Endometriosis

Definition of endometriosis

In endometriosis , the lining of the uterus (endometrium) attaches to other organs outside of the uterus. The mucosal deposits are usually benign.

• In the case of genital endometriosis , the mucous membrane cells are found in the area of ​​the female genital organs and the peritoneum. The female sex organs include fallopian tubes, ovaries, uterus, vagina and vulva.
• Adenomyosis uteri occurs when the mucous membrane cells in the muscular wall layer of the uterus spread.
• In the case of extragenital endometriosis , lining of the uterus can develop in the bladder, intestines, diaphragm, lungs and even the brain. Endometriosis foci can occur in all organs of the human body.

The uterine lining goes through the hormonal cycle every month . During the first few weeks, the mucous membrane prepares for a possible pregnancy through the implantation of the fertilized egg. It grows continuously under the influence of female hormones. If the egg has not been fertilized, the superficial layer of mucous membrane is shed. This happens as part of menstrual bleeding , which lasts for a few days.

The endometriosis foci pass through the female cycle in the same way and are subject to the influence of the female hormone estrogen. In the growth phase and during menstruation, pain can occur in the area of ​​the endometriosis foci. Since the blood cannot drain through the vagina via the cervix, blood pools and cysts form. Brownish, blood-filled cysts in the area of ​​the ovaries are called chocolate cysts. As a result of the congested blood, inflammatory reactions can occur in the surrounding tissue. These in turn lead to adhesions and strictures in the area of ​​​​endometriosis.

Who is affected by endometriosis?

Scientists assume that around 10 percent of all women of childbearing age are affected. The age of childbearing extends from the first menstrual period to the onset of menopause . Most patients are between 20 and 40 years old when they become ill.

An increased number of menstrual days is considered a risk factor for endometriosis . Very short menstrual cycles consequently lead to an increased number of menstrual days. Like a very early first menstrual period, a late first pregnancy is one of the risk factors for endometriosis. The risk of developing the disease also increases if a family member has endometriosis.

Symptoms of endometriosis

• The patients suffer from abdominal pain and abdominal discomfort , which usually increases shortly before the onset of the period and then decreases again. Back pain can also become noticeable.
• Painful menstrual bleeding is common .
• Irregular menstrual periods: Spotting and heavy bleeding may occur. The menstrual period can also last longer than seven days.
• Sexual intercourse may cause pain .
• Bladder involvement can result in bloody urine and painful urination.
• In the context of endometriosis in the intestine, bloody stools sometimes occur. It can also cause pain when going to the toilet.
• Endometriosis can also be asymptomatic . The disease is present, but the patients are symptom-free. In this case, no therapy is necessary.

Complications of endometriosis

Infertility can occur as a result of endometriosis . Chocolate cysts in the ovaries can prevent ovulation. Adhesions in the area of ​​the sex organs also lead to reduced fertility . The risk of an ectopic pregnancy increases if endometriosis prevents migration of the fertilized egg. Specialized fertility centers offer opportunities to realize the desire to have children despite endometriosis.

Causes of Endometriosis

There are various theories about the development of endometriosis. However, the origin of the disease has not been finally clarified.

The transplantation theory assumes reverse, backward menstruation. The blood does not flow naturally through the cervix into the vagina, but seeks its way through the fallopian tubes towards the abdominal cavity. During the bleeding, mucous membrane cells are carried into the abdominal cavity.

In the metaplasia theory, tissue is said to develop by itself into the lining of the uterus during embryonic development. The mucosal cells grow directly in the wrong place and lead to the characteristic symptoms as the disease progresses.

In addition, a genetic component of the disease can be assumed, since endometriosis occurs more frequently in some families.

Diagnosis and doctor consultation for endometriosis

According to studies, it often takes years from the onset of the first symptoms to the diagnosis. The symptoms are usually very unspecific, which makes it difficult to diagnose. An unfulfilled desire to have children can sometimes provide the only indication of the presence of endometriosis.

• If endometriosis is suspected, you should see a gynecologist .
• In a detailed anamnesis interview , there is the opportunity to describe complaints and symptoms. A cycle diary can be helpful in keeping track of the cycle period and noting any symptoms.
• This will be followed by a gynecological examination .
• A transvaginal ultrasound scan can detect blood-filled cysts in the abdomen, which can indicate endometriosis.
• The definitive diagnosis can usually only be made with a minimally invasive operation, a so-called laparoscopy , in which tissue samples are taken. These are then examined histologically in the laboratory for the presence of endometrium.

duration of endometriosis

Endometriosis is considered a chronic disease . Chronic diseases last a long time and are difficult to cure. Patients often suffer from relapses. Some women experience an improvement in symptoms during pregnancy. Symptoms usually go away after the onset of menopause.

You can do this yourself with endometriosis

Regular exercise can help reduce the pain of endometriosis. In addition, relaxation exercises and acupuncture provide relief for some patients. In addition, self-help groups are offered in many places, in which affected women can exchange ideas openly.

treatment of endometriosis

In principle, both medicinal and surgical treatment options are available for the treatment of endometriosis. Which therapy is best for those affected must be decided individually with the gynecologist. The earlier the therapy is started, the better the chances of recovery for the affected patients. At best, the therapy options are used in combination in order to achieve optimal treatment success.

• Pain- relieving tablets such as ibuprofen or diclofenac can be helpful to reduce the pain . In addition, these develop an anti-inflammatory effect, which counteracts the inflammatory mechanisms of the endometriosis foci.
• The endometriosis foci grow under the influence of the hormone estrogen. Progestin-containing preparations offer the possibility of inhibiting the release of estrogen and weakening menstrual bleeding. If taken continuously, the release of estrogen during menstrual bleeding is prevented and the growth stimulus for the endometriosis cells is absent.
• As a further step in the absence of improvement, GnRH agonists (Buserelin, Goserelin) are available as anti-oestrogenic drugs. Since these drugs have many side effects, their use should be carefully considered.
• Alternatively, there is the possibility of removing the endometriosis islands in an operation . If the findings are small, minimally invasive surgery can be used to remove the endometriosis. The operation is particularly suitable for women with an unfulfilled desire to have children, as it increases the chances of pregnancy in the long term.

When to seek help

In the case of severe menstrual problems such as abdominal pain , it is always worth visiting a gynecologist. Cycle irregularities should also be clarified by the gynaecologist.

How can Med-Healths help with endometriosis?

Do you suffer from severe menstrual cramps? Do you have questions about endometriosis that only a doctor can answer? You can use the Med-Healths App to contact our doctors via video call. There you will receive a detailed consultation. Our doctors take the time to answer your questions. In addition, they can issue you with a prescription for medication and, if necessary, certify that you are unable to work. In addition, they can refer you to a gynecological practice or to a specialized center.