The most common position for these formations (called endometrial implants) are the outer surface of the ovaries and the uterus, fallopian tubes, ligaments supporting the uterus (eg, uterosacral ligament), Douglas’s cord, navel, intestine rectum, bladder, inguinal lymph nodes, the diaphragm, the pelvic peritoneum the area between the vagina and rectum.

The most frequent endometriosis is the ovarian. 
It is rarely formed in the liver or lungs.

The endometrium normally responds to sex hormones, estrogen and progesterone. 
In women with endometriosis, the abnormal endometrial cells that are located in the pelvic cavity respond to these hormones. 
During ovulation , the endometrium and outer endometrial cells become hard. Unlike the endometrium, out-of-place cells can not leave the body through menstruation. 
This phenomenon causes loss of blood , inflammation and pain. 
Over time, this process can create fibrous tissue. 
Endometriosis can cause very painful menstruation and can reduce fertility , but there are several treatment options. 
This causescysts , painful cycles , severe cramps and even infertility .

However, the symptoms of endometriosis may vary and some women may have few or no symptoms.

 

Why does endometriosis cause pain and health problems?

Endometriosis is a benign (noncancerous) disease, but it can cause health problems. 
Each month, hormones cause the creation of tissue and blood vessels lining the uterus in a woman. If a woman does not become pregnant, the uterus expels this tissue and the blood. 
This leaves the body through the vagina with menstruation. 
Even the endometrial implants respond to the hormones produced during the menstrual cycle. 
Over time, the growth of endometriosis may increase with  addition of blood  and other tissues . 
The symptoms of endometriosis often get worse.

The tissue and blood that remain inside the body can cause inflammation, scars and pain. 
The developing endometrial tissue can grow in the ovaries and fallopian tubes. 
Blood trapped in the ovary can form cysts. 
This fibrous tissue can cause pelvic pain and can make pregnancy difficult for women. Endometrial tissue can cause problems to the bowel and urinary bladder.

Some scientific studies have found a link between endometriosis and cancer ovarianor endometrial cancer. However, it is not known if endometriosis is a risk factor or if both diseases have the same origin.

 

Stages or degrees of endometriosis

  • First stage (minimum)
    In the initial stage small cysts are observed with sizes varying between 1 and 3 mm.
  • Second stage (mild)
    The second stage of endometriosis is characterized by black tissue over a white fibrous area and the size is between 1 and 2 cm in diameter. These points are located in the basin or diaphragm.
  • Third stage (moderate)
    At this stage the cysts are larger than 4-5 cm and may cover the ovaries. Adhesions may also form on the pelvis or other pelvic organs.
  • Fourth stage (deep)
    The last stage is characterized by solid tumors up to 5 or 6 cm in diameter. These formations are mainly located between the wall of the uterus and the rectum.

 

Causes of Endometriosis

The cause of endometriosis remains unknown, but the research suggests a number of possible causes and risk factors.

Endometriosis and Retrograde Menstruation Retrograde
menstruation occurs when the menstrual fluid moves into the fallopian tubes, rather than exiting the body through the vagina. 
Since it can not enter the ovaries of the fallopian tubes, the menstrual fluid may drip into the pelvic cavity. 
In women suffering from endometriosis, it is suspected that the endometrial tissue contained in the menstrual fluid installs into whatever structure it arrives at (like the ovaries) and the cells begin to grow.

Endometriosis and the Immune System
Retrograde menstruation occurs in almost all women, but only three in ten percent of menstruating women develop endometriosis. 
One theory suggests that some women’s immune systems allow endometriosis to grow because it does not control or for the growth of endometrial tissue outside the uterus.

Genetics and Endometriosis
Researchers suggest that heredity may play a role in the development of endometriosis. Women who have a first-degree relative (mother or sister) with endometriosis are more likely to have the disease.

Treatment for infertility
Endometriosis is diagnosed in some women who undergo treatment for infertility .

 

Endometriosis Risk Factors

Here are some of the suspected risk factors:

  • Menstrual factors – including early onset of menses, menstrual pain , short menstrual cycles (less than 27 days), or long periods of menstruation (more than a week)
  • Allergies , eczema and hay fever
  • Obesity
  • Family history of endometriosis
  • Exposure to toxins – some research suggests that environmental pollutants, such as dioxins, may contribute to the development of endometriosis.

 

Symptoms of Endometriosis

Endometriosis is asymptomatic in one in four women, but in other cases it can cause severe symptoms.

The main symptom of endometriosis is pelvic pain, often associated with the menstrual phase. 
Although many women experience cramps during menstruation, women with endometriosis report that menstrual pain is worse than usual. 
They also report that pain is increased over time.

 

Signs and Symptoms of Endometriosis:

  • Painful menstruation (dysmenorrhea).
  • Pelvic pain and cramping may begin before the menstrual period and may extend for more than a few days. This includes lower back and abdominal pain.
  • Groin pain that can be described as blazing
  • Pain during or after intercourse is common with endometriosis.
  • Pain during defecation or urination. You are more likely to experience these symptoms during the menstrual phase.
  • Often, the patient feels a pain similar to inflammation of the sciatic nerve . This causes a constant disturbance with back pain that continues from the leg to the foot .
  • Excessive bleeding.
  • Rarely, there may be heavy menstruation (menorrhagia) or bleeding during the non-menstrual phase (menometrorrhagia).

Other symptoms

It is also possible to feel fatigue , diarrhea , constipation or nausea , especially during the menstrual phase. 
Endometriosis sometimes swells up the belly . 
The severity of pain is not necessarily a reliable indicator for the diagnosis. 
Some women with mild endometriosis may experience severe pain, while others with advanced endometriosis may experience little or no pain at all. 
Endometriosis is sometimes mistaken for other diseases that can cause pelvic pain, pelvic inflammatory disease, or ovarian cysts . 
It can be mistaken for irritable bowel syndrome, a disease that causes episodes of diarrhea, constipation and abdominal cramps . 
If the patient suffers from irritable bowel syndrome endometriosis can complicate the diagnosis.

 

Complications and consequences

Infertility
The main complication of endometriosis is infertility. 30% to 50% of women with endometriosis have problems getting pregnant. 
To get pregnant, your ovary releases an ovum, it must travel through the nearest neighboring fallopian tube, then it must be fertilized by a sperm, then it must penetrate the uterine wall to begin development. 
Endometriosis can obstruct the tuba and prevent the union between the ovum and the sperm. 
This disease seems to affect fertility in a less direct way, such as damage to sperm or ovule. 
Even so, many women with mild and moderate endometriosis can lead to full term pregnancy.
Doctors advise women with endometriosis not to wait to have children because the disease may worsen over time.

 

Risk of endometriosis and cancer

According to some scientific studies, women with endometriosis have an increased risk of developing certain types of ovarian cancer , known as epithelial ovarian cancer. 
The risk is higher in women with endometriosis and primary infertility (those who have never had a pregnancy). 
However, the use of oral contraceptive pills seems to substantially reduce this risk. 
The reasons for the association between endometriosis and ovarian epithelial cancer are still unclear. 
One theory is that endometriosis turns into cancer cells.
Another possibility is that the presence of endometriosis may be related to other genetic or environmental factors that increase the risk of developing ovarian cancer in a woman.

 

Diagnosis of endometriosis

If the doctor suspects endometriosis, refer the patient to a gynecologist to make the necessary analyzes. 
The first examination to be performed is transvaginal ultrasonography showing endometrial cysts containing blood. 
The MRI is a useful test to diagnose the extent of endometriosis.

In blood tests we can observe the CA125 human glycoprotein values ​​that are high in endometriosis, but even if the patient suffers from other diseases (eg, uterine fibroidsor uterine cancer).
The fat suppression technique allows the differentiation of fat-containing cysts from those with blood. 
Endometriosis can be diagnosed through an exam called laparoscopy.

 

Laparoscopy

For this procedure a general anesthesia is administered and inserting a tube with a camera in the end (laparoscope) in the body. 
The laparoscope is an instrument with a small camera that transmits images to a monitor, so the specialist can see the endometriosis tissue. 
The specialist takes a small sample (biopsy) for laboratory tests or inserts other surgical instruments to treat endometriosis. 
The surgeon inserts a laparoscope into the area where he thinks of finding endometriosis tissue. 
Since many women have symptoms around the abdomen and pelvis, usually a laparoscope is inserted into the pelvis through the navel. 
It is usually possible to go home the same day the laparoscopy was done.

 

Treatment for Endometriosis

Endometriosis can be treated with medication or surgery. Some women have benefited from natural treatments. 
In mild cases of endometriosis, it is possible to control the disease with regular visits to the gynecologist. 
Medications that inhibit prostaglandins, for example non-steroidal anti-inflammatory drugs like ibuprofen may help control any associated pain. 
If the symptoms progress, it is best to talk about treatment options with your doctor before making a final decision. 
Remember that mild endometriosis can become moderate or severe. 
Removal of scar tissue by surgery is the most effective therapy to decrease the likelihood of recurrence. 
Hormone treatment for endometriosis
Off-site endometrial cells are sensitive to hormones and respond to cyclical fluctuations of estrogen and progesterone during the menstrual cycle. This causes bleeding and pain that hormone therapy can handle with excellent results. 
Options for hormone therapy are:

1. Progesterone, are a group of synthetic hormones equal to progesterone, which suppress the growth of the endometrium out of place. 
The side effects are weight gain, mastalgia, acne , depression , mood swings, fatiguenausea and vomiting .

2. Gonadotrophin releasing hormone agonists are chemicals that trigger a reaction in cells. 
These drugs control the amount of estrogen produced and this inhibits the growth of out-of-place endometrial cells. 
Side effects are symptoms of menopause , ie thinning of bones, hot flashes, dry vagina, headache , depression, loss of libido ( sexual desire ), and nighttime perspiration . 
These side effects can be alleviated with estrogens and progesterone. The contraceptive pill is often used to get the long-term suspension of endometriosis symptoms.
It can be used to stop the progression of the disease in women with mild disease or recurrence after surgery or hormonal treatment. Gestrinone is a synthetic hormone that has antiprogesterone activity and suffocates the out-of-place endometrium. 
The effects of gestrinone include weight gain, acne, depression, mood swings, heat waves and loss of libido. 

3. Danazol is a mild form of testosterone (male hormone), which reduces the amount of estrogen produced by the ovaries to the same level that occurs during menopause. 
Without estrogens, the endometrial cells can not grow out of place. 
Danazol is rarely used to treat endometriosis because of its serious side effects.

4. Combined treatment for endometriosis. 
In some cases, a woman can have benefits with hormone therapy as well as surgery. Hormonal treatment can be done before or after surgery depending on the circumstances.

 

When to operate? Surgery for endometriosis

The surgical procedures used to treat endometriosis are: 
Laparoscopy (minimally invasive) can be used to diagnose and treat endometriosis. 
A thin tube is inserted into the abdominal cavity through a small incision and removed (excised) or burned (diathermy) adhesions and cysts. 
This type of intervention causes fewer postoperative complications and recovery times are faster than open surgery.

Laparotomy is an important surgical procedure that is used to cut or burn tissues or cysts when endometriosis is most severe. 
Intestinal surgery may be necessary if the bowel has developed scars caused by endometriosis. 
Removal of the uterus ( hysterectomy ) may be an option if endometriosis has a significant impact on quality of life and if other treatments did not work. 
If the ovaries are removed during a hysterectomy, it is possible to talk to your doctor about hormone replacement therapy.

 

Endometriosis and complementary and alternative medicine

Natural therapies are useful according to some women. 
It is important to always inform the doctor about the complementary therapies you are using and whether they may influence other treatments. 
Some examples of natural treatments:

  • Herbal medicine
  • Homeopathy
  • Traditional Chinese medicine
  • Diet
  • Massage
  • Yoga.

 

What to eat? Diet and food

According to the principles of naturopathy and hygienism, almost all the diseases we have are caused by surgery, medications, supplements and incorrect diet. 
Meat, animal proteins and dairy products are not suitable for nourishing the body, sugars are “toxic” and cooked foods are “dead” at nutritional level. 
Healthy eating consists of foods that are not processed by humans: raw vegetables, fresh and dried fruits, vegetables, whole grains (best to avoid white rice).

 

Prevention

It is not possible to predict endometriosis. This is because the cause is not yet known. 
However, prolonged intake of contraceptive hormones (pills, dressings or rings) may prevent endometriosis from worsening.

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