What is Endometriosis?
Endometriosis takes its name from endometrium, which is the inner lining of the uterus. Once a woman is of childbearing age, the endometrium thickens during the first half of each menstrual cycle. Its role is to welcome the embryo. If no fertilization occurs, the endometrium degrades and is evacuated at the end of the cycle.
Endometriosis occurs when endometrial mucosa forms outside the uterus. These tissues will then behave like the endometrium and destroy themselves at the end of each menstrual cycle, but will not be evacuated. The blood and endometrial tissues will then irritate the surrounding organs and form fibrous scars and - in some cases - cysts. This colonization of abnormal tissues can extend to the ovaries, ligaments supporting the uterus, fallopian tubes, urinary system, digestive system, and in rare cases to the lungs.
Endometriosis is one of the most common gynecological disorders and affects 5-10% of women of childbearing age. It is estimated that 40% of women with pelvic pain during their menstruation are affected.
Symptoms of Endometriosis
Although symptoms of endometriosis vary from one woman to another and pathology can be asymptomatic for some, the disease usually causes pelvic and abdominal pain. These pains can be felt during menstruation, during sex, or when urinating and defecating.
Some women also complain of lower back pain, diffuse abdominal pain, feeling sick in general, chronic fatigue, and uneven and changing moods. In some cases, blood may also be present in the stool or urine.
Diagnosis of Endometriosis
Women often discover that they have endometriosis between the ages of 25 and 40 years old, following a consultation for severe pain or infertility.
Infertility can be a consequence of the disease, as 40% who have endometriosis are infertile.
What are the Causes of Endometriosis?
The exact causes of endometriosis are unknown, but several theories exist. Some researchers believe that it is due to a "retrograde flow" that takes place at the same time as menstruation. While the endometrial tissue is normally expelled through muscle contractions, the retrograde flow will reverse this and cause it to migrate towards the fallopian tubes and ovaries. This may explain why certain endometrial cells are found outside the uterus. This retrograde flow, however, cannot be the only cause of endometriosis as it is also found in some women who do not have the disease.
Another hypothesis that exists is that endometriosis is caused by immune system disorders that cause it to no longer detect and destroy endometrial tissue that lies outside the uterus.
Another theory states that it is cells that are already located outside the uterus that change into endometrial cells. This mutation would be due to genetic or environmental factors. Daughters and sisters of women with endometriosis would be more prone to the disease.
Treatment of Endometriosis
Endometriosis is difficult to diagnose as its symptoms vary in their intensity from one woman to another. However, it is important to consult a doctor as soon as the first symptoms of endometriosis appear. This way the disease can be better treated. The doctor will perform a pelvic ultrasound to confirm his diagnosis.
Once a diagnosis is made, hormone therapy may be considered to block the production of hormones by the ovaries and reduce bleeding. Analgesics and anti-inflammatories may also be administered to relieve pelvic and abdominal pain.
If medications are not effective, conservative surgery to remove the endometrial growths and scar tissue that is causing infertility may be considered. In this type of surgery, the uterus and ovaries are preserved. The operation provides pain relief in 70-100% of cases, but in the long term, the pain may return.
If all other treatments are not effective, a hysterectomy may be the last solution. This surgery involves removing the uterus and ovaries in order to stop any hormonal stimulation. This operation has serious consequences as it leads to permanent menopause and sterility.