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It is estimated that up to 50% of women complaining of pelvic pain can hear a diagnosis in the gynecologist's office: endometriosis. What is this mysterious disease? What ailments and symptoms may indicate its existence?

Endometriosis , also known as external endometriosis, is the presence of the uterine mucosa (endometrium) in other organs, for example in the ovaries or fallopian tube. Much less often, this type of epithelium is detected in distant organs completely unrelated to the reproductive function, e.g. the heart or the brain.

The growth of endometrial cells is dependent on the action of female hormones - estrogens - therefore endometriosis is most common among women of reproductive age, between 15 and 45 years of age. It is estimated that this disease is diagnosed in about 7-15% of regularly menstruating women.

Causes of endometriosis

There are many theories about the formation of endometriosis. Unfortunately, despite numerous scientific studies, the exact mechanism of the disease is still unknown. The most likely assumption seems to be the so-calledthe theory of retrograde menstruation .

According to this hypothesis, menstrual blood containing exfoliated uterine epithelium does not completely leave the genital tract, and part of it returns to the fallopian tubes. There, implantation, i.e. implantation of endometrial cells into other peritoneal tissues or more distant organs, can take place. Although this theory was created over 90 years ago (in the 1920s), it turns out to be accurate.

It is now known thatdisorders of the immune responseplay a very important role in this general mechanism, which may regulate local adhesion - that is, "sticking" of cells to the substrate, as well as the formation of the state flammable.

Endometriosis is also statistically more common with autoimmune diseases (such as rheumatoid arthritis - RA or hypothyroidism). This fact additionally emphasizes its possible connection with impaired functions of the immune system.

There are also some risk factors that may predispose a woman to develop endometriosis in the future. They are:

  • short menstrual cycles,
  • long and heavy bleedingmenstrual,
  • early first menstruation,
  • family history of endometriosis,
  • low body weight.

The way you live can also influence the regulation of estrogen levels. Therefore, it is believed that the consumption of large amounts of caffeine, alcohol, and the lack of exercise may also indirectly increase the risk of endometriosis.

Symptoms of endometriosis

Due to the possibility of endometrial lesions in various organs, not only in the reproductive system, the symptoms of this disease can often be non-specific and diverse.

It should be remembered that some of the similar ailments occur in the course of many other diseases, e.g. intestinal diseases or inflammation of the urinary bladder. What then should pay special attention?

The basic symptoms of endometriosisinclude:

  • severe pain that occurs periodically during menstruation,
  • heavy contractions and menstrual bleeding,
  • so-called migrating pelvic and lower back pains,
  • pains in the bladder area,
  • painful intercourse,
  • painful bowel movements or urination,
  • flatulence,
  • frequent constipation,
  • problems getting pregnant.

Symptoms of the disease usually recur cyclically, preceding or occurring during menstruation.

Less frequently described symptoms of endometriosis , depending on its form and location of the lesions, may be:

  • bleeding occurring during the ovulation cycle,
  • blood in urine,
  • and even shortness of breath and chest pain that occurs when endometrial cells form a focus in the lungs.

Untreated endometriosis can lead to :

  • permanent infertility,
  • sexual problems,
  • disorders of the intestine and bladder.

The most troublesome for most women, however, may be chronic, severe pain accompanying menstruation, which interferes with normal functioning.

How to diagnose endometriosis?

Proper diagnosis of endometriosis may take several or even several years. Non-specific symptoms often make an accurate diagnosis difficult. Too late diagnosis of this disease is certainly influenced by the common belief in society that menstruation in women is always associated with pain and it is a natural feature.

Disregarding the problem, patients do not inform doctors about their ailments during check-up visits, and thus the disease develops for many years. Women very often start examinations only after extensionsin fruitless efforts to have a baby.

For the correct diagnosis of the disease, a detailed clinical interview and a thorough gynecological examination are necessary - often supplemented by a transvaginal ultrasound (when the device head is inserted through the vagina). It will help to locate the location of endometriotic changes, the so-called endometrial lesions.

Sometimes other non-invasive tests with higher image resolution are used for diagnostics, such as computed tomography or magnetic resonance imaging.

Unfortunately, in some cases, the lack of confirmation of the presence of endometriosis foci in the above studies does not exclude the existence of the disease, because they may be small or so specific that the apparatus will not be able to detect them.

Until recently, a biochemical marker from blood - Ca-125 - also popular in the diagnosis of ovarian cancer, was used in the diagnosis of endometriotic changes.

Although the level of this antigen may be elevated in endometriosis, this test is very non-specific and may indicate the presence of other inflammatory diseases. Therefore, this test is not currently recommended, and it should be remembered that a negative Ca-125 result does not rule out endometriosis in a woman.

Treatment methods for endometriosis

Treatment of endometriosis depends primarily on the stage of the disease and the location of the endometrial lesions. The first, main goal of the therapy isrelieving the pain of patient(initially with the use of non-steroidal anti-inflammatory drugs - so-called NSAIDs). Then, inhibition of disease progression and improvement of fertility.

There are two types of endometriosis treatment: pharmacological and surgical.

Pharmacological treatmentuses drugs that inhibit endometrial cell division and reduce estrogen levels (e.g. gestagens such as danazol, popular combined contraceptive pills). These drugs will limit the growth of the endometrium and thus reduce bleeding.

Surgical treatment of endometriosisis used when pharmacotherapy does not bring the expected results. It consists in laparoscopic excision of the foci of endometriosis, whereby tissue specimens are always taken from the localized foci for histopathological examination.

In particularly difficult cases, when the diseased tissue is damaged by adhesions and cysts, the procedure is performed to remove the ovaries and even the uterus. The operation does not, howevercauses of endometriosis, which can create new foci and adhesions. Therefore, sometimes, despite the surgery, the disease may recur.

Endometriosis - when to see a doctor?

Endometriosis is an insidious disease that can go undiagnosed for many years and eventually lead to infertility or permanent damage to many organs.

Symptoms that should encourage a woman to consult a gynecologist are certainly:

  • severe menstrual pains,
  • recurring pains in the pelvic area,
  • breakthrough bleeding
  • or pain during intercourse.

Women diagnosed with endometriosis should undergo long-term treatment to avoid complicated surgeries and relapses in the future.

As with many other chronic diseases, regular medical consultations and correct diagnosis turn out to be the key to effective treatment. Endometriosis does not have to be a sentence if detected early.

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