endometriosis

What is Endometriosis?

Endometriosis is a condition in which the endometrial mucosa lining the inner wall of the uterus grows in other areas of the body.

This formation of ectopic tissue usually occurs in the pelvic area, outside of the uterus, ovaries, bowel, rectum, bladder, and the delicate membrane lining the pelvis. However, such growths may also occur in other parts of the body.

Endometriosis is a common problem. Sometimes it can occur in following generations of the same family. Although typically endometriosis is diagnosed between 25 and 35 years, disease probably begins when regular menstruation starts.

                     

causes

Every month, the ovaries produce hormones that stimulate the uterus mucosal cells (endometrium) to multiply and be prepared to receive a fertilized egg. The mucosa increases in size and becomes thicker.

If these cells (called endometrial cells) grow out of the uterus, endometriosis arises. Unlike cells normally found in the uterus that are released during menstruation, cells outside the womb remain in place. They sometimes bleed a little, but heal and are stimulated again during the next cycle.

The exact causes of endometriosis are not yet clear, but doctors raised some possible causes for the problem:

retrograde menstruation

This happens when the menstrual blood containing endometrial cells returns the trunks of fallopian and pelvic cavity instead of leaving the body of the woman. These lost endometrial cells install themselves on the walls of the pelvic organs and begin to grow. Nevertheless, they continue to operate normally, as if they were in the right place.

embryonic cell growth

Cells lining the abdomen and pelvic cavities originate from common embryonic cells. When in tissue differentiation process, the cells lining the intestine can becomes endometrial tissue and thus endometriosis may appear.

Poor immune system

Deficiencies in the immune system can also cause the disease, making the body unable to recognize and destroy the endometrial cells that grow in the wrong place.

other causes

After some surgery, hysterectomy as, e.g., endometrial cells may relate to surgical incisions. The lymphatic system can also carry endometrial cells to other parts of the body and lead to an endometriosis above in more distant sites such as the lung, for example.

                          

Risk factors

A woman whose mother or sister has endometriosis has six times more likely to develop endometriosis than women in general. Other possible risk factors:

Start too early menstruating
Never having had children
frequent menstrual cycles
Periods lasting seven days or more
Problems such as hymen unperforated, which blocks the passage of menstrual blood
Abnormalities in the uterus.

Symptoms of Endometriosis

The first symptom of endometriosis is pelvic pain almost always associated with the menstrual cycle. However, women with endometriosis usually said that pelvic pain during menstruation period is much worse than normal and increases over time.

Other frequent symptoms are:

Dysmenorrhea (pain during menstruation)
Pain in the lower abdomen or cramping that may occur for a week or two before menstruation cyclically
Pain penetrative sex
Pain when urinating and evacuating
Excessive bleeding during menstrual periods
Infertility
Fatigue
Diarrhea
Nausea.

The intensity of pain is not related to the extent of the problem. It may happen patient not even realize that have endometriosis, where the disease does not manifest symptoms. Moreover, often the signs of endometriosis can be confused with other diseases, so it is very important to consult a doctor before starting any type of treatment.

Diagnosing Endometriosis

The diagnosis of endometriosis can be done by describing the symptoms, but the physician may be requested to performing tests, for example:

pelvic exam, where the doctor investigates the pelvic region of the patient, looking for abnormalities, such as abnormal masses in the reproductive organs or scars

Ultrasound: analysis of the images allows the doctor to see if there are cysts in the organs of the pelvic region. This examination does not allow the specialist to diagnose the patient with endometriosis, but it helps in endometriomas identification, which are cysts associated with endometriosis

Magnetic Resonance Imaging: endometriosis can be detected as well as the endometriotic cysts or called deep endometriosis. It is a very invasive procedure such as ultrasound, but with a little more sensitive than ultrasonography

Laparoscopy: This method, though often be used as the final diagnostic option is considered the gold standard for the confirmation of the disease.

The surgeon makes a small opening in the abdomen, and with the aid of a laparoscope, evaluates the abdominal cavity looking for points ectopic endometrial or ovarian endometriomas (endometriotic cysts). Once found suspicious lesions, it removes a small sample of tissue and sends to laboratory analysis. The test results indicate whether the patient has endometriosis or not.


Treatment of Endometriosis

Treatment options include:

Medicines to control pain
Drugs to prevent endometriosis worsens
Surgery to remove the areas affected by endometriosis
Hysterectomy with removal of both ovaries.
Treatment depends on the following factors:

Age
Severity of symptoms
Disease severity
If the woman wants to have children.
Some women who do not wish to have children and have a mild disease and symptoms may choose to make only periodic checkups once or twice a year, so that the doctor check if the disease is not getting worse. Symptoms can be controlled with anti-inflammatory drugs nonsteroidal or prescription pain killers to relieve cramps and pain.

contraceptive

Treatment may involve the interruption of menstrual cycle and the establishment of a state similar to pregnancy. This is called pseudo-pregnancy and can help prevent the disease from getting worse. For this they are used birth control pills with estrogen and progesterone.

You should take the drug continuously for six to nine months and stop using it for a week to menstruate. Side effects may include the presence of blood spots, breast tenderness, nausea and other hormonal side effects.

This type of therapy relieves most of the symptoms of endometriosis, but does not prevent scars (adhesions) caused by the disease. It also does not reverse the physical changes that have already occurred.

other medications

Another treatment involves progesterone tablets or injections. Side effects can be uncomfortable and include depression, weight gain and blood stains.

In some cases, they may be prescribed drugs that prevent the production of estrogen by the ovaries. Some possible side effects include symptoms of menopause, such as hot flashes, vaginal dryness, mood changes, and early loss of calcium from bones.

Because of the loss of bone density, this type of treatment is usually limited to six months. In some cases, it may be extended for up to one year if small doses of estrogen and progestin are prescribed to reduce the side effects of bone weakening.

surgeries

Once confirmed the diagnosis of endometriosis, the laparoscope can be used for the treatment of lesions. Being a minimally invasive surgery, but at the same time allow the most varied interventions, today is the most common choice when the need for surgical intervention for their treatment. Through this technique, we can cauterize the endometriosis points, either with electrocautery or laser, vacuum the endometrial cysts and then remove what's left of him (his "cover"), we can still make the resection of intestinal portions when there are some lesions involving intestinal segment, and even hysterectomy (removal of the uterus), fallopian tubes, ovary or some encompass all these organs.

If surgery preserve the woman's ovaries, for example, where a woman wishing to become pregnant, there is a return risk of disease 1 to 3 women.

The withdrawal of the female pelvic organs is restricted to cases that have not responded well to previous treatment and the woman already has offspring formed.