Endometriosis is a condition in which the layer of tissue that normally covers the inside of the uterus (endometrium) develops elsewhere in the body.
During the menstrual cycle in women, the endometrium receives the effect of hormones (estrogen, progesterone) and increases in thickness in order to be ready to receive the fertilized egg.
If there is no pregnancy, then the endometrium is eliminated with the period.
The foci of endometriosis are like small black and perhaps red or transparent dots that protrude on the ovary, the fallopian tubes, the peritoneum. These dots, negligible at first, may develop into cysts.
They grow slowly and their size can be from 2 to 15 cm.
If the bladder breaks it can lead to ovarian torsion. The ovaries, fallopian tubes and tissue around the uterus and ovaries are very common, but can rarely occur in other parts of the body, such as the large and small intestine, or the chest. The main symptoms are pelvic pain, intense pain during the period and infertility.
About half of the patients have chronic pelvic pain, while 70% of the pain is located in menstruation. Pain during intercourse is also common.
Very often women look for the cause of pain, as they have intense discomfort during sexual intercourse.
Infertility occurs in more than half of women who suffer.
Less common are urinary and gastrointestinal symptoms. About 25% of women have no symptoms.
A good gynecological examination with a complete history of the woman is essential.
Intravaginal ultrasound and computed tomography provide reliable information.
The cause is not completely known. Risk factors include a positive family history.
The areas of endometriosis bleed every month, resulting in inflammation and scarring.
Inflammations are often confused with adhesions from other abdominal surgeries. The diagnosis is based on the symptoms in combination with a medical imaging. Biopsy is the best method of diagnosis.
Other causes of similar symptoms are inflammatory bowel disease, irritable bowel syndrome, interstitial cystitis and fibromyalgia. Uncertain results indicate that the use of combined contraceptive pills reduces the risk of endometriosis.
Exercising and avoiding drinking large amounts of alcohol can also have a prophylactic effect.
There is no cure for endometriosis, but various treatments, such as analgesics, hormone therapy and surgery, can relieve the symptoms.
Hormone therapy can take 3-4 months to stop the secretion of hormones that contribute to the formation of cysts and consequently endometriosis. Using an intrauterine device with progesterone may be helpful. GnRH agonists can improve fertility.
Surgical removal of endometriosis can be done laparoscopically and when other treatments have failed to relieve the patient of symptoms.
The operation is performed laparoscopically, during which the cysts are removed with a laser or diathermy, and through three small holes.
In any case, this operation is performed low and leaves no marks except for three small warts.
The recovery is very fast and the woman stays in the clinic very short. The same day or the next day she returns home.
If there is a recurrence of endometriosis after surgery and there is a desire for pregnancy, then we often proceed to in vitro fertilization without repeating the operation, as further surgery reduces the volume of the ovaries.
However, if there are very large cysts in both ovaries, then surgical cleaning is necessary.
Endometriosis affected 10.8 million women in 2015. Other estimates put the number at 6-10% of women.
It is most common in women in their fourth and fifth decades of life, but can occur in girls as young as 8 years old. Rarely leads to death.
Endometriosis was recognized as a separate disease in the 1920s and was previously considered the same disease as adenomyosis. It is not clear who first described the condition.
40% of women who do not conceive while trying are due to endometriosis.
During pregnancy, many women do not have the symptoms of endometriosis, possibly due to the different hormonal background due to pregnancy. But endometriosis returns after childbirth.