Conception

Endometriosis: what it is, symptoms and treatments

Treatment of endometriosis depends on the severity of the disease, the symptoms and whether or not you want to have children. There is no mention of cures, because currently there is no definitive cure for endometriosis which therefore remains a chronic pathology. However, there are therapies to relieve pain and counteract infertility.

Endometriosis is a chronic pathology that affects many women and which, in 30-40% of cases, can lead to infertility.

Our uterus is lined internally by a particular tissue called the endometrium . The endometrium can be considered divided into two parts. The more superficial one undergoes the typical modifications that characterize the menstrual cycle: growth and flaking. The basal part instead has regenerative functions.

When the endometrium also develops in other parts of the body and not just inside the uterus, it is called endometriosis .

If you have endometriosis, this tissue can affect the ovaries, fallopian tubes, ligaments of the uterus, the area between the vagina and the rectum, the outer surface of the uterus, and the peritoneum (the tissue lining the peritoneal cavity).

Like the endometrium of the uterus, the endometrial tissue found in different areas is also subject to hormonal action and in particular to that of estrogen. Then it grows, flakes off and bleeds.

However, this bleeding does not have the possibility to go out and therefore the blood stagnates, inflames the affected area and as a result of the inflammation there is the formation of scar tissue. In the long run, this type of tissue can cause the formation of adhesions between the various organs. In addition to this there is the pain caused by inflammation which can coincide with the menstrual cycle or be constant. Even the adhesions themselves are a source of pain.

Endometriosis can get worse over time if left untreated. It is more frequent in women between the ages of 30 and 40, but can occur at any time during the period between the first menarche and menopause. Endometriosis occurs more often in women who have never had children. Women with a mother, sister or daughter who has had endometriosis are more likely to develop it. Endometriosis is found diagnosed in about three-quarters of women reporting chronic pelvic pain.

Symptoms

The symptoms are variable and depend from woman to woman. Pain intensity is not always a good indicator of disease severity. Some women with mild pain may be severe cases, while others reporting severe pain may be mild cases. In many situations the discovery of endometriosis is made when investigations are required because the woman is unable to get pregnant.

  •  pain before and during menstruation,
  • pain during sexual intercourse
  • chronic pelvic pain
  • pains associated with the location of the endometrial tissue: pain in the rectum, pain when urinating, pain in the lower back or along a limb, constipation or diarrhea .

A major symptom that affects 30-40% of women suffering from endometriosis is infertility .

Also for this reason it is important that it is diagnosed in time. Infertility can be due to damage to the ovarian tissues caused by endometriosis, or by adhesions that have compromised the relationship between the ovary and the tube. Or again from biochemical factors. In fact, it is thought that the modification of the peritoneal fluid could decrease the viability of the eggs.

Endometriosis diagnosis

To diagnose endometriosis, first of all a correct family history and the evaluation of all the symptoms are necessary. Then there are a series of more or less invasive tests that can help define the pathology.

Transvaginal ultrasound can give important indications but the certain diagnosis is obtained with laparoscopy which allows to evaluate the involvement of the organs and also to surgically remove the endometriotic lesions which will then be subjected to histological examination.

Of course, depending on the location of the symptoms, other instrumental investigations such as cystoscopy, colonoscopy, barium enema, or CT and magnetic resonance imaging can be used.

A marker in the blood can also be evaluated, the CA125 which, however, is also found in other inflammatory situations or pathologies.

Treatments for endometriosis

Treatment of endometriosis depends on the severity of the disease, the symptoms and whether or not you want to have children. There is no mention of cures, because currently there is no definitive cure for endometriosis which therefore remains a chronic disease. However, there are therapies to relieve pain and counteract infertility.

Treatment can be done with drugs or through surgery, or both. While treatments or surgeries may relieve pain and infertility for a time, symptoms may return after treatment.

In some cases of endometriosis, anti-inflammatory drugs (NSAIDs) are prescribed to relieve pain. These medications clearly don’t treat the other symptoms of endometriosis.

Hormonal treatments, on the other hand, can help slow down the development of endometrial tissue and prevent the formation of new adhesions, but not completely eliminate them. The most commonly prescribed hormones are:

  • Oral contraceptives
  • GnRH analogues
  • Progestogens
  • Danazolo

Another type of therapy is represented by surgery that allows you to remove the endometriosis and the scar tissue around it. In most severe cases of endometriosis, surgery is the best treatment.

Surgery is mainly performed via laparoscopy. During laparoscopy, the oedometriotic tissues are removed. In some cases, however, it is necessary to use a procedure called laparotomy. Your doctor will decide the best procedure depending on the location of the endometriosis.

Surgery is also not a definitive treatment because the symptoms can recur. 50% of patients report the return of symptoms one year after surgery. The more severe the endometriosis, the more likely it is to recur.

Women who suffer from endometriosis but are able to become pregnant may have a temporary remission of the condition. Pregnancy in fact involves a state of low estrogenic levels.

In some cases, therefore, women suffering from endometriosis are advised to become pregnant as soon as possible.

Endometriosis and nutrition

More and more studies show that the risk of endometriosis can be reduced thanks to a correct diet (rich in fruit and vegetables).

The risk, on the other hand, increases in the case of high consumption of red meat.

Nutrition also helps in controlling the symptoms of the disease.

In fact, inflammation is favored by a diet not only rich in red meat, but also in refined foods, rich in salt, sugar and dairy products.

To counteract the symptoms of the disease, it is necessary to increase not only the consumption of fresh fruit and vegetables (especially green leafy ones), but also whole grains and legumes. Seasonality is very important.

Exemptions in case of endometriosis

Endometriosis was included in the new LEAs in 2017.

The free services concern only the 3rd and 4th stage of the pathology.

The performance packages included in the Lea are two annex 8bis “old nomenclator” and annex 8 “new nomenclator”.

Basically, patients suffering from endometriosis will no longer pay for the gynecological check-up that is performed once every six months and for the necessary ultrasounds such as upper and lower abdomen, transvaginal or transrectal ultrasound.

To see all the exemptions and how to request them, please visit the APE Onlus page.

Kathryn Barlow is an OB/GYN doctor, which is the medical specialty that deals with the care of women's reproductive health, including pregnancy and childbirth.

Obstetricians provide care to women during pregnancy, labor, and delivery, while gynecologists focus on the health of the female reproductive system, including the ovaries, uterus, vagina, and breasts. OB/GYN doctors are trained to provide medical and surgical care for a wide range of conditions related to women's reproductive health.

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