Endometriosis
Introduction
Endometriosis is a complex gynaecological disease characterized by chronic pain and sometimes infertility. The disease is benign, but can have a significant impact on a woman’s personal, marital, professional and social life.
Definition of Endometriosis
Every month, a woman’s body prepares to receive a fertilized egg – a possible pregnancy. Halfway through a woman’s menstrual cycle, an egg is released from the ovary and travels down to the uterus. At the same time, the ovaries produce hormones that thicken and line the lining of the uterus with a mucous membrane called the endometrium.
If fertilisation does not take place, the ovary will decrease its production of hormones and trigger the detachment of the excess uterine lining and its evacuation through the vagina: menstruation.
In some women, at the time of menstruation, under the effect of uterine contractions, part of the blood can end up in the pelvic abdominal cavity.
In this blood, there are fragments of endometrium that can graft onto the peritoneum, a thin membrane that covers all the intra-abdominal organs, or beyond this membrane, deep down, where they infiltrate different organs and/or anatomical structures.
As a rule, the organs most affected are the ovaries, fallopian tubes, digestive and urinary organs, but in the most severe cases, the lungs and even the brain can be affected.
These fragments of endometrium, called endometriosis lesions, have the potential to proliferate and spread in flare-ups punctuated by menstrual periods.
These endometriosis lesions can behave like real benign tumours that infiltrate and deform organs while disrupting their normal function.
Symptoms of Endometriosis
Endometriosis lesions cause a variety of painful symptoms, which initially occur during menstruation. Over time, these symptoms can also be experienced outside of the menstrual period, but their intensity remains at its peak during the menstrual period.
The classic manifestations are:
– Dysmenorrhoea; painful periods – Dyspareunia; pain during sexual intercourse – Dysuria; difficulty in urinating – back and pelvic pain – digestive disorders – chronic fatigue – infertility
The three types of endometriosis
Not all women with endometriosis are necessarily symptomatic or have severe forms. Indeed, the disease does not develop in the same way or at the same speed from one woman to another. Despite the similarities found, the symptoms and intensity of pain are specific to each woman and are not correlated with the stage or type of endometriosis.
Specialists classify endometriosis lesions into 3 major groups:
– Superficial lesions, located in the peritoneum, are probably the most frequent lesions. These are small, superficial lesions whose depth of invasion does not exceed 5 mm.
– Ovarian lesions are cysts of the ovary characterized by their chocolate-colored liquid content. Variable in size (from a few mm to several cm), these lesions are not truly intra-ovarian cysts, like the other types of ovarian cysts. They are the result of intra-ovarian invagination of a lesion initially on the surface of the ovary, which progressively invades the ovary like a caterpillar penetrates an apple.
– Deep, sub-peritoneal lesions (infiltration greater than 5mm) are hard, fibrous lesions in which the hormone-dependent endometrial tissue is relatively little represented. These lesions tend to infiltrate the surrounding organs, with an aggressive behavior reminiscent of tumors, which leads to the appearance of severe forms.
Diagnosis endometriosis
There are several ways of detecting endometriosis, including abdominal examination, vaginal or rectal touch, but the most reliable examinations are pelvic ultrasound, magnetic resonance imaging and laparoscopy.
The disease of endometriosis is becoming increasingly well known, but unfortunately the diagnosis is often delayed. Women generally wait 7 years before being recognized as having this disease.
Medical treatments for endometriosis
To date, there is no definitive treatment for endometriosis.
However, if the symptoms have a negative impact on a woman’s quality of life, there are solutions that can alleviate the pain and other complications following the symptoms.
In general, it is recommended that women start with hormone therapy to stop menstruating and thus put the disease to rest.
Following hormone therapy, if symptoms persist, an artificial menopause can be implemented using GN-Rh analogue injections. This solution can be effective, but is accompanied by rather complicated side effects (bone pain, hot flushes, night sweats, dry skin, mood disorders, etc.).
After hormone therapy and/or artificial menopause, surgery can be proposed by an endometriosis specialist. The aim of this complex surgery is to remove the nodules and lesions in order to avoid a potential recurrence.
Natural treatments for endometriosis
Not all women are able or willing to undergo surgery to relieve their symptoms. Fortunately, there are several natural solutions that can help reduce pain and aid relaxation:
Applying cold or heat to the painful areas; heating belt, hot water bottle, etc.
The use of herbal teas such as yarrow, the use of essential oils, natural creams…
Meditation, hypnosis, osteopathic massage, physiotherapy, sophrology, acupuncture, etc.
Adjusting diet and lifestyle; avoiding inflammatory foods, respecting the sleep cycle.
The cause of endometriosis
Several theories attempt to explain the mechanism of appearance of endometriosis lesions. A great deal of scientific research is underway to explain more clearly the origin of the disease.
Backflow of menstrual blood through the fallopian tubes is thought to be the main cause of some lesions. In women with endometriosis, fragments of the endometrium graft abnormally onto the peritoneum. This implantation theory has long dominated the scientific literature. It explains the very frequent appearance of disseminated endometriosis lesions in women with uterine malformations which hinder or prevent the rapid evacuation of menstrual blood and increase tubal reflux.
However, this theory does not explain the occurrence of endometriosis in women with a congenitally absent uterus. It is clear that endometriosis cells are not simply cells transplanted from the uterus into the abdomen, and that other mechanisms are involved in the development of endometriosis lesions.
FAQ
What is endometriosis and how does it manifest?
ndometriosis is a gynecological condition characterized by the presence of tissue similar to the endometrium (the lining of the uterus) outside the uterus. It manifests through chronic pain, particularly during menstruation (dysmenorrhea), pain during sexual intercourse (dyspareunia), and sometimes infertility. The pain can also include difficulties with urination (dysuria), lower back and pelvic pain, digestive issues, and chronic fatigue.
What are the different types of endometriosis?
There are three main types of endometriosis, classified according to the location and depth of the lesions: superficial lesions (on the peritoneum), ovarian lesions (chocolate-colored fluid-filled ovarian cysts), and deep lesions (infiltration greater than 5mm), which can invade surrounding organs and lead to severe forms of the disease.
How is endometriosis diagnosed?
Diagnosing endometriosis can be complex and relies on several methods: saliva tests, abdominal examination, vaginal or rectal examination, with possible confirmation through pelvic ultrasound, magnetic resonance imaging (MRI), or laparoscopy. Regular gynecological follow-up is crucial for early diagnosis.
What treatments are available for endometriosis?
There is no definitive cure for endometriosis, but several options can alleviate symptoms: hormone therapy to suppress the disease, an artificial menopause regimen, and, in some cases, surgery to remove lesions. Natural treatments, such as heat application, herbal medicine, or dietary adjustments, can also help manage symptoms.
What are the causes of endometriosis?
The exact cause of endometriosis remains unknown, but several theories exist, with the most common being menstrual reflux, where blood containing fragments of endometrial tissue flows back through the fallopian tubes into the pelvic cavity. Other research suggests that genetic, immune, or environmental factors may contribute to the onset of the disease. Studies are ongoing to better understand these mechanisms.
