Endometriosis – Stages, Symptoms & Treatment

Endometriosis mainly affects women of childbearing age, from 20 to 50 years old. It is important to diagnose it as soon as possible to avoid causing damage such as sterility. We explain everything you need to know about this pathology, its causes and its possible treatments.

Endometriosis is a leading cause when you have trouble conceiving a child. Below, we break down the causes, consequences and treatments to overcome this pathology, which affects large numbers of women of childbearing age.

What is endometriosis?

Endometriosis is a disease of women of reproductive age. The uterus is lined with a mucosa called the endometrium. This endometrium is made up of glands that only exist in this part of the body. In endometriosis, we find this endometrial tissue outside the uterus, for example, in the ovaries, the pelvic cavity, or even other, more distant places such as the lung. Although the most frequent ectopic location is the ovary.

In these cases, cysts are formed which are known as endometrioma. These grow over time, so endometriosis is a progressive chronic disease.

The cause of this problem is not yet precisely known. Every month, under the influence of female hormones, this abnormal tissue develops, causing inflammation and damaging surrounding areas.

Stages of Endometriosis

Endometriosis is classified into one of four stages :

  1. Minimal,
  2. Mild,
  3. Moderate,
  4. Severe

Based upon the depth of the endometriosis implants, the exact location, and as well as the presence and severity of scar tissue and the presence and size of endometrial implants in the ovaries.

How to avoid a late diagnosis?

Unfortunately, one of the problems of this pathology is the difficulty in diagnosing it.

Increased menstrual pain is the main symptom of this disease, but it is often underestimated because it is considered something physiological. Thus, it sometimes happens that many years pass before endometriosis is detected.

During this time, menstrual flows continue month after month, with an inevitable worsening of the situation. Therefore, the best thing, if you suspect having this disease, is to go to a specialized centre.

Gynaecological control and a transvaginal ultrasound may suffice to diagnose the disease.

In some cases, depending on the site where the presence of lesions is suspected, the doctor may decide to continue exploring (MRI, opaque enema, cystoscopy, colonoscopy, renal and urinary tract ultrasound, etc.).

Also, the blood analysis allows identifying the possible presence of endometriosis thanks to the analysis of CA-125.

Therapies used to treat endometriosis include

Endometriosis treatment is based on hormonal medications, such as the birth control pill. The objective is to “block” the menstrual cycle and, therefore, the atypical growth of the endometrium.

In this way, clearly, the causes of the pathology are not eliminated, but at least it is possible to stop its evolution and keep the symptoms under control in 70-80% of patients.

Therapies used to treat endometriosis include:

  • Hormonal contraceptives
  • Gonadotropin-releasing hormone (Gn-RH) agonists and antagonists
  • Progestin therapy
  • Aromatase inhibitors

Thus, treatments for endometriosis can range from drug administration, to suppress the activity of the ovaries and thus reduce the growth of endometrial tissue, to surgery, to remove as much of the tissue that has grown outside of its site.

In the worst case, it would be necessary to remove the uterus.

Pharmacotherapy

In this case, a drug is administered that inhibits the production of female sex hormones, estrogens (which stimulate the growth of the endometrium).

In this way, a kind of artificial menopause is obtained.

Oral contraceptives, Progestogen, Danocrine, and gonadotropin-releasing hormone (GnRH) agonists are used in this treatment.

These types of treatments do not cure endometriosis and, in addition, they are complex, because their application will depend on the age of the woman, the extent of endometriosis and the pain it causes, among others.

Surgical Treatment

It can be said that it has a higher success rate and is currently considered the most effective therapy.

Surgery is indicated in women with severe endometriosis who wish to maintain the possibility of pregnancy.

Surgery removes endometrial tissue, removes cysts and adhesions, and restores the pelvic anatomy.

The percentages of pregnancies achieved after conservative surgery vary according to severity: in mild cases, approximately 75% of those affected achieve pregnancy, in moderate cases 55%, and in severe cases 35%.

Today, the most widely used procedure is laparoscopy, which is gradually replacing laparotomy.

Laparoscopy is a minimally invasive surgery

The main objective of this technique in affected patients is to eliminate all visible endometriosis, preserving and restoring reproductive function if necessary (conservative surgery), although hysterectomies, or oophorectomies, can also be performed in more severe cases.

Laparoscopy is more effective than open surgery in adhesiolysis (release of internal structures affected by adhesions) since manipulation of internal organs is avoided.

Laparotomy is the opening of the abdominal cavity through a horizontal or vertical incision

Among its advantages is the speed and precision of the surgeon when accessing any area of ​​the abdomen.

However, as it is an aggressive intervention, it implies greater postoperative complications and requires more time for admission and recovery.

Due to the direct manipulation of the internal structures, the risk of the appearance of adhesions also increases.

What if you want to have a baby?

Although the chances are lower compared to a healthy woman, it is not impossible for a woman suffering from endometriosis to become pregnant. The situation should be evaluated on a case-by-case basis, according to the severity and extent of the disease.

If there are no bulky ovarian cysts and the tubes continue to function (that is, they have no injuries or adhesions with other organs), then there are all the conditions to start a pregnancy.

Of course, treatment must be discontinued. Normally, a period of attempts of 6-12 months is anticipated, variable according to the advance and the speed of evolution of the disease.

If during this time the woman does not become pregnant, she proceeds with a laparoscopic surgical intervention, to eliminate possible causes that hinder conception and restore the correct autonomy of the pelvis.

If the search for spontaneous pregnancy is not successful, it may be appropriate to resort to assisted reproduction.

Pregnancy: A Natural Treatment

The good news is that, once the pregnancy has started, the woman can be calm: the pregnancy is not affected by the successive pathological condition and no special precautions are needed, even if the pathology is also present in the uterus ( in this case, it is called “adenomyosis”).

Pregnancy represents a kind of physiological hormonal treatment for endometriosis. In this period, in fact, the woman’s body spontaneously produces the hormone that has this disease under control: progesterone.

After delivery, it is normally recommended that the woman start hormonal treatment again.

If you want to breastfeed, you can use the so-called “mini-pill” which, unlike the classic birth control pill, contains only progesterone and does not interfere with breastfeeding.

What are the signs and symptoms of endometriosis?

The following discomforts are those that could indicate the presence of this disease. So it is very important to pay attention to them.

  • Difficulty getting pregnant.
  • Intense pain during menstruation and the premenstrual phase.
  • Pain during sexual intercourse (especially with deep penetration).
  • Abundant and long menstrual flow.
  • During the menstrual period, the presence of itching when peeing without having urinary infections.
  • During the menstrual period, defecation disorders (constipation or diarrhoea, pain when defecating, blood in the stool).
  • Chronic pain in the pelvis.
  • Pain in the lumbar region or in a lower limb.

Other symptoms that can be related to endometriosis include

  • Chronic Fatigue,
  • Irregular menstruation,
  • Painful Urination,
  • Blood in urine,
  • Lower abdominal pain,
  • Diarrhoea and/or constipation,
  • Lower back pain

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