What is Endometriosis

endometriosis It is a common disease in our society with significant medical and emotional implications. Not all women with endometriosis have symptoms or discomfort. On the other hand, others report pain with their rules and relationships, as well as a poor quality of life.

Women with endometriosis frequently come to our clinic for gynecology.

On Institute of Dra. Gómez Roig endometriosis is studied and treated as an integrated pathology in our medical services.

La endometriosis It is a disease in which we find endometrial tissue outside its usual place.

The most frequent places where endometriosis is usually found are the ovaries, Fallopian tube, and the intestine among others.

Endometrial tissue grows inside the uterus and sheds each month giving the rule. This tissue is called endometrial tissue, which in cases of endometriosis, can be found abnormally elsewhere.

Some women with endometriosis do not know they have it by not presenting any symptoms.

In contrast, others present dolor abdominal with the rules or with sexual relations. Another percentage, not the majority, have difficulty getting pregnant.

Endometriosis is a personal predisposition that is maintained throughout a woman's fertile life. It is hormone-dependent and therefore there is no definitive cure if the woman is in her fertile stage. During menopause this disease improves.

Despite this, there are several treatment options to minimize pain and complications that may appear. Treatment should always be individualized and tailored to each woman.

How common is the disease?  

The prevalence of this disease in the general population is unknown. Estimates vary depending on the population studied, whether it is symptomatic or asymptomatic. It also depends on the diagnostic method: if it is a clinical diagnosis or after a surgical intervention.

The disease is diagnosed in 25-38% of adolescent girls with chronic pelvic pain. And also in 47% of people with chronic pelvic pain, who require a laparoscopy.

What are the causes of endometriosis?

The actual cause of this disease is currently unknown.

One of the existing theories about what are the causes of endometriosis, is that of retrograde menstruation. This is based on the fact that during menstruation part of the period blood flows backwards from the uterus through the fallopian tubes and passes to the abdomen and its structures. Subsequently, this tissue with endometrial cells grows giving inflammation and pain.

Other theories include:

• The spread of cells, or endometrial tissue, through the lymphatics and blood vessels.
• The existence in the abdominal cavity of cells capable of differentiating or becoming endometrial tissue.
• Sometimes by direct transplantation: this explains the endometriosis that develops in the perineal scar after childbirth, in the cesarean section scar, and in other surgical scars.
• A deficiency in cellular immunity, in the defenses of women, a moment that favors the proliferation of endometrial tissue outside its usual place.

There are other theories, and ongoing research, to find a real cause.

What symptoms does endometriosis cause?

There are women with endometriosis who do not have any discomfort, and may even be unaware that they have it.

Instead, others have the most common symptom: pain in the lower abdomen called pelvic pain. This pain is usually accentuated when the woman has her period. In medical terms this pain is called dysmenorrhea.

Less frequently, pain may also appear with sexual intercourse, which is called dyspareunia. Some women have pain with bowel movements or urination, especially during menstruation.

Apart from the pain, other events related to endometriosis may coexist:

• Greater difficulty getting pregnant. This can happen because this disease causes inflammation and damages the ovaries or fallopian tubes.
• endometriomas  or chocolate ovarian cysts. If endometrial tissue accumulates in the ovary, it can cause ovarian cysts that contain endometriosis. Endometriomas are filled with old blood that darkens over time and resembles melted chocolate.

Is pelvic pain always due to endometriosis?

El pelvic pain It can be caused by different causes among which is endometriosis. It is always necessary to carry out the differential diagnosis so as not to make mistakes in the approach and treatment.

In the face of abdominal pain that persists, we must think about:

• Endometriosis: when cells that should only exist in the uterus grow outside of it. Women who suffer from it often have very painful periods with their periods. In some cases, they also have trouble getting pregnant.
• Pelvic inflammatory disease: This disease appears after an infection that usually occurs through sexual intercourse. Some women have pain after a while, due to the residual scarring left after the infection. They may also have problems getting pregnant in the future.
• irritable bowel syndrome: This syndrome is an inflammatory process of the intestines that causes pain and problems with bowel movements. Women with irritable bowel syndrome usually also have constipation or diarrhea.
• Painful bladder syndrome or interstitial cystitis: Women suffer pain in the bladder when it is filling up. Women with this problem often feel better when they empty their bladders, so they go to the bathroom more often.
• Pain in the pelvic floor muscles: pain occurs in the muscles of the pelvic area due to lack of relaxation and increased sensitivity.
• Fibromyalgia: is a disease that causes pain in various parts of the body and not just in the abdomen

Differentiating the cause well is necessary to carry out an adequate treatment.

How can I know if I have endometriosis?

To find out if a woman has endometriosis, she must perform a gynecological review with the specialist doctor. If you have endometriosis symptoms you can check to rule it out.

In a gynecological physical examination and with the practice of a bimanual vaginal examination, it can be suspected.

La gynecological ultrasound can see if there are ovarian cysts or endometriomas.

Magnetic resonance imaging (MRI) may be helpful in further defining a suspicious abnormality that is not clear on ultrasound. Despite this, the NMR it should not be used as a first-line imaging test due to its cost and poor detection sensitivity.

CT scan or TAC it is also an insensitive test to study this disease, unless an endometrioma-like cyst is identified.

Finally, the diagnosis It is performed if there is a tissue sample and the pathology analysis confirms it. This is possible after surgeries. But, an intervention is not always indicated in these cases.

This pathology is considered mild, moderate or severe depending on what is found during surgery.

Women with mild disease may have severe symptoms, and women with severe disease may have mild symptoms. That's why it's important to know what is endometriosis and everything related to this disease.

It is important to note that surgery does not cure this disease. And it won't necessarily lead to long-term improvement in symptoms. While the woman's fertile stage lasts, this inflammation can remain active.

Types of Endometriosis 

The types of endometriosis, which appears mostly inside the abdomen, can be classified as superficial, ovarian and deeply infiltrating.

The general appearance and size of the implants are highly variable at the time of surgery.

According to the classification we talk about:

superficial endometriosis 

Sometimes there are small implants of endometrial cells superficially in different tissues. A common example is the inner wall of the abdomen called parietal peritoneum. Sometimes it can also appear in the superficial layer of the different organs, called the visceral peritoneum.

Involvement of the parietal or visceral peritoneum are usually findings found on laparoscopy. If laparoscopy or surgery is performed due to pain with menstruation or sexual intercourse, it is common to find this type of superficial implants. These can be burned or removed in one operation.

ovarian injury

La ovarian injury and formation of cysts called endometriomas form when endometrial tissue causes some bleeding within the ovary. These have hard, capsule-shaped walls and are filled with a chocolate-colored syrup or liquid.

deeply infiltrating

La deeply infiltrating endometriosis It is defined as an affectation that penetrates the structures. For example, a mass located more than 5 mm deep in the peritoneum.

There are several places where this disease can appear infiltrating. The most common sites are the ovaries, lower-posterior part of the abdomen, between the uterus and the bladder. Also in lateral ligaments of the uterus, posterior ligaments of the uterus, fallopian tubes, intestine, and appendix.

Other less commonly involved sites include the vagina, cervix, other intestinal parts, scars after childbirth or after a cesarean section, and the navel.

How are endometriosis and endometriomas treated? 

To treat endometriosis we have several therapeutic options:

• Analgesics and anti-inflammatories to treat pain. The ones of choice are NSAIDs: non-steroidal anti-inflammatory drugs.
• contraceptives so that there is no hormonal activity at the level of the ovaries.
• Other forms hormone treatment to block hormone production and create an artificial menopause: Gonadotropin-releasing hormone (GnRH) agonists.
• Surgery.

Before deciding on a treatment, it is necessary to know which are the most frequent symptoms. As well as the future plans of the woman related to the desire or not of pregnancy. These data must be very clear and we show you all in this post, what is endometriosis and what we show you next.

Anti-inflammatories (NSAIDs)

It is recommended to start treatment with anti-inflammatories one or two days before menstruation, since in this way it prevents and reduces pain.

The ELDERS reduce inflammation, but do not reduce or prevent the growth of endometriosis.

Examples of NSAIDs are ibuprofen and naproxen sodium.

Sometimes these medications do not completely relieve pain related to the disease. They probably work best when combined with another treatment, such as hormonal birth control.

Side effects of NSAIDs, although rare, include stomach upset, kidney problems, and increased blood pressure.

Hormonal contraceptives 

The hormonal contraceptives with estrogen and progesterone: the classic pill, the patch and the vaginal ring, are often useful to treat pain because they reduce heavy bleeding.

Progesterone-only contraceptives: mini-pill and subcutaneous implant, are also very effective in controlling endometriosis-related pain. The progesterone IUD can also be very effective in treating pain.

The Side effects of estrogen-containing contraceptives are: nausea, increased breast tenderness, and irregular vaginal bleeding.

These effects usually improve after using the treatment for several months.

Serious side effects, such as thrombosis, are rare in women who do not smoke.

Smoking is not advised if you take hormones.

Side effects associated with progesterone are: bloating, weight gain, irregular vaginal bleeding, acne, and rarely, worsening depression.

Gonadotropin-releasing hormone (GnRH) agonists

The GnRH agonists are medications that work by causing a temporary menopause. The treatment causes the ovaries to stop producing estrogen, which makes the endometriosis implants unable to function.

This treatment reduces pain in more than 80% of women, including women with severe pain.

GnRH agonists cannot be used if there is a desire for pregnancy.

Women can take this medication, but it is not recommended for more than 12 months. Menopause, even artificial, can cause loss of bone density.

How is endometriosis operated? 

Surgery or operation could be a correct option to treat this pathology in specific cases such as:

• If there is severe localized pain that does not respond to medical treatments.
• The existence of a mass or tumor that grows in the pelvic area. Surgery can remove the mass and together with subsequent pathology study can confirm the diagnosis.
• In the face of continued difficulty in achieving pregnancy.

The goal of surgery is to remove the implants and scar tissue.

More than 80% of women after the intervention have less pain.

However, there is a good chance that the pain will return over time if medication is not taken.

La laparoscopy It is the most widely used technique for this type of disease. Sometimes the situation may require open surgery. Each case is different and must be individualized.

endometriomas, or chocolate ovarian cysts, they are usually operated if the size exceeds 4 to 5 cm, if they give symptoms or grow. Removal of smaller endometriomas is not recommended, as they do not appear to be the cause of possible sterility, and operating on the ovary may reduce its reproductive capacity over time.

Disadvantages of the operation

disadvantages of the operation they include the risk of injury to neighboring organs, especially the bowel and bladder. As everything is inflamed, they are usually surgeries with a little more risk. Operating the ovary may also have a decrease in future fertility of the ovary. Adhesions or subsequent scars can also occur in these surgeries.

We generally avoid surgery in women with:

• A pelvic pain without a complete study.
• Persistent pelvic pain after several repeat surgeries.
• Women who are approaching menopause: the stage in which there is no longer hormonal activity prevents endometriosis from progressing, which is why it is considered a treatment as such.

What happens if I have endometriosis and I get pregnant? 

If a woman who has endometriosis becomes pregnant, the disease cannot affect the pregnancy. The growth of the fetus does not influence the disease either. On the other hand, on not insignificant occasions, the discomfort of this disease can improve after pregnancy. Everything to keep in mind in What is Endometriosis.

Pregnancy in a woman with endoemtriosis should never be discouraged.

What should I do if I don't get pregnant? 

If pregnancy is not achieved, there are several options to treat sterility or infertility in women with this disease.

The best treatment is one that adapts to the individual characteristics of the woman.

Within this treatment, age must also be taken into account. Whether there are other infertility problems and how severe the endometriosis is.

Treatment options include:

• Medication to improve fertility such as clomiphene. These medicines allow correct ovulation.
• Pharmaceutical products which also stimulate ovulation together with artificial insemination.
• Surgery to remove endometriosis and/or endometriomas.
• In vitro fertilization (IVF).

How does Endometriosis act during Menopause? 

During menopause, the ovaries stop working and stop producing female hormones. This fact implies that at menopause substances that stimulate the growth of endometriosis are no longer produced.

This disease is hormone-dependent, and therefore menopause can cause the completion of the process.

It is not always accurate, but in most cases it improves or stops bothering at the stage of life.

If a woman enters menopause, treatment alternatives are left to observe how the disease evolves with age.

On Institute of Dra. Gómez Roig problems related to gynecology are attended to. Being the endometriosis a frequent disease that requires good specialized medical support.

If you think you may have this disease, you have read this entry what is endometriosis and you think you have it. Do not hesitate to come to our center.

Our specialists will assist you with professionalism and humanity.