Endometriosis is a benign disease in which tissue that is normally inside the uterine cavity and called the endometrium grows outside the uterus (or womb). The tissue when it grows inside the uterus is called "endometrium" and when it does outside it is called "endometriosis".
It is located primarily in the ovaries and uterine tubes, and we call it tubeovascular endometriosis, and less frequently in any part of the pelvis and abdomen such as intestines, peritoneum (tissue layer that covers the intra-abdominal organs), rectovaginal or vesicovaginal septum, and bladder urinary tract. In these latter cases we speak of deep endometriosis. There is also a condition called "Adenomyosis" which consists of the endometrium growing inside the uterine muscle.
It is a very variable disease in its presentation, development, extension (ranging from minimal implants to large cysts), symptomatology, treatment and prognosis.
Causes of Endometriosis
The cause of endometriosis is unknown. A theory called "retrograde menstruation theory" says that it would originate in the retrograde menstrual flow flowing through the tubes into the pelvic cavity of the woman and subsequent implantation of endometrial cells away from their natural location. However, there are other theories and research in progress to clarify the origin of this disease.
Symptoms of Endometriosis
Some women with endometriosis do not have any symptoms. Most refer to pain in the lower belly before or during menstruation (dysmenorrhea), even less frequently between menstrual periods; may also cause dyspareunia (pain during or after intercourse), and may cause pain when urinating or when there is movement of bowel loops if the urinary bladder, ureter or intestines are affected.
Another symptom is the difficulty to become pregnant (approximately 40% of patients with this disease will be infertile).
It is necessary to emphasize that not always that these symptoms give the cause is the endometriosis. There are other conditions that can cause similar symptoms.
Does endometriosis affect fertility?
Although it can affect fertility it does not always, so a woman can get pregnant before treatment.
25-35% of infertile patients will have endometriosis, being the third cause of infertility in women. According to some statistics if the patient is infertile and has pelvic pain the percentage of endometriosis rises to 50-70%.
On the contrary, pregnancy exerts a protective effect of endometriosis , preventing its progression or relapse.
There is currently no test to confirm the diagnosis of endometriosis, but it may be suspected to know the symptoms and do the gynecological examination. Ultrasonography, especially transvaginally , is highly effective as a complementary test for diagnostic suspicion.
Sometimes endometriosis cysts are discovered in the course of a routine health examination by examination or ultrasound by gynecologists. But the only way to know for sure if you have endometriosis is to undergo surgery to look for and find the typical tissue of endometriosis outside the uterus.
Treatment of endometriosis
Endometriosis can be treated in many ways and can range from the simple expectant attitude to the most radical surgery. The two conditioning factors of the treatment are two fundamentally. On one side would be the own disease and the symptoms that provoke and on the other the circumstances and desires of future gestation of the patient.
Medications for Endometriosis
- Analgesics for pain (do not treat endometriosis properly)
- Oral or gestagenic contraceptives (not indicated if the patient wishes to become pregnant)
- Hormones that cause amenorrhea (cessation of menses). These treatments should not be continued beyond one year because of the side effects it causes. Nor are they appropriate if the woman wishes to become pregnant.
Surgery for Endometriosis
Often the necessary treatment is surgery. In the vast majority of cases the laparoscopic route will be used and laparotomy will be avoided, which is not very acceptable at present. In general they are often very complex and sometimes multidisciplinary surgeries (collaborating gynecologists, general surgeons, urologists, ...), especially if you want to be a fertility conservative. Since the surgery is so complex there are advanced pelvic surgery units or specifically units of specialized endometriosis.
The surgical modalities are:
- Removal of visible endometriotic tissue, fundamentally excision of ovarian cysts.
- Ovariectomy or anexectomy: remove ovaries with or without traps.
- Hysterectomy (excision of the uterus)
- Resections of endometriosis foci of non-gynecological organs such as partial cystectomy (urinary bladder removal) or intestinal resections, etc.
If the patient wishes to become pregnant there are very effective fertility treatments as well as assisted reproduction techniques, which are also frequently used.
Prognosis for the patient with endometriosis
In general the prognosis is good since it is a benign disease. With the right treatment it can be managed to cure it or at least achieve an adequate quality of life for the woman. This is: a life without pain and getting to complete the desires of fertility.