What is Endometriosis?
Endometriosis is a chronic gynecological condition affecting millions of women worldwide. It is characterized by the development of endometrial tissue (tissue normally found inside the uterus) in areas outside the uterine cavity.
This "ectopic" tissue continues to function like normal endometrium, responding to menstrual cycle hormonal changes. During the period, the tissue thickens, breaks down, and bleeds, but because it cannot be excreted from the body like normal endometrium, it creates inflammation, scars, and cysts.
Symptoms of the Endometriosis
Main Symptoms
Pelvic pain is the most common symptom of endometriosis. This pain can be:
- Chronic and intense during the period (dysmenorrhea)
- Persistent pain in the pelvic area
- Pain during or after sexual intercourse (dyspareunia)
Secondary Symptoms
Women with endometriosis may also present with:
- Gastrointestinal problems: bloating, diarrhea, constipation, nausea
- Fatigue and exhaustion
- Infertility
- Bleeding between periods
- Irregular cycles
Causes and Risk Factors of the Endometriosis
Theories for Causes
Although the exact cause of endometriosis remains unknown, several theories exist such as:
- Retrograde Menstruation: The most accepted theory suggests that menstrual blood containing endometrial cells flows backward through the fallopian tubes into the abdominal cavity.
- Coelomic Epithelium Metaplasia: Cells in the abdominal cavity transform into endometrial cells.
Diagnosis of Endometriosis
Clinical Examination
Diagnosing endometriosis can be difficult as symptoms resemble other conditions. The doctor will:
- Take a detailed symptom history
- Perform a pelvic examination
- Assess the pain intensity and character
Imaging Studies
- Ultrasound: Can detect endometriotic cysts (endometriomas) but not smaller foci.
- Magnetic Resonance Imaging (MRI): Provides more detailed pelvic organ imaging and can detect deep infiltrating endometriosis.
Laparoscopy
Laparoscopy remains the gold standard for definitive diagnosis. This minimally invasive surgical technique allows direct visualization and biopsy of the suspicious tissue of endometriosis.
Staging of Endometriosis
The American Society for Reproductive Medicine (ASRM) uses a four-stage staging system:
- Stage I (Minimal): Few, superficial lesions
- Stage II (Mild): More lesions, some deeper
- Stage III (Moderate): Many lesions, ovarian cysts, some adhesions
- Stage IV (Severe): Numerous lesions, large cysts, extensive adhesions
Treatment Options of Endometriosis
Pharmaceutical Treatment
- Painkillers
- Non-steroidal anti-inflammatories (NSAIDs) such as ibuprofen
- Provide pain relief and reduce inflammation
- Hormonal Therapy
- Contraceptive pills: Help control pain and reduce disease progression
- Progestin: Reduces endometrial tissue growth
- GnRH agonists: Create temporarily menopause, reducing estrogen
Surgical Treatment
- Conservative Surgery
- Laparoscopic removal of endometriosis lesions
- Fertility preservation
- Indicated for women desiring children
- Radical Surgery
- Hysterectomy (uterus removal) and Oophorectomy (ovary removal) and removal of endometriosis lesions
Endometriosis and Fertility
Endometriosis is one of the main causes of female infertility. It affects fertility through:
- Anatomical distortions of reproductive organs
- Inflammation affecting egg quality
- Hormonal disorders
Treatment Options for Fertility
- Ovarian stimulation and intrauterine insemination
- In vitro fertilization (IVF)
- Surgical removal of lesions before conception attempt
Prognosis and Long-term Management of Endometriosis
Disease Evolution
Endometriosis is a chronic condition requiring long-term management. Its course can be:
- Stable
- Progressively worsening
- Cyclical with periods of remission and exacerbation
Long-term Management Strategies
- Regular imaging monitoring
- Symptoms monitoring
- Treatment adjustment according to needs
When to Visit the Doctor
You should visit a gynecologist if you experience:
- Severe pain during period
- Chronic pelvic pain
- Difficulty conceiving after one year of trying
- Pain during sexual intercourse
- Unusual menstruation
Conclusion
Endometriosis is a complex gynecological condition significantly affecting women's quality of life. Timely diagnosis and appropriate treatment are critical for effective symptom management and fertility preservation.
With modern therapeutic approaches, lifestyle changes, and appropriate support, women with endometriosis can live symptom-free. Ongoing research and newer therapies give hope for even better outcomes in the future.
If you suspect that you may have endometriosis, don't delay visiting the doctor. Early intervention can make the difference in disease management and your quality of life.
Kostis Nikolopoulos is an expert in minimally invasive endometriosis surgery.
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