What is endometriosis, what are its causes and symptoms? + Treatment

Endometriosis is a benign disease that responds to estrogen levels. Although referred to as benign, it often has invasive manifestations, as in the case of malignant diseases. However, it is stated that the risk of reversing a malignant disease (cancer) is only 1%.

This disease was first diagnosed in 1860 by a professor from Hradec Králové C. Rokitanský. However, the term endometriosis was not used until 1927 by the professor of gynecology J. Sampson, who in 1921 also described the chocolate choices characteristic of the disease.

What is the endometrium?

The uterus otherwise referred to as the uterus, Hyster or tube, is pear-shaped, hollow, and stored in a small pelvis. It consists of the body, narrowing, and cervix. Its wall is divided into the perimetrium, which is the serous membrane, ie as the peritoneum, the myometrium, which is the smooth muscle, and the internal mucosa, the endometrium.

The endometrium lines the uterine cavity and changes its thickness and function during the menstrual cycle. Based on hormonal changes. It has two layers:

• stratum basalis, which remains the same during the menstrual cycle
• stratum functionalis, which changes under the influence of hormones (endometrial cycle)

The endometrial cycle is divided into 4 phases:

1. menstrual phase, stratum functionale is separated and washed away by menstrual blood, on the 1st - 4th day of the cycle
2. proliferation phase from the 5th - 14th day of the cycle, regeneration of the mucosa (from the stratum basalis), and its growth under the influence of estrogens
3. the secretory phase from the 15th to the 28th day, the mucosa increases, it is filled with the mucus secretion, which prepares it to receive the fertilized egg
4. the ischemic phase occurs when the egg is not fertilized, the blood vessels narrow, leading to bloodlessness of the mucosa, then the vessels rupture, the mucosa bleeds, and a new menstrual phase continues, and thus a new cycle

What is endometriosis?

The name endometriosis refers to the occurrence of endometrial deposits at sites outside the uterus. An example is a fact that endometrial deposits have been demonstrated in all tissues of the body except the heart and spleen. It mainly affects women of reproductive age, most often in the period of 20-40 years of age.

Occurrence before the first menstruation, ie menarche is rare and has a declining tendency after menopause. Endometriosis is the most common gynecological disease. In some cases, Nemo, unnoticed, is transient and thus heals. In other cases, it causes serious and typical problems.

Its causes are not fully known, but the importance of the interaction of several risk factors is attached. These include genetic, hormonal, anatomical, but also immunological. It is reported to occur in 50% of cases of painful menstruation and in 75% of women who have pelvic pain.

Also interesting is the fact that 25-40% of women with a problem getting pregnant are affected by endometriosis.

The most common occurrence of the endometrium is on the peritoneum, ie on the peritoneum, ovaries, but also in the area of ​​the rectovaginal septum and also in the muscle of the uterus. According to which it is also referred to as follows:

• peritoneal endometriosis - deposits on the peritoneum, ie on the serous membrane that lines the abdominal cavity
• ovarian endometriosis - on the ovaries and fallopian tubes
• endometriosis of the rectovaginal septum - in the area between the vagina and rectum
• adenomyosis - in the muscle of the uterus

 Another division deals with the type of bearing, namely:

• red deposits - with the presence of blood
• black deposits - blue to black deposits with the appearance of gunpowder, also known as chocolate cysts
• white bearings - scarred

The table shows the distribution of endometriosis according to the degree of severity

The exact cause of the disease is not clear, and there are several theories that try to explain it. Implantation theory states that it occurs as a result of retrograde menstruation. This means that menstrual blood, even with particles of peeled endometrium, enters the space of the small pelvis.

The immunological theory states that menstrual blood in the abdominal cavity causes an inflammatory process. In it, the cells of the endometrial mucosa should be destroyed. Especially with a normal immune response. If a problem occurs at the immune level, the disease can break out.

LUF syndrome is the theory of an unbroken luteinized follicle. And behind the disease are hormonal problems. Metaplastic theory (coelom metaplasia theory) describes that undifferentiated cells in the abdominal cavity differentiate into the endometrium.

And transport theory is responsible for the transfer of endometrial cells by the vascular and lymphatic routes. Thus, the circulation of blood cells from the bone marrow is otherwise referred to as stem cell theory. 

Endometriosis is affected by the hormonal level, ie estrogen. In the case of endometriosis, it is formed in the ovaries, in adipose tissue, and also in the deposits of endometriosis. This is also influenced by prostaglandin production and progesterone resistance. 

In addition, various risk factors are involved, including:

• early onset of menarche, first menstruation onset of the first menstruation, and menopause also have an effect
• late menopause
• late pregnancy
• the low number of pregnancies
• short menstrual cycle
• menstrual blood drainage obstruction
• obesity
• heredity
• smoking
• alcohol

The disease is also divided according to whether the endometrium is located in the area of ​​the woman's reproductive system, ie genital endometriosis. And in case of occurrence on the intestine, bladder, even in postoperative scars on the extragenital.

The endometrium can be found anywhere in the body. It is most often on the fallopian tubes, ovaries, in the small pelvis, in the rectovaginal area. The disease can take various forms. And even depending on the behavior of the tissue. Its manifestations also depend on it.

Localization is an important factor that affects the manifestations of the disease. Even large endometriosis does not have to cause any problems and is hidden. Or, conversely, a small scale can cause great and intense difficulties.

The most typical manifestation of the disease is long-term pain in the lower abdomen. And even where the mucosa has occurred, so it can be back pain, in the chest area and the like. The intensity of pain is tied to the hormonal cycle.

During menstruation, the intensity is highest, then the difficulties subside. Pain during sexual intercourse or menstrual disorders may also occur. In addition, the disease has a major impact on female infertility, in almost half of the cases.

During menstruation, excessive bleeding and pain are typical. Endometriosis is characterized by pain in the pelvis, ie the abdomen. It can become chronic if it lasts more than 6 months. 

Characteristic of the menstrual pain (dysmenorrhoea), which occurs approximately 24-48 hours before the menstrual phase. The pain is located in the lower abdomen, in the area of ​​the crosses. Nausea and vomiting are also associated.

The intensity and character also depend on the place and extent of occurrence. The aforementioned pain during sexual intercourse may also be present. It is bound to the location of the endometrium in the rectovaginal space or on the ligaments that run from the uterus to the sacrum (sacrouterine ligaments).

Rarely, when the endometrium is in the bladder, so is the blood in the urine. But also pain when urinating. Discharge disorders are present in the endometrium near the intestine or rectum. Similarly, stool emptying pain is present.

For a better overview, we summarize the difficulties caused by endometriosis:

• pain
  • premenstrual pain 24-48 hours before the cycle 
  • local inflammation for bleeding from the mucosa during the menstrual cycle
  • abdominal pain, sacrum
  • chronic pelvic pain
• infertility, inability to bear the fetus
• ectopic pregnancy
• painful menstruation, ie dysmenorrhea
• pain during sexual intercourse
• pain during defecation, ie bowel emptying
• emptying disorders, constipation, diarrhea
• pain when urinating
• nausea to vomiting
• flatulence
• fatigue, exhaustion

First, the doctor is interested in the information provided directly by the woman in question. And this is a history and a clinical picture of the difficulties, and therefore a gynecological examination. Cyclic pain or other difficulties that occur according to the extent are important. Information on infertility is important.

Imaging methods include mainly USG, hysteroscopy. Laparoscopy is performed to confirm the diagnosis. Laparoscopy is a diagnostic but also a treatment method. Differential diagnosis is important to rule out other causes of the problem, even before surgery. The disease can be mistaken for chronic inflammation or ovarian cysts. Thus, MRI can also be used in diagnosis. Laboratory blood tests, CRP, urine tests, vaginal or cervical swabs, and others are also performed.

So the course of the disease depends on several factors. A small finding can cause serious problems and can be invasive. On the contrary, a larger finding may not cause such intense problems. Pain is the main symptom.

The pain is tied to the menstrual cycle, 24-48 hours before bleeding, pain begins, which can occur in the pelvic area, ie the abdomen. But it can also radiate into the cross area. Subsequently, the pain subsides after the menstrual cycle.

Another type is chronic pelvic pain that lasts for more than 6 months. It is often intense and prevents any activity. Significantly impairs the quality of life , has a significant psychological impact. Endometriosis is proven in up to 75% of cases of pelvic pain.

Endometriosis can cause painful menstruation in up to 90% of cases. Pain during sexual intercourse in 25 - 50%. The deposits form substances that are synergistic in the inflammatory process. There are scars, adhesions, and thus connections with difficulties, such as painful defecation or urination.

Another significant manifestation of endometriosis is infertility, up to 50%, as well as the inability to deliver a fetus or an ectopic pregnancy. Even in this problem, growth plays a big role. Of course, other difficulties are associated with location dependence. It is important to have a professional examination and an accurate description of the symptoms to the doctor.