Endometriosis is a disease that primarily affects women and is characterized by the abnormal growth of endometrial tissue outside the uterus, in various locations throughout the body.
The endometrium, a soft tissue lining inside the uterus, plays a crucial role in each menstrual cycle by shedding and causing the characteristic bleeding.
In cases of endometriosis, the presence of endometrial tissue extends beyond the uterus. It can be found near the uterus, such as in the fallopian tubes and ovaries. Moreover, it can also appear outside the uterus in various locations, including the bladder, rectum, abdomen, scars from previous surgeries, and in rare instances, it may even reach the lungs or the meninges in the brain.
The primary concern arises from the fact that the endometrium, even when located outside the uterus, continues to respond to sex hormones as if it were still within the uterine cavity. This abnormal response can lead to a variety of issues, including bleeding, adhesions, and pain in the affected areas.
Endometriosis is a chronic and recurrent disease that not only causes abdominal pain, typically intensifying after menstruation, but is also associated with infertility. However, its impact extends beyond these symptoms, potentially leading to various complications when endometrial tissue is found in other organs.
Endometriosis is generally considered a benign condition that does not progress into cancer.
The exact causes of endometriosis remain unclear, giving rise to numerous theories attempting to explain its occurrence.
The leading theory regarding the cause of endometriosis is retrograde menstruation, which suggests that a portion of the endometrial tissue flows backward into the fallopian tubes and implants itself in other organs outside the uterus.
Additional researchers have put forth alternative explanations, including stem cell migration from the bone marrow, the concept of endometrial cells migrating through the blood as "benign metastases," and several other hypotheses. However, despite extensive exploration, a definitive conclusion regarding the precise cause of endometriosis has yet to be reached.
Consequently, the elusive nature of its origins presents challenges in terms of prevention and treatment.
Endometriosis affects a significant proportion of women of childbearing age, estimated to be between 5% and 10% from the onset of their first period until menopause.
Endometriosis is a highly prevalent condition, with approximately 30 to 40% of women experiencing fertility issues attributing them to this cause. It is noteworthy that a significant number of these women affected by endometriosis have not yet had any children.
Furthermore, endometriosis accounts for over 70% of women seeking medical attention due to chronic pelvic pain.
The symptoms of endometriosis can vary significantly, ranging from asymptomatic cases to severe pain and the formation of large ovarian cysts with blood retention.
Women affected by endometriosis may experience a range of symptoms, including:
The intensity of symptoms associated with endometriosis does not always align with the severity of the disease. It is possible for women with mild endometriosis to experience severe pelvic pain, while others with extensive lesions may remain asymptomatic.
Endometriosis can lead to infertility by impeding the passage of the egg cell (ovum) through the fallopian tubes to reach the uterus, primarily due to the presence of abnormal tissue. However, it is important to note that infertility can occur even in cases where there are no apparent anatomical abnormalities associated with endometriosis.
Typically, endometriosis is suspected during the evaluation of infertility or sterility through comprehensive medical history, physical examination, and relevant diagnostic tests.
Furthermore, it is not uncommon to discover endometriosis when assessing women who have been experiencing persistent pelvic pain for an extended period.
Vaginal examination, visualization using a vaginal speculum, and transvaginal ultrasound can aid in detecting endometriosis located near the uterus. However, the definitive diagnosis of endometriosis is typically confirmed through laparoscopy.
Laparoscopy is a diagnostic procedure that enables the visualization of endometrial lesions and facilitates the collection of biopsy samples. It involves the insertion of a thin tube fitted with a camera through a small incision in the abdominal area. Additionally, laparoscopy offers the advantage of simultaneous surgical treatment if necessary.
While previously recommended for all women with suspected endometriosis, current practice favors initiating less invasive procedures as an initial approach, reserving laparoscopy for cases where treatment is required or when diagnostic uncertainty remains.
The recommended initial tests for the evaluation of endometriosis include:
If there is suspicion of endometrial seeding in other regions of the body, the following diagnostic procedures may be conducted:
The treatment approach for endometriosis varies based on the severity of symptoms and focuses on achieving three primary goals:
In general, there are two main treatment options available:
Chronic pain associated with endometriosis can be challenging to manage, and conventional treatments such as nonsteroidal anti-inflammatory drugs (NSAIDs), antidepressants, or anticonvulsants may not always provide effective relief.
The effectiveness of hormone treatments for endometriosis varies among individuals. The following options are available:
Previously commonly prescribed medications like Danazol have fallen out of favor in recent times due to their associated side effects. Danazol works by altering androgens, progesterone, and corticosteroids, leading to various undesirable effects, including acne, weight gain, bleeding between periods, edema (fluid retention), cramps, deepening of the voice, and increased facial hair. Consequently, it is no longer recommended unless no alternative treatment options are available.
The decision for surgical intervention in endometriosis greatly depends on the extent of the condition and the woman's desire to preserve fertility. There are two main approaches: