Endometriosis is diagnosed in every tenth woman in the world. This is the statistics of the American College of Obstetricians and Gynecologists. In September, comedian Amy Schumer spoke about her illness – she published a post from the hospital with the caption “If your periods are very painful, you may have endometriosis.” The disease can indeed manifest itself as pain in the lower abdomen and heavy periods . And sometimes the symptoms are unnoticeable, and women learn about endometriosis after an unsuccessful attempt to get pregnant.
What is endometriosis and how does it occur?
Endometriosis is a disease in which the tissue lining the uterine cavity begins to grow outside of this organ. This tissue is called the endometrium, hence the name. Unhealthy tissue usually grows within the organs of the pelvic cavity. Most often, these are the ovaries and fallopian tubes. Less often, endometriosis affects the outer surface of the uterus and its ligaments, the bladder, and the rectum.
In essence, endometriosis is like menstruation, only outside the uterus. Endometrial tissue responds to changes in estrogen levels: it grows and bleeds during the menstrual cycle. Only normally, the blood flows out, and with endometriosis, it stays inside. This leads to inflammation of the surrounding tissue, and it often ends with the appearance of a scar. The growth of pathological tissue may not give any symptoms at all or manifest itself as pain and heavy bleeding.
It is not exactly known why endometrial tissue extends beyond its territory. Scientists have identified several theories for the development of the disease:
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retrograde menstruation theory – is that part of the menstrual blood and endometrial tissue during menstruation does not come out, but ends up in the pelvis;
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genetic – based on the fact that in some families several generations of women suffer from endometriosis, and certain races are more susceptible to the disease;
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immune – suggests that the body recognizes endometrial tissue outside the uterus as foreign and fights it through the development of inflammation;
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The theory of embryonic cell transformation – considers the influence of hormones on the development of endometrial cells during puberty.
Each hypothesis explains the mechanism of endometriosis only partially, so the disease is considered multifactorial.
Can a woman be predisposed to endometriosis?
There are only risk factors that increase or decrease the likelihood of a woman developing the disease.
Cases where the risk is higher
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You have a close relative with endometriosis (mother, sister, daughter).
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My period started before I was 11 years old.
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Your menstrual cycles are shorter than 27 days.
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Menstruation is heavy and lasts for a week or longer.
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You have been diagnosed with infertility.
Cases where the risk is lower
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You were pregnant.
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My period started late ( after 14 years ).
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You breastfed.
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You have a normal body mass index.
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Your meals are rich in fiber (vegetables and fruits).
Endometriosis usually occurs within a few years after menarche – the first period. During pregnancy, patients note improvements in their condition, and after menopause there are no complaints at all. Exceptions occur if a woman takes estrogen medications during postmenopause.
What are the symptoms of endometriosis?
The main symptom of the disease is pain. Some people endure it every month, while others cannot get out of bed or do any activity. The pain can be different and occur under different circumstances:
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during menstruation,
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during sex,
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during urination and bowel movements.
There are other symptoms, too. For example, a woman complains of constipation or diarrhea, nausea and fatigue during her period. Or she notes that she loses a lot of blood, and the menstruation itself lasts more than a week.
Endometriosis can be asymptomatic. Some women experience no discomfort at all during their periods, and the disease is discovered during abdominal surgery for another reason or when having difficulty conceiving a child.
Is it possible to differentiate between normal menstrual pain and a sign of endometriosis?
Dysmenorrhea – menstrual pain – is divided into primary and secondary.
Primary menstrual pain. Caused by contractions of the muscles and blood vessels of the uterus due to the production of natural chemicals in the body. They are called prostaglandins, and on the first day of menstruation, their level in the body is high. But after a few days, it decreases and falls – the pain disappears.
Secondary menstrual pain. Occurs when the female reproductive system is disrupted. It lasts longer than primary dysmenorrhea, may become stronger over time and not subside after menstruation. This type of pain occurs with endometriosis, but not only. Therefore, it is difficult to suspect the disease on your own.
How does a doctor make a diagnosis and what tests are needed for this?
Endometriosis may be suspected during a conversation and examination in a gynecological chair , as well as ultrasound and MRI. Clinical recommendations for gynecologists advise using these diagnostic methods.
But the diagnosis can only be confirmed by diagnostic laparoscopy. This manipulation is performed by a surgeon: he makes a small incision in the abdomen and passes a thin tube through it to examine the genitals inside and take a piece of tissue for biopsy. This study helps to find foci of endometriosis. The diagnostic operation does not leave scars, is not accompanied by significant blood loss, and you can be discharged after it on the same day or the next morning.
How is endometriosis treated?
It is impossible to cure the disease completely because doctors do not know the exact cause of the disease.
But it is possible to alleviate the symptoms of endometriosis. First of all, with the help of painkillers and hormonal drugs. The right drugs in the right dosage will be selected by a gynecologist.
Another way to combat the disease is surgery . Patients undergo laparoscopy, not for diagnostic purposes, but to remove areas of endometriosis from the affected organs. According to statistics, 75% of women note improvements after surgery. The pain may return after a while, but be less pronounced and cause less discomfort.
In some cases, surgeons perform a hysterectomy – removing the uterus and sometimes the ovaries. This is done if nothing helps relieve the pain and the patients do not plan to have children.
Is it true that women with endometriosis are infertile?
Not all women with endometriosis are infertile. But among the complications of the disease, this problem is given special attention. Women with this diagnosis have a harder time conceiving a child.
A scientific article published in 2004 in The Lancet reported that 35–50% of women with endometriosis are infertile. It is not yet completely clear what exactly causes infertility. It is possible that damage to the fallopian tubes and ovaries affects women’s fertility.
Endometriosis treatments and surgery do not improve fertility in patients with infertility. They may help with symptoms of the disease, but do not guarantee that it will allow you to become pregnant.
However, most women diagnosed with the disease are still able to have children and become pregnant without medication or surgery.
Famous women who were able to give birth to children and then have their endometriosis removed include comedian Amy Schumer and model Chrissy Teigen. Both have shared their difficult stories in the media. Schumer gave birth to a son despite her illness, and then had multiple endometriosis lesions removed, along with her uterus and appendix, which was also affected. Chrissy Teigen gave birth to two children before undergoing surgery. She does not specify which one.