Endometriosis

Many women suffer from painful periods with lower abdominal pain, and it can take years for them to find a satisfactory answer to the cause of their suffering, which is none other than a common and often undiagnosed condition: endometriosis. And yet, endometriosis is the second most common gynecological condition…

According to facts and figures about endometriosis (https://www.endometriosis-uk.org): 10% of women worldwide have endometriosis. That’s 176 million worldwide. Endometriosis affects 1.5 million women and those assigned female at birth, a similar number to those affected by diabetes. The prevalence of endometriosis in women with infertility can be as high as 30–50%.

What is endometriosis?

Endometriosis occurs when tissue from the interior of the uterus (endometrium) is found elsewhere in the body, on the lining of the pelvis (peritoneum), or in the ovaries and involves other pelvic organs, like the bowel or bladder. Less commonly, endometriosis can also be found outside the pelvis, such as in the chest. The tissue can grow and change in response to hormones in the menstrual cycle, causing inflammation, pain, and scar tissue.

When cells similar to the ones in the lining of the womb grow within the muscle of the womb wall, you have adenomyosis. Adenomyosis affects 10% of women. You can have only endometriosis or adenomyosis, although it’s quite common to have both.

Common symptoms of endometriosis include:

Diagnosis can be difficult and often delayed. Between first seeing a doctor about your symptoms and receiving a firm diagnosis, there is an average of 8 years and 10 months.
Scans, blood tests, and internal examinations are not a conclusive way to diagnose endometriosis. The only way to diagnose endometriosis is by laparoscopy. A minimally invasive gynecologic approach in which a camera (a laparoscope) is inserted into the pelvis via a small cut near the navel. The surgeon uses a camera to see the pelvic organs and look for any signs of endometriosis. If they exist, treat or remove them for further examination during the laparoscopy. Laparoscopy allows for both direct visual inspection of the lesions and biopsy. In some cases, it enables simultaneous treatment with cauterization or laser.

If you have been diagnosed with endometriosis, adenomyosis, or both, your doctor should discuss possible endometriosis treatment options with you to reduce the severity of symptoms. Working out the best endometriosis treatment method for you, he will consider many different factors, such as your age, the severity of the endometriosis you have, and the severity of your symptoms.

Treatment options available to those with endometriosis are:

• Hormone treatments
• Pain relief
• Surgery

Pain relief

Heat and comfort: A simple hot water bottle or hot bath may help to reduce pain. Some women also find heated wheat bags to be effective. Being comfortable and reducing stress will also be beneficial.

Painkillers: Simple analgesics such as paracetamol can be used to treat mild pain.  Stronger analgesics such as Ibuprofen, Voltarol, and Ponstan (mefanamic acid) block the production of prostaglandins in the body. Prostaglandins are making the womb contract during a period (which helps with the shedding of the womb lining). These contractions can cause pain. It is thought that women with endometriosis may produce more prostaglandins than women without the condition.

Codeine-based painkillers are effective painkillers but can cause constipation and gastrointestinal upset, which may aggravate symptoms in women with endometriosis.

 Physiotherapy: A program of exercise and relaxation techniques designed to help strengthen pelvic floor muscles, reduce pain, and manage stress and anxiety. After surgery, rehabilitation in the form of gentle exercises, yoga, or Pilates can help the body get back into shape by strengthening compromised abdominal and back muscles.

Surgery

When our main concern is a woman’s fertility or staging the disease and pain management, we are primarily talking about laparoscopic techniques. Usually, during laparoscopy, the gynecologist finds endometriosis in 50% of women with infertility. Then, using intra-abdominal lasers or other forms of energy, such as CO, lasers or KTP laser beams that destroy visible endometriosis lesions, it enters the abdomen without incisions and drains endometrial cysts, opening and destroying their walls, restores the ovary to its normal state, and clears the cysts around the peritoneum. The woman can immediately start trying to become a mother.

During pregnancy and breastfeeding, endometriosis is inactive. The same happens, to a lesser extent, during menopause, when the foci of endometriosis atrophy due to hormone decline.

Definitive surgical intervention

For the definitive elimination of pain, dysmenorrhea, and large endometriosis cysts in women who have already had children and are not planning to have more in the future, a hysterectomy and bilateral salpingo-oophorectomy are usually performed, in other words, a complete pelvic clearance.

Common symptoms of endometriosis include:

• Painful periods (dysmenorrhea). Pelvic pain and cramping may start before a menstrual period and last for days into it.
• You also may have lower back and stomach pain.
• Fatigue, diarrhea, constipation, bloating, or nausea
• Pain with sex (dyspareunia). Pain during or after sex is common with endometriosis.
• Pain with bowel movements or urination (dysuria).
• Excessive bleeding.

Endometriosis and fertility

Many women discover that they have endometriosis while trying to figure out why they’re having difficulty conceiving. However, the good news is that today the majority of women with endometriosis are able to have children!

Endometriosis may cause infertility, as it often affects gametes and embryos, the fallopian tubes and embryo transport, and the ectopic endometrium; these abnormalities likely all impact fertility. Current treatment options for endometriosis-associated infertility include surgery, superovulation with IUI, and IVF. Potential future treatments for endometriosis-related infertility would be stem cell transplantation and immunotherapy.

For further information:

Endometriosis.org is the global forum for news and information on endometriosis. It provides up-to-date information on the latest endometriosis research.

EUROPEAN SOCIETY OF HUMAN REPRODUCTION AND EMBRYOLOGY

http://www.eshre.eu