Endometriosis

An Overview

Endometriosis is a benign yet often painful condition where tissue similar to the lining inside the uterus, called the endometrium, starts to grow outside the uterus. This tissue can spread to various organs such as the ovaries, fallopian tubes, bladder, or intestines, causing cysts, scars, and inflammation. The precise causes of endometriosis are not fully understood, but it is thought that genetic factors, hormonal changes, and immune system issues may play a role. The condition affects 6-10% of women of reproductive age and can lead to infertility. Common among most forms of endometriosis is their occurrence coinciding with the menstrual cycle. Endometriosis can cause pain, especially during menstrual periods. But treatments can help you take charge of the condition and its complications.

Localization:

Endometriosis primarily settles on the peritoneum and the ovaries. The spread can vary from a few millimeters in diameter to the size of the palm when it extensively infiltrates the peritoneum.

Endometriosis Affecting the Ovaries and Uterus:

It also commonly nests in the bladder and intestines, where the associated symptomatology includes pain during urination, occasionally accompanied by blood discharge from the urethra. Endometriosis of the intestines can also signal dramatic symptoms: in addition to other complaints, severe diarrhea often occurs, which is typically mucus-laden and bloody. This disease can also be found in atypical locations – in the vagina, around the navel, and even in the heart or lungs.

Etiology:

Despite intensive research, the etiology and pathogenesis of endometriosis are only partially understood. Various concepts and theories on the origin of endometriosis exist, including:

• The transplantation theory by J.A. Sampson from 1924,
• The metaplasia theory by R. Meyer,
• The "endometriotic disease theory" by P.H. Koninckx,
• The archimetra concept by G. Leyendecker.

Experts agree that no single theory can exhaustively explain the emergence of endometriosis in its various forms. It appears that the interplay of different factors such as genetic predisposition, endocrine, immunological, and mechanical/anatomical factors lead to metaplasia, implantation, and the formation of endometriosis implants.

Description:

Endometriosis can grow in nodular, vesicular, polypoid, plaque-like, cystic, or infiltrative forms, often presenting in combinations. Descriptions of endometriosis lesions can provide an indication of their biological activity, with red lesions considered active, blue-black lesions as less active, and white-scarred findings as inactive.

Clinical Presentation:

Classic leading symptoms of endometriosis include:

• Cyclical or chronic pelvic pain,
• Dysmenorrhea,
• Dyspareunia,
• Gastrointestinal symptoms,
• Dysuria or painful periods: Pelvic pain and cramping may start before a menstrual period and last for days into it. You also may have lower back and stomach pain.
• Sterility/infertility: For some people, endometriosis is first found during tests for infertility treatment.
• Bleeding disorders,
• A notable accumulation of 'nonspecific' symptoms like fatigue, diarrhea, constipation, bloating or nausea.

These symptoms are more common before or during menstrual periods.

Fertility Desires and Sterility:

It is estimated that about 50% of infertile patients suffer from endometriosis. Advanced endometriosis, with corresponding changes to the internal genitalia, represents a factor in infertility. However, the mechanisms underlying the unfulfilled desire for children in cases of minimal or mild endometriosis are subtle and controversially discussed in the literature.

Therapy:

Current knowledge suggests that the origins of endometriosis are multifaceted, and the more medicine learns about this disease, the more differentiated its treatment becomes. The therapeutic concept for patients with endometriosis is always individualized. Treatment depends on the severity of the symptoms and the desire for children. Options include pain medication, hormonal therapy (e.g., the pill, GnRH agonists), and surgical removal of endometriosis lesions. Although endometriosis can lead to infertility, there are treatment options to improve fertility, including surgical procedures or assisted reproductive technologies (ART) such as in-vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI).

When to See a Doctor?

See a member of your health care team if you think you might have symptoms of endometriosis. Endometriosis can be a challenge to manage. You may be better able to take charge of the symptoms if:

• Your care team finds the disease sooner rather than later.
• You learn as much as you can about endometriosis.
• You get treatment from a team of health care professionals from different medical fields, if needed.

For further professional inquiries, we are always at your disposal and you can request an appointment.

For more information on this topic, please visit the following links:

• endometriosis.org
• ncbi.nlm.nih.gov
• medscape.com