- What is Endometriosis?
- 1. Definition of endometriosis
- 2. Symptoms
- 4. Diagnosis
- 5. Endometriosis and pregnancy
- 6. Food for Thought
- 7. Pathogenic mechanisms (what happens)
- 8. Prevention
- 9. Treatment of endometriosis
- 9.1. Drug therapy:
- 9.2. Hormone therapy:
- 9.3. Natural Treatment
- 9.4. Surgical treatment
- 9.5. Infertility Treatment
- 10. Major recommendations in endometriosis
- 11. Disclaimer:
What is Endometriosis?
Endometriosis is the disease of the female genital organ. In every menstruation cycle, the female uterus lining grows its thickness, and if fertilization didn’t occur, the uterus lining starts shading itself, which is called menstruation. This is a normal phenomenon of uterus lining but imagine if these phenomena start to happen in other parts of the uterus and other genital organs and even worse in other abdominal organs. Then it is called endometriosis.
Endometriosis is a common disease, affecting many women of childbearing potential. The incidence of this pathology has increased in recent years, mainly due to the development of diagnostic techniques but also to the improvement of information by the media that led to the recognition of symptoms by patients and their addressing the physician. However, many women are still suffering from the disease and not know they have it. Most women take pain in pelvic area as such, not knowing that in fact, they are not at all normal and that behind them lies a very serious disease.
1. Definition of endometriosis
Endometriosis is the growth of the endometrium (lining of the uterus) outside of the uterus. It occurs when tissues that are similar to the endometrium start growing on other parts of the uterus, ovary, fallopian tube, and rarely other abdominal organs. It can grow on and inside of the ovary, causing an endometriosis cyst. This cyst is referred to as a chocolate cyst.
2.1. Menstruation pain:
Dysmenorrhea (painful menstruation) – pain generally occurs during the second day of menstruation, then progressively worsen. Menstrual cramps can begin before menstruation, persist for several days and may be associated with back pain or abdominal pain.
Moderate to severe menstruation pain is a very common sign of endometriosis. The organ where endometrium tissues are attached also starts shading and bleeding. This unusual bleeding has no place to go out through the body. This trapped blood causes inflammation and infection of that particular organ which causes severe pain.
2.2. Menstruation problems:
Menstruation problems like abnormal uterine bleeding, metrorrhagia, menorrhagia are common.
- Abundant menstrual flow (menorrhagia)
- Menstruation that lasts more than 8 days
- Menstruating early (before 11 years)
2.3. Lower abdominal pain or endometriosis pain:
Females with it often feel continuous dull pain in the lower abdomen or severe pain with a sudden on and off pattern.
2.4. Pain during sex:
Sexual pain is often associated with it.
Infertility is the main problem of endometriosis. Around 30% of females with infertility are also associated with it. Infertility with endometriosis usually occurs because of two reasons. First, endometrium tissues in the ovary cause disturbance in ovulation. Second, inflammation or growth of the fimbrial end of the fallopian tube is not able to catch ovum, or growth of tubes do not allow sperm to enter. In both ways, fertilization is not happening.
Endometriosis is one of the top three causes of infertility in women.
During a normal menstrual cycle the uterine lining (called endometrium) thickens in preparation for pregnancy. If you don’t get pregnant that month, your body eliminates the endometrium during menstruation. In endometriosis, for reasons still unknown by doctors, a tissue resembling the endometrium develops outside the uterus: the ovaries, fallopian tubes, or perineum. Sometimes it appears in the cervix, vagina, rectum, bladder, or intestines.
Back pains a day or two days before the start of menstrual period (or later), becoming lighter during the menstrual period.
2.7. Other symptoms:
- Discomfort in bowel movement.
- Recurrent urinary tract infection.
- Muscle pain during menstruation
- Acute abdominal pain before or after menstruation
- Pain or chronic pelvic pain
- Menstrual flow or bleeding profusely outside menstruation
- Rectal pain
- Pain during bowel movement
- Other lower limb pain or bladder pain
- Urinary problems
- (Sometimes) blood in urine or stool
Around 40% of females suffering from endometriosis do not feel any of the symptoms. It is accidentally diagnosed for another surgery.
The appearance of pain, its repeatability and/or worsening are clues that may lead to the diagnosis of endometriosis.
The most common and important symptom of this disease is chronic recurring pain. But the pain felt by the individual patient is independent of disease advancement. Other more common symptoms are pelvic pain following a medical examination or after sexual intercourse, including heavy menstruation, dysmenorrhea, back pain, pelvic or abdominal pain, constipation, diarrhea, pain or blood loss when the patient uses the toilet (the unremoved tissue presses on the rectum , intestines or bladder, causing pain or abnormal bleeding), nausea, vomiting episodes, sterility or reduced fertility, feeling tired or gastrointestinal upset that can be confused with other conditions.
Endometriosis can affect any woman from puberty until the postmenopausal period, regardless of race, ethnicity or number of previous pregnancies. Endometriosis persists even after menopause and in rare cases, girls may develop the disease even before they have their first menstruation.
The cause of the disease is not known precisely and progress in recent years still do not allow elucidation of the origin of this disease. It is known however that hiperfoliculemia (overproduction of the hormones estrogen by the ovaries) and a poor function of the immune system influences it.
The theory of the reverse menstruation suggests that during menstruation some of the menstrual tissue goes back into the fallopian tubes and stops in the abdomen, where they increase. Some experts believe that this happens to all women and that an immune system problem or a hormonal one allow this tissue to grow and develop endometriosis. According to another theory, there is a hereditary predisposition to the appearance of endometriosis. In addition, a weak immune system may contribute to the development of endometriosis.
Another theory suggests that endometrial tissue is sent from the uterus in other parts of the body through the lymphatic system or blood veins. Another theory says that the disease is found in the genes of families or that some families have predisposition to endometriosis. Other researchers claim that the remains of tissue from the time when she was only one embryo can determine the development of endometriosis along the years or that some adult tissues retain the property they had in the embryo stage, that of transforming reproductive tissue in certain situations. Researchers found that exposure to dioxin causes endometriosis.
Also we must not forget the major role in developing these diseases and others that the accumulation of toxins in the body in all tissues and body fluids (under the theory of “broken blood” after which he guided Valeriu Popa in everything was good its peers).
The mere presence of pain in the pelvic area requires a gynecological consultation!
The only accurate way of diagnosing endometriosis is laparoscopy, which is sometimes combined with biopsy. Laparoscopily, endometriosis can be both detected and treated surgically.
To diagnose endometriosis or another condition that causes pelvic pain, the doctor will do a history (he asks questions related to these symptoms, their location and when they manifest pain). Then, the doctor will perform a pelvic exam to detect any cysts on the reproductive organs or scar tissue from the uterus. Endometrial growths can often be detected only if they led to the formation of a cyst.
Other tests for physical signs of endometriosis are:
4.1. Transvaginal ultrasound
Transvaginal ultrasound consists in introducing a tube into the vagina to obtain images of reproductive organs.
As the endometrial implants can not be detected by other tests, a frequent method to determine accurately the diagnosis of endometriosis is laparoscopy.
The surgeon makes a small incision below the navel, trough which he inserts a thin tube (laparoscope) that allows viewing of pelvic or abdominal organs. In women with endometriosis, laparoscopy will provide information about the location and size of implants, information to be used in choosing treatment. Sometimes, the signs and symptoms are so obvious that laparoscopy is not necessary.
4.3. Blood analysis
Researchers have tried to find a substance whose blood dosing allows the diagnosis of the disease (markers). On the other hand, by determination of markers dozes, it is possible to assess the evolution of the disease.
In endometriosis we screen for CA 125 marker, whose normal level is 35 international units / ml of blood. When the level is high there is a suspicion of endometriosis.
Unfortunately, some patients have a normal level of CA 125, although suffering from endometriosis. This test shows an increase in women with endometriosis in an advanced state, but it cannot detect mild to moderate cases of endometriosis.
On the other hand, increasing levels of CA 125 is produced in other diseases such as ovarian or uterine cancer.
5. Endometriosis and pregnancy
Most women suffering from endometriosis may have children. But if she fails to remain pregnant, the cause may be endometriosis. To be sure, you can perform a laparoscopy-screening method consisting of introducing an optical instrument into the abdominal cavity. Diagnosis can then be confirmed by biopsy. If you have been diagnosed with endometriosis, you have several treatment options, depending on severity.
Medication, alone or associated with surgery may reduce inflammation and pain. Surgery consists in removing, where possible, the affected tissue. In some women surgery significantly increases the chances of getting pregnant. However, in case of severe endometriosis, the number of successful tasks is reduced.
As many women with endometriosis have disorders of ovulation, another treatment option is to take fertility drugs (Clomid) to stimulate ovulation. Hormone therapy may also be indicated for the same reason. If you start to have a normal ovulation, your doctor may recommend artificial-insemination procedure which consists in placing sperm directly into the uterus.
It overlooks the fact that the standard treatment for endometriosis may prevent the installation of pregnancy, or can cause serious birth defects. Do not forget to tell your doctor that you are trying to get pregnant when he prescribes a treatment for endometriosis.
6. Food for Thought
Ovarian cancer risk is increased in women with endometriosis. Contraceptive use for 5 or more years reduces this risk. Danazol may increase ovarian cancer risk.
All use of hormonal therapies for endometriosis have side effects and put women’s health in danger. Some of them have more unpleasant side effects. Before taking medications or hormone therapy the possible adverse effects should be reviewed. If they are less unpleasant than the symptoms of endometriosis, hormone therapy should be discussed with your doctor.
GnRH and increased doses of progesterone can cause bone demineralization. Side effects of GnRH administration’s cause of low-dose hormone or combination with other drugs, and use only 6 months of GnRH. The effects of high dose progesterone on bones is low, it is required a therapy for 2 years to cause problems to the bone. After this therapy, bone density returns to normal in the majority or entirety.
It turned out in some studies on infertile women with severe endometriosis who are in therapy for 6 months with GnRH before in vitro fertilization that they had increased chances of conceiving a pregnancy.
Some studies show that use of GnRH therapy after surgery can extend painless periods, prevent proliferation and restoration of endometriosis.
7. Pathogenic mechanisms (what happens)
The mechanisms involved in the development of the disease are not completely understood: it is possible that some fragments of uterine lining are not removed during menstruation. Snippets move forward through the fallopian tubes and are fixed on other organs of the pelvic cavity (ovaries, bladder, rectum, colon), sometimes reaching up to the lungs. This attachment takes the form of cysts, most commonly located on the muscles of the uterus: in this case is called the adenomyosis disease.
Endometrium is under hormonal fluctuations during the menstrual cycle. Similarly, the fragments that have migrated to other parts of the body will react to the hormonal changes. Endometrium is sensitive to the action of estrogen and progesterone, and the decreased level of these hormones in the blood will result in the bleeding that characterizes menstruation. Fragments of endometrium will react in a similar fashion and will bleed during menstruation, just like the uterine lining.
On the other hand, endometriosis appears to be the consequence of a trauma of the cervix, following a biopsy, an electrocoagulation, a laser surgery or after a conization (ablation of the cervix as part of the con).
Pain can be explained by the fact that in the abdominal cavity organs are in contact with each other, separated by a fine membrane, on which fragments of endometrium may attach. During disease evolution, areas affected by endometriosis scars and give birth to grip. Depending on the organs between which these bonds appear, the location of the pain is variable. In the ovaries, endometriosis leads to pain that can be explained by compression and eventually by breaking hemorrhagic cysts.
As the causes of endometriosis are not known with precisely, there are no specific techniques to reduce the risks of the disease.
It seems that women who had children present less risk than nulliparous women. A recent study shows that strenuous exercise significantly reduce blood estrogen levels and thus the risk of endometriosis. On the other hand, use an IUS is considered an aggravating factor.
9. Treatment of endometriosis
There is currently no cure for endometriosis, but there are therapies that can help relieve symptoms.
- Pain relievers: such as ibuprofen as well as paracetamol.
- Hormonal agent drugs as well as contraception. These include mixed pills, contraceptive site, uterine system (IUS), and also drugs called gonadotrophin-releasing hormone analogs (GnRH).
- Surgery to remove plaques of endometriosis.
- A procedure to remove component or all organs affected by endometriosis such as surgery to remove the uterus (removal of the uterus).
Your doctor will definitely talk about your options with you. In some cases, they may advise you not to start treatment right away to see if your symptoms improve on their own.
9.1. Drug therapy:
There is no universally valid optimal treatment. Although endometriosis does not heal, the recommended treatment can remove the pain and resolve infertility. Treatment depends on the severity of symptoms and the desire to become pregnant.
Therapeutic recommendation is surgery for the removal of ectopic tissue or Danazol therapy, an anti-estrogenic, but the drug produces unpleasant side effects. Besides, the disease tends to return after some time and if it worsens, the only solution would be a hysterectomy (removal of uterus). I believe that treatment should be aimed at potential factors that led to the disease, trying to eliminate accumulated toxins, balance the hormonal balance, to strengthen the central nervous system.
Treatments attempt to obtain pain relief or to treat the sterility, given that there is currently no treatment for this condition.
To relieve pain, your doctor may recommend painkillers such as ibuprofen (Advil, etc.).. However, if pain is still present even after taking the maximum dose, you have to adopt a different treatment to reduce signs and symptoms.
9.2. Hormone therapy:
Hormone therapy is effective in reducing or eliminating pain caused by endometriosis, because hormonal fluctuations during the menstrual cycle cause thickening and disintegration of endometrial implants bleeding.
Oral contraceptives – help to control the hormones responsible for monthly accumulation of endometrial tissue. For most women, menstruation becomes shorter and less abundant when taking these contraceptives. In addition, the treatment reduces and even eliminates the pain that accompanies endometriosis.
Agonists and antagonists of Gn-RH (gonadotrophin releasing hormone) – these drugs block the release of hormones that stimulate the ovaries. So, they stop menstruation and reduce estrogen levels, causing endometrial implants decrease. GnRH agonists and antagonists of a train artificial menopause can have adverse effects such as hot flashes or vaginal dryness. A small dose of estrogen can be taken together with these medicines to reduce side effects.
9.2.1. Danazol (Danocrine):
Another drug that blocks production of hormones that stimulate the ovaries and stop menstruation and symptoms of endometriosis is danazol. In addition, the drug interrupts endometrial proliferation. However, danazol is not the first choice of treatment because it can lead to adverse effects such as acne and excessive facial hair.
Administered by injection, this medicine stops menstruation and proliferation of endometrial implants, thereby reducing the signs and symptoms of endometriosis. Its side effects include weight gain and depression.
Inhibitors of aromatase – these inhibitors, used to treat breast cancer, may be effective in treating endometriosis. Inhibitors of aromatase block the conversion of androstendione and testosterone to estrogen as well as the production of estrogen by the endometrial implants. Thus, the body is deprived of the estrogen required for the proliferation of the endometrium.
9.2.3. Inhibitors of aromatase:
These inhibitors, used to treat breast cancer, may be effective in treating endometriosis. Inhibitors of aromatase block the conversion of androstendione and testosterone to estrogen as well as the production of estrogen by the endometrial implants. Thus, the body is deprived of the estrogen required for the proliferation of the endometrium.
9.2.4. Should hormone therapy be used to treat endometriosis?
If hormone therapy is not effective or if the endometrial proliferation affects other organs, the next necessary step is surgery to remove endometrial proliferation and mucosal scars. It consists of one or more small incisions, called laparoscopy. After surgery, hormone therapy may prevent the recurrence of endometriosis. Surgery removes the pain for a year or 2 years, although in 20% of women it persists.
In severe cases of endometriosis the treatment option consists in removing the uterus and ovaries (hysterectomy and bilateral oophorectomy). Early menopause is established following this therapy. This radical therapy is reserved for women who had children and in which other treatments had low effect. However, more than 15% of women continue to complain of pain after radical therapy.
9.2.5. Reappearance of pain after hormone therapy
After any hormone treatment, the pain of endometriosis can recur:
- In a year, more than 20% of women treated with hormonal drugs are again sore
- At 37% of women who had hormone treatment for mild forms of endometriosis, pain occurring later than 5 years post-treatment
- At 74% of women who had hormone treatment for severe forms of endometriosis, pain occurring later than 5 years post-treatment.
- Using GnRH or progesterone for treatment of recurrence of pain is recommended when the pain is as strong as or worse than at the beginning.
9.3. Natural Treatment
If you are experiencing painful periods or pelvic pain, it’s important to see your doctor to get a proper diagnosis. Here are eight natural treatments that are used for endometriosis.
9.3.1. Reduce Chemical Intake:
Although earlier studies in women were conflicting, there is increasing evidence that chronic exposure to the environmental chemicals dioxins and polychlorinated biphenyls (PCBs) is associated with an increased prevalence and severity of endometriosis.
One way to reduce intake of these chemicals is to cut back on animal fat, especially high-fat dairy, red meat, and fish. Dioxin and PCBs both accumulate in animal fat, and it is our main route of exposure.
Interestingly, studies on diet and endometriosis also support this link. For example, an Italian study examined data from 504 women with endometriosis and found an increased risk with a high intake of red meat and ham. Fresh fruit and vegetables were associated with a reduction in risk.
9.3.2. Vegetables and Flaxseeds:
There is evidence that a group of plant chemicals called flavones can inhibit aromatase, the enzyme that converts androgens to estrogens. Good food sources of flavones are celery and parsley.
Broccoli, cauliflower, cabbage, kale, Brussels sprouts, and bok choy, contain compounds called indoles, which appear to improve estrogen metabolism.
Flaxseeds are high in lignans and fiber, which have been found to be beneficial for estrogen-related conditions.
9.3.3. Progesterone Cream:
Alternative practitioners sometimes recommend progesterone cream. Progesterone is thought to slow the growth of abnormal endometrial tissue. Although it’s not considered a cure, it may improve symptoms such as pain during menstrual periods and pelvic pain. There haven’t been any studies on progesterone cream for endometriosis, so we don’t know for certain about it’s effectiveness or safety.
Progesterone cream is derived from either soy or Mexican wild yam. A molecule called diosgenin is extracted in a lab and converted to a molecule that’s exactly like human progesterone and added to back to the cream. Some companies sell wild yam cream, but unless it has been converted in a lab it is useless, because the body can’t convert wild yam to progesterone on its own.
Natural progesterone cream is applied to the wrists, inner arms, inner thighs, or upper chest at a dose and schedule that should be recommended by a professional. It’s important to be supervised and to have progesterone levels monitored on lab tests, because too much progesterone can cause such side effects as mood changes, depression, water retention, weight gain, and absent or abnormal menstrual bleeding.
Natural progesterone cream is available from a compounding pharmacy (the website www.iacprx.org has listings) or at regular drug stores.
9.3.4. Omega-3 Fatty Acids:
Omega-3 fatty acids are found in fish such as salmon, mackerel, sardines, and anchovies. They are also available in fish oil capsules, which may be the preferable form because good brands contain minimal amounts of PCBs and dioxins.
Several studies have found that omega-3 fatty acids may be beneficial for people with endometriosis. For example, an animal study by the University of Western Ontario found that fish oil containing two specific compounds, EPA and DHA, can relieve pain by decreasing levels of an inflammatory chemical called prostaglandin E2. Researchers also found that fish oil could slow the growth of endometrial tissue.
9.3.5. Stress Reduction:
Cortisol is a hormone involved in the stress response but is also needed to make other hormones such as progesterone. Prolonged stress can lead to elevations in cortisol, which alternative practitioners say may decrease the available progesterone and result in a hormonal imbalance.
One study involving 49 women found that cortisol levels were significantly higher in women with advanced endometriosis compared to women who didn’t have this condition.
Herbs and nutrients that alternative practitioners commonly recommend for stress reduction include:
- B vitamins
- Vitamin C
Other stress reduction methods include:
- Relaxation Response
- Mindfulness Meditation
- Diaphragmatic Breathing
A contrast sitz bath is often recommended by alternative practitioners for endometriosis. It is a home remedy and has not been studied.
A contrast sitz bath involves sitting in a small basin or tub filled with hot water for three minutes, then getting up and sitting in another basin filled with cool water for one minute. The hot water-cold water cycle is repeated another 3 times. It is not usually done during menstruation.
9.3.7. Ginger Tea:
Ginger tea may relieve the nausea that can occur with endometriosis.
9.3.8. Bacterial or yeast overgrowth:
William Crook, author of The Yeast Connection believed there was a strong connection between endometriosis and candida yeast overgrowth.
A study by the Woman’s Hospital of Texas examined 50 women with endometriosis and found that 40 women showed bacterial overgrowth. After eight weeks of treatment, here was a significant reduction in symptoms.
9.4. Surgical treatment
Although hormone therapy is effective in reducing or eliminating the symptoms of endometriosis, it also prevents pregnancy. For patients who desire a pregnancy, surgery to remove implants may increase the chances of success. Surgical treatment is indicated as well in patients faced with severe pain caused by endometriosis.
Conservative surgery removes endometrial growths, scar tissue and adhesions without removing reproductive organs. This procedure can be performed by laparoscopy or through traditional abdominal surgery in severe cases. During laparoscopic surgery, a thin tube (laparoscope) with a laser and cautery – an instrument that destroys tissue by burning – is inserted through a small incision is made below the navel.
In severe cases of endometriosis, it might be required a total hysterectomy with removal of both ovaries (oophorectomy). This operation is the last option, especially for women of childbearing age. Hysterectomy leeds to early menopause and after the intervention women can not get pregnant.
There is no ideal treatment for all patients, but most women suffering from endometriosis find a solution to reduce symptoms. If pain persists or if finding an effective treatment takes some time, it may take some measures to reduce discomfort. Hot baths, electric pillows or other sources of heat applied to the lower abdomen helps to relax muscles and reduce pelvic cramping and menstrual pain.
9.5. Infertility Treatment
If a woman fails to become pregnant, treatment decisions for endometriosis should be more complex.
In case of severe pain caused by endometriosis in a woman who wants to become pregnant, the first treatment option for pain control is laparoscopic surgery. (Hormone therapy for endometriosis prevents pregnancy).
If infertility is associated with an easier form of endometriosis, intrauterine artificial insemination or in vitro fertilization (laboratory) is considered necessary, which lead to an increased chance of pregnancy.
In a moderate or severe endometriosis, the doctor will indicate laparoscopy to see and remove the signs of endometriosis. Laparoscopic surgery can remove the pain caused by endometriosis and thereby increasing and the chance of getting pregnant. In vitro fertilization also increases the chances of pregnancy when a woman has moderate or severe endometriosis, which causes infertility.
After laparoscopy, the following approach depends on the severity of endometriosis and the woman’s age. If a woman is over 35 she has less time to get pregnant – egg quality is deteriorating and the risk of miscarriage increases with age.
10. Major recommendations in endometriosis
In most patients with chronic pelvic pain the treatment with GnRH agonists for at least 3 months or Danazol for at least 6 months have similar efficiency.
- If treatment with GnRH agonist it is recommended a combination of alternative therapies to reduce or eliminate bone loss induced by agonists of GnRH.
- GnRH agonist therapy can be started in women with chronic pelvic pain even in the absence of surgical confirmation of endometriosis, but after rigorous exclusion of other causes of pelvic pain.
- For the treatment of the pelvic pain in endometriosis oral contraceptives are just as effective (contraceptive pill) or depot medroxyprogesterone acetate form, available treatments in terms of cost.
- Estrogen replacement therapy is contraindicated after a hysterectomy with bilateral anexectomie for endometriosis.
- In severe endometriosis, medical treatment is often insufficient.
- Since endometriosis is unpredictable and may regress spontaneously, in asymptomatic patients is recommended for expectant conduct.
- In comparison to laparotomy, operative laparoscopy in the surgical treatment of endometriosis-related pelvic pain is associated with faster recovery, less risk of postoperative adhesions and lower rate of complications.
- Danazol treatment cost is lower than that of treatment with GnRH analogues and more expensive than treatment with contraceptive pills or medroxyprogesterone acetate.Danazol at a dose of 600-800 mg daily is as effective as GnRH agonists, but is associated with a significantly increased incidence of side effects.
- GnRH agonists are associated with decreased bone density (bone demineralization) and vasomotor symptoms (heat waves, migraine, depression, vaginal dryness, dyspareunia).
The above article is only for knowledge purposes. Please contact your healthcare provider before using any of the above medicine or method. For any query or personal consultation according to your health condition