What causes endometriosis?
It is believed that the following factors have a considerable impact on development of endometriosis lesions: dysfunctions in the immune system, genetic and environmental factors. Endometrial implants can be found on the ovaries, Fallopian tubes, uterine ligaments, external side of the uterus, peritoneum, intestines, in the bladder, vagina and on the cervix. When endometrium grows in other locations, it leads to constant state of inflammation in the body. The lesions react accordingly to hormone fluctuations during menstruation cycle, but the exfoliating endometrium has no way out, it stays in the body, and by decaying conduces to formation of adhesions and cysts.
Women with endometriosis can suffer from different symptoms, but usually they are similar to other gynaecological afflictions, what causes that endometriosis diagnostics can be a really difficult task, especially in its early stage of development. The typical symptoms are: strong pain in the hypogastrium during menstruation, more profuse and longer menstruation, spotting, blood present in urine or in faeces, feeling pain while defaecation. Over time the pain can become persistent and stronger. Women with endometriosis can also feel pain during intercourse and therefore it has a negative impact on their sexual life.
Problems with conceiving can also be one of the symptoms of endometriosis. Even 40-50% women struggling with infertility suffer from endometriosis. This condition can cause damage of ovaries, Fallopian tubes, ovulation dysfunction and can also provoke failure of the embryo implantation in the uterus.
To fully diagnose endometriosis, precise medical interview and gynaecological examination are required. Next step is to perform gynaecological ultrasound scan, which enables to detect endometriosis cysts on the ovaries, and to undergo magnetic resonance imaging (MRI) in cases of endometriosis located in extraperitoneal area. The most accurate diagnostic method is laparoscopy as it makes it possible to additionally take a sample for histopathological test.
Endometriosis has been classified by the American Society for Reproductive Medicine as following:
- Stage I (minimal) – the size of adhesions does not exceed 5 mm and they are located in the uterus, on the ovaries and Fallopian tubes.
- Stage II (mild) – adhesions and cysts up to 5 mm, often spontaneously bursting. They are more aggressive and cover bigger area of the uterus, ovaries and Fallopian tubes.
- Stage III (moderate) – the size of adhesions and cysts exceeds 5 mm and they cover as well the uterosacral ligament.
- Stage IV (severe) – endometrial cysts have a couple of centimetres. The uterus is immovable, bended to the back, attached to the bowel loop. Adhesions and cysts are located on the appendix, bladder, vagina or cervix as well.
Treatment plan depends on its stage of development, on location, extent, depth of endometrial implants, and patient’s age. Contemporary medicine unfortunately cannot prevent this disease nor to restore it completely, but scientists work on modern diagnostic and therapeutic techniques. Talking about pharmacological treatment, first it is necessary to use nonsteroidal anti-inflammatory drugs, oestrogen-progestin hormone therapy or progestins alone (pills, intrauterine device) in order to reduce the pain. Next step is a diagnostic or surgical laparoscopy, which enables to destroy endometriosis lesions and to take samples for histopathological test. When endometriosis is confirmed, the treatment with use of Gonadotropin-releasing Hormone Analogs (GnRH agonists) is implemented and drug-induced menopause occurs. For women struggling with endometriosis it is often recommended to undergo stimulation of ovulation and to try conceiving through assisted reproductive technologies, such as intrauterine insemination and IVF. Maintaining healthy and balanced diet has also enormous positive impact on managing endometriosis.