endometriosis

We call endometriosis a disease in which small "islands" of the uterine lining (endometrium) are also found outside the uterus.

Endometrial foci are most often located in the pelvic area, that is, behind the uterus, on the walls of the small pelvis, it happens that they occur on the arch of the bladder, small foci of endometrial cells are also found on the peritoneum (Peritoneum), on the fallopian tubes and in the ovaries ( E. genitalis externa), but, in principle, can spread to any point of the body, although much less often endometrial lesions occur outside the pelvis and abdomen (the so-called E. extragenitalis).

In the event that small particles of the uterine mucosa enter the abdominal cavity during a cesarean section, the development of endometriosis in the postoperative suture is not excluded.

Causes

When studying endometriosis, we are dealing with two main theories of its occurrence, which, although they are opposed to each other, most likely both are true and should be considered as something unified.

First theory proceeds from the assumption that cell formations, that is, small particles of tissue, are transferred from the internal cavity of the uterus to other places. This is possible during menstruation if retrograde bleeding is observed, that is, part of the outflow of menstrual blood is directed backward, in which not all blood from the uterus flows towards the vagina, but partially enters the abdominal cavity through the fallopian tubes. The theory of cell transfer is based on observations of endometrial lesions in the abdominal wall in patients after caesarean section.

The second assumption is the presence in the observed patients of a likely congenital defect in the body's defenses (immune defect), which, as it were, allows the transferred cells to gain a foothold and - in the future - take root in a new place. This situation suggests the emergence of new blood vessels that develop solely for the purpose of "servicing" the endometrial "islands".

Like the lining of the uterus, endometrial lesions behave in accordance with the hormonal cycle. In the first half of the menstrual cycle, the mucous membrane is stimulated and grows in order to start bleeding at the right time. Microbleeding is accompanied by painful symptoms in the abdomen and can lead to adhesions and scarring of tissues. Often there is the formation of cysts in the ovaries with dark, viscous contents, the formation of which is associated with the thickening of small amounts of menstrual blood regularly entering the ovaries. Because of their appearance, these cysts are also called "chocolate".
As a result, pain is observed, the likelihood of infertility (impaired fertility), organ dysfunction increases, such as a rare obstruction of urine outflow with the formation of urine stagnation in the kidney, caused by cicatricial changes in the peritoneum, leading to a narrowing of the lumen of the ureter.

Prevention

Since the occurrence and development of endometriosis is not fully understood, there are no methods of treatment or prevention that would be aimed directly at getting rid of the causes of the disease. Taking into account the fact that the occurrence and spread of symptoms of endometriosis is associated with the cycle, especially with the menstrual cycle, it is possible to use medicines as a preventive measure that prevent the rupture of the egg and thereby suppress menstrual bleeding (oral contraception (contraceptive pills).

Natural prevention is the period of pregnancy and breastfeeding, during which there is no menstruation and therefore a positive effect is observed.

Symptoms

Often, the diagnosis of endometriosis is made as a result of an operative examination of the abdominal cavity and is thus an accidental discovery. The disease can proceed completely unnoticed or be accompanied by minor symptoms.

Typical for endometriosis is the situation when a day or two before menstruation, pain is observed, which becomes stronger over the years. Often, the diagnosis of endometriosis is voiced in the process of finding out the causes of infertility, when there is an obstruction of the fallopian tubes due to adhesions resulting from endometriosis. On the other hand, the explanation of infertility may also be based on a malfunctioning mechanism for transporting menstrual blood (see retrograde bleeding above) and, thus, fertility is already impaired at this stage.

Diagnostics

The diagnosis of "Suspicion of endometriosis" as a working hypothesis can be made in the presence of typical complaints and symptoms already as a result of collecting anamnesis and gynecological examination of the patient with the determination of characteristic pain points.

Prescribed for the purpose of clarifying the diagnosis for a sufficiently long period (the so-called long cycle), a contraceptive that suppresses menstrual bleeding can, in the event of a rapid onset of improvement and the disappearance of symptoms, strengthen the diagnosis, but not confirm it.

Certainly to determine the disease, to make an accurate diagnosis is possible only with the help of invasive diagnostics, for example, laparoscopic examination of the abdomen.

Also, a gynecological (transvaginal) examination with ultrasound examination (ultrasound) can significantly help in the diagnosis. Difficult to detect endometrial foci ingrown into the wall of the uterine muscles can, under certain conditions, cause very painful internal endometriosis (Endometriose genitalis interna, also Adenomyosis).

Treatment

Depending on the situation, treatment may have different goals: it is about “only” relieving the patient of pain and subsequent symptoms, as a rule, effective hormonal contraception is prescribed (contraceptive pills, reservoir hormone-containing drugs, such as a vaginal hormone-containing ring hormonal spiral). It is also possible to use pure preparations of the corpus luteum hormone (progesterone) without estrogen.

If the patient wants to have children in the future or if there are organic complications, it is necessary to first carry out surgical treatment. Endometrial foci must be completely removed, and within healthy tissues, after which anti-hormonal treatment ("artificial menopause") is prescribed to prevent the recurrence of the disease.
Depending on the spread and localization of endometriosis, a minimally invasive operation may be performed as part of a laparoscopic examination. Sometimes there is a need for complex abdominal operations, in which, along with a gynecologist, a surgeon or urologist is involved.