What is Endometriosis, and what characterizes it?
Endometriosis is a chronic gynecologic disease characterized by endometrial-like tissue outside the uterus. As an estrogen-dependent disorder, those ectopic lesions undergo cycles of growth and bleeding in synchrony with the menstrual cycle.
The three main types are:
- Ovarian
- Peritoneal
- Deep infiltrating
How does Endometriosis occur?
There are several hypotheses arguing about the origin of Endometriosis; however, Sampson’s theory of retrograde menstruation is the most widely accepted.
The theory holds that endometrial tissue shed during menstruation is transported via the fallopian tubes into the peritoneal cavity, which implants on the pelvic organs’ surface. Other mechanisms have also been proposed, but none explains all cases of Endometriosis. Nevertheless, each contributes to it to some extent.
It should be emphasized that Endometriosis is also characterized by an altered behavior of the woman’s immune system and that there is also a complex genetic component. The latter also explains why Endometriosis occurs more frequently in families.
What symptoms may indicate that I have Endometriosis?
Severe menstrual pain. These start shortly before or at the beginning of menstruation and are sometimes so intense that the affected women can only manage their daily lives to a limited extent.
Non-menstrual pelvic pain. It is often uncharacteristic and is independent of the timing of menstruation.
Pain during defecation (dyschezia) and micturition (dysuria). Both result from the involvement of the corresponding organs by Endometriosis (rectum, bladder).
Infertility. The prevalence of Endometriosis increases dramatically in women with infertility, and many women with Endometriosis are infertile.
Severe pain during sexual intercourse.
(Non-specific) Migraine, mood swings, sleep disorders.
It is worth noting that several studies have shown that the severity and the stage of the disease do not correlate with the symptoms. Women with advanced disease may have few or no symptoms, and those with minimal or mild disease may have incapacitating pain. An exception is deep infiltrating Endometriosis.
How is suspected Endometriosis diagnosed?
Surgery is currently required for definitive diagnosis, and laparoscopy with histologic examination of the excised lesions has traditionally been the gold standard.
The histologic criteria of excised lesions can confirm surgical impressions, which are preferred, but not required to establish the diagnosis.
Transvaginal ultrasonography and MRI are highly sensitive and specific for detecting ovarian endometriomas. Still, they cannot reliably image peritoneal implants of the disease.
How does Endometriosis affect my desire to have children?
Endometriosis is known to affect female fertility in several ways.
- Distorted anatomy. The distorted anatomy can inhibit or prevents egg release and capture after ovulation.
- Chronic inflammation. It affects ovarian, tubal, or endometrial function.
- Premature depletion of the ovarian follicular pool. It may result from endometriosis cysts on the ovary or chronic inflammation of the ovary.
- Abnormal expression of genes in the endometrium. This could lead to an impeded embryo implantation.
I was diagnosed with Endometriosis. What now?
The treatment of Endometriosis depends on its clinical manifestations, which currently fall into two categories: pelvic pain and infertility.
It can be expectant or involve one or a combination of medical treatments, conservative or definitive surgery, or medical and surgical treatments. Expectant management is generally reserved for patients without significant symptoms and those approaching menopause. Young women with substantial symptoms usually require more aggressive medical or surgical treatment.
Ultimately, treatment decisions must be individualized after carefully considering the severity of symptoms, the extent of the disease, the desire for future pregnancy, age, and potential side effects.
What can I do myself to relieve my symptoms?
Change of diet and exercise. A diet rich in vital substances and plant-based can ease the intensity of the symptoms. Several studies have shown that vitamins B1, C, E, and folic acid are effective.
Avoid Stress. Endometriosis is more painful the tenser the woman is. Therefore, avoiding stressful situations and finding ways to cope best is essential. Autogenic training, muscle relaxation exercises, yoga, or similar can reduce stress in everyday life.
Existing desire to have children and Endometriosis
It should be emphasized that many women with Endometriosis can become pregnant and usually have children. Many of them do not even know that they have Endometriosis.
Studies on the relationship between mild Endometriosis and surgical removal of Endometriosis in the presence of a current desire to have children are controversial.
The situation is different for women who have severe pain. In this case, the surgical intervention aims to relieve the patient of the pain, especially before proceeding with assisted reproductive techniques (ART), which can stimulate endometriosis lesions and intensify symptoms.
In a prospective cohort study involving 169 infertile women under age 38 with symptomatic deep infiltrating Endometriosis, the pregnancy rate achieved within in vitro fertilization was significantly higher in women who chose to have preliminary surgical treatment.
It is clear that In vitro fertilization is currently the most effective treatment of Endometriosis- associated infertility, especially in women with advanced disease.
Would you like to have more information?
Christos Roukoudis, M.D. is a gynecology and obstetrics specialist specializing in gynecological endocrinology and reproductive medicine. He possesses the highest level of expertise in treating disorders of gynecologic endocrinology, including Endometriosis. Request an appointment now for more information.
- Gruppos Italiano per lo Studio Dell’Endometriosi, Relationship between stage, site and morphological characteristics of pelvic endometriosis and pain, Hum Reprod 16:2668, 2001.
- Vercellini P, Trespidi L, De Giorgi O, Cortesi I, Parazzini F, Crosignani PG, Endometriosis and pelvic pain: relation to disease stage and localization, Fertil Steril 65:299, 1996.
- Fedele L, Bianchi S, Bocciolone L, Di Nola G, Parazzini F, Pain symptoms associated with endometriosis, Obstet Gynecol 79:767, 1992
- Porpora MG, Koninckx PR, Piazze J, Natili M, Colagrande S, Cosmi EV, Correlation between endometriosis and pelvic pain, J Am Assoc Gynecol Laparosc 6:429, 1999
- Koninckx PR, Meuleman C, Demeyere S, Lesaffre E, Cornillie FJ, Suggestive evidence that pelvic endometriosis is a progressive disease, whereas deeply infiltrating endometriosis is associated with pelvic pain, Fertil Steril 55:759, 1991.
- Anne Marie Darling, Jorge E. Chavarro, Susan Malspeis, Holly R. Harris, Dr. Stacey A. Missmer https://doi.org/10.5301/JE.5000151
- Bianchi PH, Pereira RM, Zanatta A, Alegretti JR, Motta EL, Serafini PC, Extensive excision of deep infiltrative endometriosis before in vitro fertilization significantly improves pregnancy rates, J Minim Invasive Gynecol 16:174, 2009.
