MY MEDICAL SUITCASE
WHAT IS ENDOMETRIOSIS?
Endometriosis is a common gynaecological disorder that affects one in ten women.
It is a chronic disease in which fragments of endometrium-like tissue grow outside the uterus. The endometrium is the mucous membrane that lines the uterus.
The fragments can affect different organs as they migrate to neighbouring organs and embed themselves there.
Because they react to hormones, these endometrial fragments also bleed in the womb during menstruation.
Where does endometriosis occur?
In the case of endometriosis, the endometrial tissue most often forms:
- On the ovaries;
- On the Fallopian tubes;
- On areas close to the uterus, the uterosacral ligaments, end of the vaginal fornix, end of the pouch of Douglas, etc.
- When it occurs on the exterior surface of the uterus or inside the uterus it is also called adenomyosis.
More rarely it can also develop on nearby organs such as the intestine or the bladder.
In the rarest cases endometrial tissue can be found in places much further away from the uterus, such as the diaphragm, nerves, lungs, etc.
WHAT FORMS DOES ENDOMETRIOSIS TAKE?
There are three forms of endometriosis, which often appear in combination:
- Superficial (or peritoneal) endometriosis refers to superficial lesions. They are probably the most common type of lesions and occur on the peritoneum, which is the membrane that lines the interior wall of the abdomen and covers the organs found there.
- Ovarian endometriosis takes the form of ovarian cysts, characterised by their liquid, chocolate-coloured contents.
- Deep pelvic (or sub-peritoneal) endometriosis refers to lesions that infiltrate more than 5 mm into the sub-peritoneal tissue. These are hard, fibrous lesions, containing relatively little hormonal-dependent tissue (15-20% of the endometrial nodule’s volume).
Painful periods: occasionally severe, recurrent pelvic pain, particularly during menstruation. The pain is often debilitating.
Infertility associated with the painful symptoms mentioned above can be a reason for considering endometriosis.
Chronic, neuropathic, pelvic pain
Digestive and urinary problems: pain during bowel movements or urinating.
Dyspareunia: pain during sexual intercourse felt deep inside the pelvis.
HOW IS ENDOMETRIOSIS DIAGNOSED?
Endometriosis can be diagnosed at any time from puberty to the menopause.
A detailed, guided interview carried out by a specialist, generally supported by a gynaecological examination, should form the basis for a diagnosis of endometriosis.
The medical practitioner can then prescribe different scans, such as MRI and ultrasound, and offer first-line treatment, particularly for the pain, and referral to specialists if necessary.
WHAT TREATMENT DOES EXIST?
All forms of endometriosis require personalised treatment, with the main objectives being to:
- Improve the quality of life by reducing the pain
- Prevent the development of lesions
- Suppress menstruation, often the source of pain
1 – Hormonal treatment to prevent the onset of menstruation/the artificial menopause cure
Hormonal treatment limits the progression of endometriosis and therefore reduces the pain.
During each menstrual cycle, any endometrial lesions present in the abdomen react to the effects of the hormones and bleed. This causes inflammation, pain, adhesions and can damage the organs.
Hormonal treatment stops the menstrual cycle and prevents the lesions from bleeding and growing.
When hormonal treatment is successful, the lesions dry out and stabilise, thus reducing inflammation and pain.
Examples: Contraceptive pill, Implant, Hormonal IUD, Injection (artificial menopause).
2 – Surgery
If medical therapy fails to reduce the pain significantly, a surgical operation may be feasible.
Its purpose is the resection or destruction of endometrial lesions and repair of the affected organs, with the aim of treating pain and infertility.
The mechanisms that cause the pain associated with endometriosis are many and complex.
Pain associated with endometrial lesions can be explained by several mechanisms which may co-exist within the same patient:
- Nociception, perception of the stimuli that cause physical pain;
- Hyperalgesia, heightened sensitivity to pain;
- Central sensitisation, plays a role in some chronic pain syndromes. Changes in how the central nervous system processes pain signals lead to sensitisation (amplification of pain perception) and sensory hypersensitivity.
Pain typology (dysmenorrhoea, deep dyspareunia, digestive or urinary physical symptoms) is related to the location of the lesions.
There are two types of treatment.
– Primary therapy: daily medication is taken to reduce central sensitisation and neuropathic pain, in conjunction with hormonal treatment aimed at eliminating menstruation and cyclical pelvic inflammation.
– Flare-up treatments: to be used specifically if the pain worsens.
There are different levels you can try out with your doctor: anti-inflammatory drugs, opioids and morphine derivatives.
On the other hand, an understanding of your symptoms and a thorough examination of your case will enable you to manage the pain with our specialists, who will offer you personalised solutions.
Talking about it and getting a diagnosis is the first step to ensuring that your unexplained pain is no longer inescapable. Stop the pain from developing and becoming chronic.