Endometriosis is a disease in women in which the inner lining of the uterus, the lining of the uterus (endometrium), grows in places outside the uterine cavity where it does not actually belong.
This disorder occurs at a young age, before the age of 20.
Endometriosis mainly affects the outer surfaces of the ovaries and uterus, the fallopian tubes, retaining ligaments of the uterus (e.g. the ligamentum sacrouterinum), Douglas space, navel, rectum, bladder, lymph nodes of the groin, diaphragm, inner area between vagina and rectum, as well as the peritoneum of the pelvis.
Most often, the ovaries are affected by endometriosis.
Rarely, it occurs on the liver or lungs.
The uterine lining naturally reacts to the sex hormones estrogen and progesterone.
In women with endometriosis, the abnormal endometrial cells located in the pelvic cavity also respond to these hormones.
During ovulation, the uterine lining and external endometrial cells condense. Unlike the uterine lining, however, the latter are not excreted from the body with the menstrual period.
This leads to bleeding, inflammation and pain.
Over time, this process can lead to the formation of fibrous tissue.
Endometriosis can cause very painful menstruation, cysts, severe cramps, and even infertility, but there are several treatment options.
The symptoms of endometriosis vary from woman to woman, some patients have only mild or no symptoms.
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Why does endometriosis cause health problems and pain?
Endometriosis is a benign (not cancerous) disease, but it can cause health problems.
Every month, hormone-related tissue and blood vessels are built up to form the inner lining of the uterus. If the woman does not become pregnant, tissue and blood are secreted from the uterus and leave the body with the menstrual period through the vagina.
Endometriosis lesions also react to the hormones produced during the menstrual cycle.
Over time, endometriosis can grow and build up more and more extra blood and tissue.
Often the symptoms worsen.
Tissue and blood that remains in the body can cause inflammation, scar tissue, adhesions and pain.
Endometriosis foci can grow in the ovary and close the fallopian tubes.
The blood trapped in the ovaries can form cysts.
The fibrous tissue can cause pain in the pelvic region and cause women to have difficulty getting pregnant. The functioning of the intestine and bladder may also be impaired by the endometrial tissue.
Some scientific studies have found a link between endometriosis and ovarian tumors or endometrial tumors. However, it is not known whether endometriosis is a risk factor or whether both diseases have the same origin.
Stages or severity of endometriosis
- First stage (minimal)
At the initial stage, small cysts of a size between 1 and 3 mm are formed. - Second stage (mild)
The second grade of severity is characterized by black tissue on a white fibrous area with a size of 1-2 cm in diameter. These spots are found in the pelvis or diaphragm. - Third stage (moderate) At this stage,
the cysts are larger than 4-5 cm and can cover the ovaries. Adhesion can occur in the pelvis or on the pelvic organs. - Fourth stage (severe)
The last stage is characterized by solid tumors, the diameter of which reaches up to 5-6 cm in diameter. They form mainly on the posterior wall of the uterus and rectum.
Causes of endometriosis
The exact causes of endometriosis are still unknown. There are numerous explanatory models and possible risk factors.
Endometriosis and backward-flowing menstruation
Backward-flowing (retrograde) menstruation occurs when menstrual fluid flows back into the fallopian tubes instead of leaving the body via the vagina.
Since entry into the ovaries via the fallopian tubes is not possible, the fluid can drip into the abdomen.
Women with endometriosis are suspected that the endometrial tissue contained in menstrual fluid attaches to any structure it reaches (e.g. ovaries) and cell growth begins there.
Endometriosis and immune system
Retrograde menstruation occurs in almost all women, but only 3 – 10% develop endometriosis.
According to one theory, the immune system of some women allows the development of endometriosis because it does not control or stop the growth of endometrial tissue outside the uterine cavity.
Genetics and endometriosis
research results give reason to believe that the development of endometriosis may be hereditary. First-degree relatives (mother or sister) of endometriosis patients are more likely to develop it themselves.
Risk factors for endometriosis
Potential risk factors include:
- Menstrual factors – these include early first menstrual period, menstrual pain, short menstrual cycles (less than 27 days) or long menstrual periods (longer than 1 week).
- Allergies: food allergies, eczema and hay fever.
- Obesity.
- Family members with endometriosis.
- Environmental toxins – some research has shown that continued exposure to environmental toxins, such as dioxins, could contribute to the development of endometriosis.
Symptoms of endometriosis
Endometriosis occurs in one out of four cases without any symptoms, but can cause severe symptoms in the remaining cases.
The main symptoms of endometriosis are – mostly menstrual – pain in the pelvic region.
Even though many women suffer from cramping pain during menstruation, women with endometriosis experience menstrual pain more than normal.
In addition, the pain increases in intensity over time.
Signs and symptoms of endometriosis:
- Painful menstrual period (dysmenorrhea).
- Cramps and pain in the pelvic area that begin before menstruation and can last until a few days after bleeding. These include abdominal and lower back pain.
- Burning pain in the abdomen.
- Pain during and after sexual intercourse is typical of endometriosis.
- Pain during bowel movements and urination, especially during menstruation.
- Pain often occurs that can be compared to that of sciatic nerve inflammation. The result is constant back pain that extends over the leg to the foot.
- In rare cases, heavy menstrual bleeding (menorrhagia) and intermenstrual bleeding (metrorrhagia) occur.
Treatment for infertility Endometriosis is diagnosed in some women who are undergoing treatment for their infertility.
Other symptoms
Other symptoms include fatigue, indigestion (diarrhoea, constipation) or nausea, especially during menstruation.
Endometriosis sometimes leads to a bloated abdomen.
The severity of pain is not necessarily a reliable diagnostic indication.
Some women with mild endometriosis experience severe pain, while other advanced women may experience little or no pain.
Endometriosis is sometimes confused with other conditions that cause pelvic pain, such as inflammation in the small pelvis or ovarian cysts.
It can also be confused with irritable bowel syndrome, a condition characterized by attacks of diarrhea, constipation, and abdominal cramps.
If the patient suffers from both irritable bowel syndrome and endometriosis, this can complicate the diagnosis.
Complications and effects
Infertility
The main complication of endometriosis is infertility. About 30 – 50% of women suffering from endometriosis have difficulty getting pregnant.
To get pregnant, the ovary must release an egg; this must migrate through the fallopian tube, be fertilized there by a sperm cell and finally implant in the uterine wall, where growth begins.
Endometriosis can occlude the fallopian tube and prevent the union of egg and sperm cells.
This condition also seems to affect fertility in less direct ways, such as damage to sperm and eggs.
For many women with mild or moderate endometriosis, conception and completed pregnancy are quite possible.
Doctors may advise women with endometriosis not to wait any longer with family planning, as the disease can get worse over time.
Endometriosis and cancer risk
According to some scientific studies, women who suffer from endometriosis have a higher risk of developing certain types of ovarian cancer called epithelial ovarian tumors.
The risk is higher in women who suffer from endometriosis and primary sterility (women who have never been pregnant).
However, taking the birth control pill seems to significantly reduce this risk.
The reasons for a link between endometriosis and epithelial ovarian cancer are still unclear.
One possible explanation could be that endometriosis lesions turn into cancer cells.
Or the occurrence of endometriosis is related to other genetic or environmental factors that increase the risk of ovarian cancer.
Diagnosis of endometriosis
If endometriosis is suspected, the doctor will refer the patient to a gynecologist so that the necessary examinations can be performed.
First, a transvaginal ultrasound is performed, which indicates blood-containing cysts in the uterine lining.
To clarify the extent of deep endometriosis, magnetic resonance imaging (MRI) may be helpful.
A blood analysis examines the levels of the human glycoprotein CA-125, a tumor marker that increases in the case of endometriosis, as well as in other disorders (e.g. uterine fibroma or uterine tumor).
The imaging technique with fat suppression can distinguish between fatty and blood-containing cysts.
Endometriosis can be diagnosed by laparoscopy.
Laparoscopy
Laparoscopy is performed under general anesthesia; a small tube equipped with a camera (laparoscope) is inserted into the body.
The camera transmits the images to a monitor and displays the endometriosis tissue to the specialist,
who takes a tissue sample (biopsy) and has it examined in the laboratory or inserts other surgical instruments to treat endometriosis.
The surgeon inserts the laparoscope into the body where he suspects endometriosis.
Since in many women the symptoms occur in the pelvis and lower abdominal region, the laparoscope is usually inserted through the navel.
Usually, the patient is discharged home ready on the day of laparoscopy.
When does surgery have to be performed? Treatment of endometriosis
Endometriosis can be treated with medication or surgery. Natural forms of therapy can also be used effectively.
Mild endometriosis can be kept under observation by regular check-ups at the doctor or gynecologist.
Prostaglandin-inhibiting drugs, e.g. nonsteroidal anti-inflammatorydrugs (NSAIDs) such as ibuprofen help to keep pain under control.
As symptoms progress, the possible treatment options should first be discussed with the doctor before making a definitive decision.
Keep in mind that mild endometriosis can progress to moderate or severe endometriosis.
Surgical removal of scar tissue is the most effective therapy to reduce the likelihood of recurrence.
Hormone therapy for endometriosis
The cells of the uterine lining located outside the uterus are sensitive to hormones and react to the menstrual cyclic fluctuations of estrogen and progesterone, causing bleeding and pain; here hormone therapy can be used very effectively.
Options of hormone therapy:
- Progestins belong to a group of synthetic hormones, similar to progesterone, that suppress the growth of uterine lining outside the uterine cavity.
Side effects include: weight gain, chest pain, depression, mood swings, fatigue, nausea and vomiting. - GnRH agonists are chemical substances that trigger a reaction in cells.
These drugs control the amount of estrogens produced, which inhibits the growth of endometrial cells located outside the uterus.
Side effects include the symptoms of menopause, i.e. bone loss, hot flashes, dry vagina, headache, depression, decreased pleasure (loss of libido) and night sweats.
These side effects can be alleviated with estrogen and progesterone. The birth control pill is often used to combat endometriosis in the long term.
It can be used to stop the progression of the disease or to inhibit the formation of new forms after hormonal or surgical treatment. Gestrinone is a synthetic hormone with antiprogestin action that suffocates endometrium found outside the uterus.
Side effects of gestrinon include weight gain, acne, depression, mood swings, hot flashes, and lack of libido. - Danazol is a derivative of testosterone (male hormone) that reduces the amount of estrogen produced by the ovaries to the level prevailing during menopause.
Without estrogens, the endometrial cells located outside the uterus cannot grow.
Due to the serious side effects, Danazol is rarely used to treat endometriosis. - Combined treatment for endometriosis.
In some cases, the woman may benefit from both hormone therapy and surgery. Hormone therapy is used before or after the procedure, depending on the circumstances.
Surgical treatment of endometriosis
There are the following surgical procedures for the treatment of endometriosis:
Laparoscopic surgery (minimally invasive surgery) can be used to diagnose and treat endometriosis.
A thin tube is inserted into the abdominal cavity through a small incision and adhesions and cysts are removed (excision) or burned (diathermy).
This type of procedure causes significantly fewer postoperative complications and recovery times are shorter than after open surgery.
Laparotomy (abdominal incision) is a significant surgical procedure performed to cut out or burn tissues and cysts if more severe endometriosis is present.
Bowel surgery may be necessary if the intestine has developed scars due to endometriosis.
Removal of the uterus (hysterectomy) may be an option if endometriosis significantly reduces the woman’s quality of life and other treatments have been unsuccessful.
If the ovaries are removed during hysterectomy, hormone replacement therapy should be discussed with the doctor.
Endometriosis and complementary or alternative medicine
Natural treatment methods are helpful for some women.
It is important to discuss with the doctor what complementary treatments are being performed and whether they may interfere with other therapies.
Here is a list of alternative treatments:
- Natural medicines
- Homeopathy
- Traditional Chinese Medicine
- Diet
- Massage
- Yoga
What to eat? Diet and nutrition
According to the principles of naturopathy, almost all disorders of our body are caused by improper nutrition, medications, nutritional supplements and surgical intervention.
Meat, animal proteins in general and dairy products are not suitable for feeding the human body, sugar is “poison”, and cooked food is “dead” from the point of view of nutritiousness.
A healthy diet consists of natural foods: raw foods, nuts and fresh fruit, legumes, whole grains (white rice should be avoided).
Prevention
It is not possible to detect endometriosis, also because the causes are still unknown.
However, prolonged use of contraceptive hormones (in the form of patches, pills or hormone rings) can prevent worsening of endometriosis.
