Endometriosis is popularly known as the silent disease, as its symptoms are often confused with those of other less severe pathologies, leading to late diagnoses and the disease progresses without specific treatment.
A delay that also prolongs the sorrow that this disease generates in the women affected by not knowing what happens to them, how to alleviate the pain, and cope with the anxiety and stress they feel. This situation ends up affecting both the personal and working life of the sick, as well as becoming really invalidating and reducing her quality of life a lot.
According to specialists, this disease, still very unknown, affects about 170 million women worldwide and one million throughout Spain, about 10% of women of childbearing age.
What Is It?
Endometriosis is an inflammatory and chronic gynecological disease that consists of the presence of endometrial tissue outside the uterus. It is often located in the ovaries, although it can adhere to other organs and find spotlights in both the pelvic area, i.e. peritoneum, ovaries, intestine, and bladder, as well as in the skin or lungs.
The evolution of the disease is uneven and these tissues may evolve cyclically as the menstrual cycle and go so far as to bleed. Endometriosis is very painful, especially during menstruation, being intense pelvic pain.
Endometriosis presents a series of phases in its evolution. Thus, and attending to its extent, endometriosis may be:
- Stage I: without adhesions and isolated adhesions.
- Stage II or light: with adhesions spread through the area of the ovaries and the peritoneum.
- Stage III or moderate: implants multiply and can already be both superficial and invasive. Adhesions are located in the area of the ovaries or the fallopian tubes.
- Stage IV or severe: implants are already deep and numerous, with large cysts and extensive adhesions already located.
Causes
The causes of endometriosis have not yet been fully clarified, with only a series of possible explanations of its origin and development. These possible causes include:
- A retrograde menstruation process. Menstrual blood, rich in endometrial cells, does not come out of the body and returns to the pelvic cavity through the fallopian tubes. These endometrial cells end up adhering to the pelvic walls and pelvic organs, growing and thickening in each menstrual cycle.
- The transformation of cells lining the inner side of the abdomen, peritoneal cells, and embryonic cells into endometrial cells.
- Adherence of endometrial cells to surgical incisions such as C-sections or hysterectomy.
- Transportation of endometrial cells to other parts of the body through the blood vessels.
- Problems in the immune system prevent the body from being able to detect and destroy endometrial tissue that grows outside the uterus.
Added to these possible causes are several risk factors exposed in the Guide to Care for Women with Endometriosis, facilitated by the non-profit association that we want to have. Mulleres with endometriose of Galicia:
- Factors related to reproduction and menstruation: situations involving greater exposure to hormonal changes (early menarche, late menopause), shortening the intermenstrual period, longer duration of menstruation, greater volume of menstruation, small number of children, Daughters or sons and daughters, seem to increase the risk of endometriosis significantly. Breastfeeding also seems to reduce the risk of the disease.
- Factors associated with the female phenotype: an association between overweight and endometriosis has been described. Other associations of a specific phenotype (skin color, hair, etc.) with the disease are even more inconsistent if it fits more inconsistent.
- Lifestyle-related factors: exercise, tobacco, alcohol, and caffeine have been related to the incidence of endometriosis, although the evidence, again, is variablely solid, and sometimes contradictory. He referred to an inverse association of tobacco use with endometriosis, although at least one job does not find such an association. Moderate exercise, of at least four hours a week, has also been associated with the risk of endometriosis.
- Environmental factors: exposure to dioxins and biphenyl-polychlorinated compounds (PCB) has been experimentally correlated with endometriosis in Rhesus monkeys, but this association has not been able to be established epidemiologically in humans.
- Genetic factors: genetic factors are those, along with those related to reproduction and menstruation, for which there is stronger evidence that links them to the risk of endometriosis. There is a high coincidence of endometriosis between univiteline twin sisters (although theoretically, they could have the same environmental factors being involved), and the existence of a high family predisposition is known. However, to date, no genes specifically related to the disease have been identified, and the most accepted theory today is that these family constellations are due to the action of multiple genes of low or very low penetrance.
Symptoms
Endometriosis usually develops a few years after the onset of menstruation and has a slight improvement during pregnancy and even disappears when it reaches menopause. Among the main signs that we may have endometriosis are:
- Shooting or painful sexual intercourse when pressure is on affected areas during vaginal penetration.
- Dysmenorrhea or menstrual pains. This is one of the main symptoms of this disease and usually appears shortly after the first menstrual period. The pain is increased with each menstrual cycle.
- Abnormal uterine bleeding outside the menstrual cycle.
- Infertility or sterility. They’re not usually very frequent. Women with endometriosis are at higher risk of abortions.
Treatment
Once the disease has been diagnosed by physical examination, transvaginal ultrasound, and/or pelvic laparoscopy, treatment will be established based on the symptoms of the patient, how the disease is widespread, the age of the patient, and whether or not you want to become pregnant or not in the future.
Depending on where the lesions and adhesions occur, we can find ourselves in the face of peritoneal endometriosis, ovarian endometriosis, or deep endometriosis, the most severe and extensive.
Endometriosis treatments usually consist of hormones, analgesic therapies, and surgical methods. In addition to trying to eliminate pain with painkillers, antihyperal painkillers, and opioids; relaxation techniques can also be used to learn to live with pain and manage pain, in some cases psychological and physiothermal support is also often used. About hormonal therapies, contraceptives, and progesterone injections are often used to stop the development of tumors.
According to the guide to care for women with endometriosis in the National Health System (SNS) of the Ministry of Health, Social Services and Equality, the pharmacological treatment normally used according to its mechanism of action is:
- Analgesics / anti-inflammatory : paracetamol, ibuprofen, dexketoprofen trometamol, metamizole etc.
- Antihyperalges: amitriptiline, duloxetine, gabapentin, pregalin, etc.
- Opioids: morphine, fentanyl, methadone, etc.
To treat the disease surgically, operations such as a hysterectomy are usually used, the most invasive as it involves the removal of the uterus, tubes, and ovaries; a laparoscopy or a laparotomy.
Endometriosis surgery is not only comparable in complexity to oncological surgery, in many cases more difficult, but we are faced with unexpected situations that require a change of strategy or surgery with greater difficulty than expected. This is why the experience of the surgery staff and the team is of the utmost importance in complex laparoscopic surgery. Most surgery in cases of deep endometriosis should be performed by multidisciplinary teams that have professionals in gynecology experienced in advanced laparoscopic surgery and who know properly deep endometriosis.