to estrogen. This thickening of the uterine tissue occurs in anticipation of a possible pregnancy. If fertilization does not occur, the lining breaks down and is then expelled during menstruation.
In endometriosis, this tissue thickens in an uncontrolled manner. It then grows into other organs, particularly the ovaries and the peritoneum. Often, it also reaches the vagina, the digestive tract (rectum, colon, and intestine), the urinary tract (uterosacral ligaments and bladder), and sometimes even the lungs. These endometrial cells, which then grow out of the uterus, will develop into adhesions, internal injuries, or ovarian cysts.
All women of childbearing age are at risk of developing this disease. Today, doctors estimate that about one in ten women suffers from endometriosis. A rather alarming figure, especially considering that this estimate does not take into account undiagnosed cases, and therefore the disease actually affects more women.
The disease can take different forms depending on the patient. Its severity also varies from woman to woman, depending on how much abnormal tissue is present and how severely the organs are damaged.
The causes of endometriosis
But how does this disease occur? First of all, endometriosis is characterized by the presence of tissue similar to the uterine lining in other organs. This is due to the tissue migrating upwards and entering other parts of the pelvis and lower abdomen through the fallopian tubes. The factors that trigger or promote this migration are not yet precisely known, but the pathways through which the uterine tissue migrates have been identified.
It may be a case of retrograde menstruation. In this case, a part of the menstruation that contains endometrial cells travels back into the fallopian tube. Cell transplantation can also occur via lymphatic or vascular pathways or "mechanically" as part of a surgical procedure affecting the pelvic area (cesarean section, laparotomy, episiotomy, etc.).
Endometriosis can also be caused by a so-called metaplasia. In this case, normal tissue transforms into abnormal tissue, either spontaneously for an unknown reason or due to hormonal disturbances.
This disease is primarily diagnosed in industrialized countries, but that does not mean that its existence is limited to these countries. Many women may also suffer from it in other parts of the world without being properly diagnosed.
Furthermore, experts estimate that 90% of women suffer from so-called retrograde menstrual bleeding (i.e., the bleeding does not occur in the normal way). However, officially only 10% suffer from this condition. There are still unknown individual factors that may - so the hypothesis goes - be related to genetics.
Symptoms that should alarm you
"If the disease is not asymptomatic, it primarily manifests through pain:"
- Pelvic pain: Women with endometriosis often experience pain in the lower abdomen. If you are suffering from this pain, you should seek medical advice.
- Pain during menstruation: "In addition to the pelvic area, the sites affected by the endometrial cells can also be painful. A very rare case observed in 1993 even experienced epileptic seizures on the first day of her menstruation, as the endometrial cells had penetrated into the brain."
- Pain during bowel movements and when urinating: "If you have difficulty with bowel movements and experience pain when urinating, that is not a very good sign. This is the case when the endometrial cells have reached the urinary tract and the digestive system."
- Pain during intercourse or dyspareunia: you should know that it is also not normal to have pain in the lower abdomen or vagina during sexual intercourse.
- Lumbago and Sciatica: The pain can also affect the lower back, the pelvis, and the navel. Sometimes it radiates down to the legs.
These chronic pains vary in intensity from case to case. It may happen that a woman with endometriosis can carry out her daily activities, or that severe pain may even prevent her from getting up. The pain may also be accompanied by vomiting.
"If you are suffering from one or more of these symptoms, it is strongly advisable to see a gynecologist. On the other hand, you should also urgently see a doctor if the following symptoms occur:"
- Irregular bleeding: You suffer from spotting or bleeding from the rectum or uterus. This often occurs in the premenstrual phase.
- Digestive disorders and urinary tract problems: "It can lead to constipation or diarrhea. As for the problems with urination, you may feel a frequent urge to go to the bathroom. Sometimes there is blood in the urine and it burns when urinating."
- Chronic fatigue: You are so tired during the premenstrual phase or during menstruation that your daily life and quality of life are affected.
Women with endometriosis often have difficulty conceiving. Many women do not know what the cause of endometriosis is and discover it by chance during examinations related to fertility issues.
In France, the disease is diagnosed an average of five years too late. This means significant damage to the affected organs. Therefore, it is important to see a doctor at the first signs of suspicion.
The diagnosis is made using an ultrasound examination. A magnetic resonance imaging (MRI) may also be necessary to confirm the results of an initial gynecological examination. Sometimes a laparoscopy is also required, a surgical technique in which the inside of the organs is observed with a tiny camera. This is performed more for healing.
What treatments are available for the healing of endometriosis?
Endometriosis is a chronic, recurring disease, and unfortunately, there is still no definitive cure. Treatment is usually hormonal and palliative. It involves "blocking" the menstrual cycle. In this way, the bleeding and pain from the lesions that occur during menstruation are suppressed. Hormonal treatments include, for example, the continuous intake of a birth control pill or the insertion of a coil that continuously releases hormones.
"It was also found that endometriosis decreases and eventually disappears in most cases when women reach menopause. Therefore, there are methods in which patients are induced into a artificial menopause to reduce or eliminate their suffering. This involves the injection of hRNG analogs, usually along with a small dose of estrogen to minimize the side effects of menopause (hot flashes, dry skin, etc.)."
Finally, a surgical procedure can be planned if contraceptives and other hormonal treatments do not work. The lesions are removed through laser burning or electrical methods. The pain disappears, but in most patients, there are recurrences. Therefore, it is often sensible to carry out hormone treatment to prevent the reappearance of the abnormal tissue. As a last resort, a hysterectomy may be considered for women over 45 years old who have already undergone all treatments and surgeries unsuccessfully.
