Endometriosis: what it is, its causes, symptoms and treatments

Endometriosis is a relatively common problem among women. It manifests shortly after the first period, but is usually diagnosed in adulthood, between 20 and 30 years, and can affect female fertility. Therefore, when trying to get pregnant without success, women often go on to investigate and discover the disease. About 50% of women with endometriosis have infertility.

Gynecologist and obstetrician Kelly Alessandra Tavares explains that this is a chronic disease in which the endometrium (the layer that lines the uterus internally and is shed during menstruation) adheres to another location. “The most common sites of disease involvement are: retrocervical region, peritoneum, fallopian tubes, uterosacral ligaments, ovaries, intestine and bladder.”

Endometriosis can be classified into 5 types, and this classification is based on a sum of points that the doctor must make.

Generally speaking, Kelly explains that endometriosis can be superficial or deep. On the surface, the lesions are small and do not cause anatomical changes in the organs of the pelvic region. If it affects more than 5 mm of any organ and causes deformities of these organs, it is considered profound.

Superficial endometriosis: usually affects the peritoneum, which is a tissue that surrounds the organs of the abdominal and pelvic cavity.

Ovarian endometriosis: Endometriosis that affects the ovaries, usually caused by the formation of cysts.

Deep endometriosis: occurs when the foci of the disease reach the wall of an organ more than 5 mm in size. Depending on the severity, immediate surgery may be required.

Wall endometriosis: affects the abdominal wall, forming nodules that usually cause more discomfort during the menstrual period.

Pulmonary endometriosis: It is a rare type in which endometrial tissue reaches the lung region through the bloodstream.

Causes

The causes of endometriosis are still not fully understood. The reasons why endometrial cells grow outside the uterus are unclear.

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According to Kelly, there are several theories that could explain the causes of endometriosis: genetic factors, hormonal factors, spread of cells through the lymphatic system, remnants of embryonic cells, among others. “The most accepted theory is that of retrograde menstruation. In this situation, the blood that flows back through the fallopian tubes during menstruation implants itself in the aforementioned locations,” she says.

Retrograde menstruation: occurs when menstrual blood refluxes back into the pelvic cavity through the fallopian tubes. These endometrial cells settle on the walls of organs in the pelvic region and begin to grow.

Embryonic cell growth: Some cells that line the abdomen and pelvic cavities can convert to endometrial tissue, initiating the disease.

Deficient immune system: Deficiencies in the immune system can make the body unable to recognize and destroy endometrial cells that grow in the wrong place.

Symptoms

The symptoms of endometriosis can vary depending on the affected region. Pain at the site, usually pelvic pain, is one of the first symptoms to manifest.

Kelly cites the most common symptoms: intense, progressive and disabling menstrual cramps, pain during intercourse and infertility. “Some women also have urinary disorders (pain when urinating during menstruation) and intestinal disorders (pain when having a bowel movement, mucus or blood in the stool during menstruation).”

Check out the most common symptoms:

Infertility
Fatigue
Diarrhea
Pain in sexual intercourse
Menstrual period pain
Pain when urinating or having a bowel movement
Lower abdominal pain or cramping that may occur cyclically for a week or two before menstruation

Endometriosis diagnosis

See a doctor when you experience the first symptoms of endometriosis. Severe pain during your period is not normal.

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Kelly emphasizes that the gynecologist must be attentive to the complaints presented by the patient and must suspect the diagnosis based on the clinical history presented. Confirmation of the diagnosis can be made by means of transvaginal ultrasound with bowel preparation or magnetic resonance imaging of the pelvis.

Treatment

There are two types of treatments for endometriosis: medical or surgical. The doctor will indicate the most appropriate according to the patient’s age, the severity of the disease and her desire or not to become pregnant.

Medicines

In clinical treatment, anti-inflammatory drugs and hormones such as contraceptives and hormonal IUDs can be used.

Surgery

Laparoscopy is the most common surgical approach and can remove all foci. “Laparoscopic surgery is indicated when there is a failure in clinical treatment (patient does not show improvement in pain) or when endometriosis affects organs such as the intestine or bladder”, explains Kelly. In some cases, hysterectomy (removal of the uterus, fallopian tubes and ovaries) may also be indicated.

Only the doctor, together with the patient, can decide which treatment is appropriate for each case.

Endometriosis has no cure. Hormone therapy and laparoscopy can relieve symptoms for several years. A hysterectomy is the best possible cure, however, the disease can still return.

Living with endometriosis

To live well with endometriosis, it is necessary to treat the physical and emotional symptoms of the disease.

Kelly stresses that endometriosis causes physical and emotional exhaustion in women who are affected by this disease. “Your interpersonal and professional relationships can be damaged. As a result, many women experience anxiety and depressive symptoms.”

To alleviate physical and emotional symptoms, they should be encouraged to practice physical exercises, acupuncture and have a balanced and balanced diet.

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Emotional symptoms can be more intense if the woman wants to have children. However, endometriosis does not prevent a woman from becoming pregnant. After the first few weeks of pregnancy, it may be necessary to supplement progesterone to prevent miscarriage, but the pregnancy will proceed normally, with medical supervision.

Risk factors

Some conditions can favor the appearance of endometriosis. “The following are considered risk factors for endometriosis: early menarche, late menopause, nulliparity (never having been pregnant) and short menstrual cycles.

Know more:

Early menarche: starting menstruation too early can be a risk factor for the onset of endometriosis.

Late menopause: in the same way, entering menopause late can also favor the disease.

Nulliparity: Women who have never been pregnant are more likely to have the disease.

Short menstrual cycles: Menstrual cycles that last a few days is also a risk factor.

complications

The most common complications of endometriosis are infertility and ovarian cancer. However, other complications can arise.

The patient may present, for example, an intestinal occlusion depending on the size of the lesion that affects the intestine, according to Kelly.

Infertility
Ovary cancer
chronic pelvic pain
Large cysts in the pelvis
Obstructions in the gastrointestinal or urinary tract

Although endometriosis has no cure, it is possible to achieve very satisfactory results with treatments, and can relieve symptoms partially or even completely for several years. Therefore, always seek medical advice at the slightest sign that may indicate the disease.

The information contained on this page is for informational purposes only. They do not replace the advice and follow-up of doctors, nutritionists, psychologists, physical education professionals and other specialists.