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Complete guide to endometriosis

By Dr. Jesús Alberto Félix Atondo

Endometriosis is a benign, chronic and sometimes progressive disease. It is characterized by the presence of abnormal endometrial tissue located outside the uterine cavity, causing inflammation, adhesions, and fibrosis. Although the risk of it being a malignant condition is low, it is related to fertility problems.

 

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In order for you to know more about endometriosis, today we will give you a complete guide where you will find the answers to the most frequently asked questions about this disease. Let’s get started!

 

What is endometriosis?

It is estimated that endometriosis is a disease that affects between 75 and 10% of reproductive age women. The endometrium has the capacity to grow, infiltrate and spread in a similar way to tumor tissues, so in endometriosis this tissue is located outside its original place in the uterus and settles in the abdomen, ovaries, ligaments, sacrum, septum recto-vaginal and, in severe cases, it reaches other places such as the digestive tract, urinary tract, liver, pancreas, navel or lungs.

 

Signs and symptoms

The endometriosis symptomatology is very variable since, in some cases, women do not have any discomfort, and the diagnosis is made when doing an examination for other reasons, such as infertility.

The most common discomforts are:

  • Intense menstrual pain that can become disabling
  • Heavy menstruation
  • Abdominal or belly pain outside the menstrual period, without apparent cause
  • Pain during intercourse·
  • Pain when defecating, without colon diseases or constipation·
  • Discomfort when urinating, or blood in the urine without association with urinary tract infection
  • Anal bleeding during menstruation
  • Difficulty getting pregnant
  • The intensity of the symptoms varies from one patient to another, and one or several may occur at the same time.

 

Endometriosis Causes

Although endometriosis is considered one of the most diagnosed diseases in gynecology, and the third cause of gynecological surgeries in the United States, its causes are not fully known.  Theories about the etiology of the disease are: ·

  • Retrograde menstruation. This theory has been discarded, since retrograde menstruation, which runs through the fallopian tubes towards the abdomen instead of going out, is a situation that occurs in women who do not have endometriosis.·
  • Hereditary factors. Since in some families endometriosis affects the mother and sisters, it is considered that genetics influences the development of the disease.·
  • Defects in the immunity of cells in the abdomen. This theory points to a defect in the immunity of the cells in the abdomen, which would prevent them from recognizing the endometrial cells that should only be inside the uterus as foreign, and allowing them access to internal organs.

 

Risk factors

Dysmenorrhea (painful menstruation) is associated with endometriosis, although it is usually interpreted as a symptom, while proimenorrhea (abnormal menstrual bleeding, with shorter periods) is a risk factor as menses are more frequent and in greater volume, which entails risk of menstrual reflux.

High BMI, smoking and obesity, which are usually factors associated with other gynecological conditions, are not related to endometriosis. However, it has been detected that this disease is frequent in patients who underwent surgery for the ovarian cancer treatment.

 

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Treatment

Endometriosis requires treatment not only because it is associated with pain and infertility, but because it is a progressive disease, worsening in 30% to 60% of patients during the year after diagnosis, and in more than 90% of patients two years after diagnosis. The most common treatments are:

 

Hormone treatment

It usually consists of the hormonal cycle alteration by means of oral contraceptives or by generating a state of pseudo menopause with gonadotropin antagonist drugs (GnRH), or a state of chronic anovulation by means of progestogens. This treatment´s goal is to control the menstrual cycle and the bleeding flow.

Surgical treatment

Surgical removal of endometrial tissue by laparoscopy usually achieves a temporary remission, and is only advised to remove tissue that is causing problems in organs beyond the uterus. Since endometriosis is a chronic disease, the recurrence risk is 5% to 20% in one year, with a cumulative rate of 40% in five years.

Pharmacotherapy

It consists of drugs for the relief of pain associated with symptoms, the elimination of endometriotic lesions and the recurrence prevention.

 

Diagnosis

The diagnosis must be made taking into account several factors:

  • Gynecological examination. It is performed to detect a possible increase in the size of one or both ovaries, the ovaries immobility, fixation or injuries.
  • Imaging exams. A pelvic ultrasound is usually done to visualize lesions and cysts with specific patterns.
  • Blood test. They are performed to detect increases in the CA 125 marker, by which other gynecological diseases such as hemorrhagic cysts or uterine fibroids are detected.
  • Nuclear magnetic resonance (NMR). It is an imaging test that allows to delimit the extension of the disease in areas of lesser access for ultrasound, such as the ureters, pelvis, abdomen, among others.
  • Laparoscopy. This technique allows the interior of the abdomen to be observed through small incisions in the navel through which the work instruments are inserted. It should be noted that laparoscopy allows endometriosis visualization and treatment by the same route, and in the same session.

 

Prevention measures

Unfortunately, there are no clear measures to prevent this disease, but there are some in order to prevent its recurrence.

At The Fertility Center we have specialists in endometriosis diagnosis and treatment. Also we have other procedures such as intrauterine insemination, in vitro fertilization and the benefits of the low cost of IVF in Mexico. Contact us today to schedule your assessment appointment. We will gladly assist you!

 

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Dr. Jesús Alberto Félix Atondo

Gynecology, Obstetrics and Biology of Human Reproduction Surgeon at the Autonomous University of Guadalajara, specialist Biologist of Human Reproduction by the Mexican Institute of Infertility.

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