What is endometriosis?

Endometriosis is a chronic condition in which the lining of the uterus, like the endothelial layer, grows excessively and invades the boundaries of other tissues. Endometrial tissue often affects the ovaries, fallopian tubes, and pelvic lining. Rarely, endometrial tissue growth can be found outside the pelvic organs.

Endometrial tissue, in other tissues, shows the same properties as in the uterus - it thickens, falls off and bleeds according to the phases of the cycle.

When ovulation is involved in the process, cysts - endometriomas - are formed from the endometrial tissue. Ovarian endometriomas are also called "chocolate cysts" because their contents have a chocolate-like consistency.

Endometrial cysts cause pain, menstrual disorders and often infertility due to scar degeneration of the fallopian tubes.

The most common areas for the development of endometriosis are:

• The posterior region of the uterus
• Myometrium - the muscular layer of the uterus
• ovaries
• Peritoneum (abdomen partially covering the pelvic cavity and organs)
• Fallopian tubes

Rarely, endometriosis may develop in the following organs:

• rectum
• Bladder
• small intestines
• Aperture
• vagina
• lungs

Endometriosis affects 10 in 1 women. Symptoms can be managed with treatment.

Symptoms of endometriosis

There are many symptoms of endometriosis, but the most characteristic is pain in the pelvis. The pain is moderate or severe. Symptoms worsen during and before the menstrual cycle. The reason for this is the inflammatory changes caused by the hormonal background.

Symptoms of endometriosis are:

• painful menstruation
• Abdominal and/or back pain during and between periods
• Heavy bleeding during the cycle or bloody discharge in between
• Dyspareunia – pain during sexual contact
• Infertility
• Pain during urination and bowel movement
• Alternation of diarrhea-constipation-bloating

There are completely asymptomatic cases of endometriosis. Often it is revealed during a successful attempt to conceive.

There is no relationship between the intensity of the symptoms and the severity of the disease.

Does endometriosis cause weight gain?

Endometriosis does not cause weight gain, but bloating and fluid retention in the body can cause weight gain.

What causes endometriosis?

The exact cause of endometriosis is unknown. There are studies linking endometriosis to conditions such as:

• retrograde Menstruation - a condition in which menstrual blood flows through the fallopian tubes into the abdominal cavity, which may be the cause of endometriosis.
• Immune system disorders
• Hormonal disorders

Is endometriosis genetic?

However, one specific reason for the development of endometriosis has not been established, there are data that the risk of developing endometriosis is much higher if there is a family history of the disease.

Who gets endometriosis?

Endometriosis is a condition that mainly affects women between the ages of 20-40. During menopause, the symptoms of endometriosis decrease, although there may still be clinical manifestations - pain and discomfort.

Risk factors for the development of endometriosis

• Family history of endometriosis
• Short menstrual cycle (less than 27 days)
• Prolonged and painful menstrual bleeding (8 days or more)
• Infertility

Complications in endometriosis

Endometriosis, in addition to pain and discomfort, causes various complications. The most typical complications are:

• Infertility - endometriosis is one of the leading causes of infertility.
• Bowel or bladder problems – when endometrial tissue grows in these organs
• Shortness of breath and pain in the heart and chest - during the involvement of the lungs and diaphragm.

Diagnosis of endometriosis

Diagnosis of endometriosis is most often made after symptoms appear. The patient's medical history, family anamnesis, as well as instrumental examination of pelvic organs and laboratory tests, if necessary, are important in diagnostics.

Finally, the diagnostics is confirmed by laparoscopic surgery. During laparoscopy, the inner surface of the pelvis is examined and, if necessary, a biopsy of endometrial tissue is performed for further research. Removal of endometrial tissue is carried out by the laparoscopic method, within the scope of the possibility.

Management and treatment of endometriosis

The treatment plan for endometriosis is based on several factors:

• severity of the condition
• Pregnancy planning
• Age of the patient
• Intensity of symptoms

The treatment plan is usually focused on symptom reduction and the success of a planned pregnancy.

Medical treatment of endometriosis

Medical treatment is mainly symptomatic and aimed at reducing pain and discomfort. Anti-inflammatory non-steroids, hormonal drugs - used to regulate pain and menstrual cycle.

• Contraceptives – both estrogenic and combined estrogen-progesterin,  Helps to regulate the menstrual cycle and relieve symptoms.
• Gonadotropin-releasing hormone agonists or antagonists  - These drugs block the hormones of the menstrual cycle, temporarily stopping the cycle and thereby helping to relieve symptoms.

Discontinuation of treatment may lead to recurrence of symptoms. In some cases, surgical treatment is necessary.

• Laparoscopic surgery  - It is a medical-diagnostic procedure by which it is possible to take biopsy material for diagnostics and also to remove endometrial tissue within the scope of possibility.
• Hysterectomy - Surgery to remove the uterus and/or ovaries, when other methods of treatment are ineffective.

Surgical treatment greatly improves the patient's condition, however, since endometriosis is a chronic pathology, symptoms may develop again several years after surgery. A combination of surgical and medical treatment often gives better results.

Can endometriosis heal itself?

Very rarely, the symptoms may subside on their own, especially after menopause, which is associated with a decrease in estrogen levels in the body.

Untreated cases of endometriosis

Over time, endometrial tissue grows outside the uterus, causing cysts, healing, and the formation of fibrotic (scar) tissue. This habit makes the complaints even worse, especially during the period of the cycle.

Prevention

Endometriosis cannot be prevented, but some factors can reduce the risk of developing endometriosis:

• Pregnancy
• breastfeeding

Literature:

https://my.clevelandclinic.org/health/diseases/10857-endometriosis

https://my.clevelandclinic.org/health/diseases/22004-ovarian-endometrioma

https://www.mayoclinic.org/diseases-conditions/endometriosis/symptoms-causes/syc-20354656

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