Endometriosis

Endometriosis

Endometriosis occurs when tissue, similar to the lining of the womb (endometrium), has started to grow outside the womb. This can be painful, and can also lead to problems conceiving. One of the most common symptoms is pain during intercourse.

What is endometriosis?

In endometriosis, tissue similar to the lining of the uterus (endometrium) begins to grow outside the uterus. Common places to find endometriosis:

• The inside of the fallopian tubes

• On/around the ovaries

• Outside the womb

• In the peritoneum

• In the pelvis

• The intestines

• The urinary bladder

• Vagina

• In rare cases, endometriosis can also be seen elsewhere on the body, such as in the lungs or urinary tract.

The endometrial tissue grows thick every month as a result of the influence of estrogen. The condition causes cysts of varying sizes to form where the endometriosis is located. The small blisters (cysts) are often seen on the ovaries or peritoneum, or you can see spots. The color of the cysts and spots varies from red-blue to brown. The blisters contain thick, old blood. The size of the cysts can vary from a few millimeters to several centimeters.

The endometrial tissue will be affected by sex hormones that vary throughout the menstrual cycle. When the rest of the uterine lining begins to bleed, the endometrial tissue also bleeds. But this tissue will not be expelled with the rest of the menstrual bleeding. Blisters or cysts with blood are therefore formed. You can also get irritation in the tissue, and this can cause inflammation and eventually scars or knots. Chronic inflammation causes the release of cytokines and prostaglandins, which can damage the ovaries and fallopian tubes, or other vets, and cause adhesions of the tissue. This can cause problems with getting pregnant.

Although endometriosis usually develops between the ages of 20 and 30, the disease can affect all women of childbearing age, including teenagers. Endometriosis in itself is not dangerous, but in rare cases complications resulting from the disease can be life-threatening.

Not everyone with endometriosis has symptoms, and it will often be discovered by chance. Among those suffering from infertility, endometriosis is more frequent than in the rest of the population.

Adenomyosis

We differentiate between endometriosis and adenomyosis. In adenomyosis, tissue that is normally found inside the uterus grows into the muscle walls of the uterus. In endometriosis, tissue similar to the lining of the uterus (endometrium) grows outside the uterus, as described above.

Causes of endometriosis

No one knows for sure what causes endometriosis, and there may be several factors at play, but there are several different theories.

One theory is that endometriosis occurs by itself when remnants of amniotic fluid in the peritoneum are transformed into uterine lining.

Another theory claims that cells from the lining of the uterus are shed during menstruation and that some of the blood with the cells ends up in the abdominal cavity instead of being passed out through the vagina. Bleeding from the uterus into the abdominal cavity occurs in most women, but only in some the body's immune system allows the lining to grow in the wrong place.

Some also claim that endometriosis cells or tissue can be transported around the body via the bloodstream and lymphatic system, in the same way as cancer cells.

Heredity also appears to play a role in the development of endometriosis.

Estrogen is necessary for endometriosis to form, and therefore the condition usually does not occur before puberty, and the changes normally reverse after menopause.

Not everyone with endometriosis has symptoms, and it will often be discovered by chance. Among those suffering from infertility, endometriosis is more frequent than in the rest of the population.

Symptoms of endometriosis

• Menstrual pain, often severe and you often experience a poor effect of painkillers.

• Pain before menstruation and at ovulation.

• Bleeding disorders; often heavy menstrual bleeding

• Pain during intercourse, especially with deep thrusts.

• Childlessness can be a problem.

• Coolness in the stomach, bleeding before menstruation and a feeling of heaviness in the abdomen can also occur.

• Nausea.

• Pain in the lower back.

• Endometriosis on the bladder can cause painful urination.

• Endometriosis in the intestines can cause pain when defecating, and can also cause constipation and/or diarrhoea.

• Fatigue, exhaustion and low energy levels can result from the pain.

The pain can vary in intensity throughout the menstrual cycle.

About 20% of all women with endometriosis have no symptoms. It is not known why some women experience very severe pain, while others have no symptoms. Nor has a correlation been found between the degree of pain and the severity of endometriosis.

Occurrence of endometriosis

About 10% of women have endometriosis, and the disease is therefore one of the most common women's diseases. Not everyone knows they have the disease, as many can live without symptoms and pain. About. 40% of childless women and around 25% of women who experience abdominal pain suffer from endometriosis.

How is endometriosis diagnosed?

Medical history and gynecological examinations are part of the diagnosis. Cysts or nodules in the tissue can also be detected using MRI or ultrasound examinations. With peephole surgery, a safe diagnosis can be made in most cases.

Endometriosis and infertility

The ovaries store all the eggs, and the fallopian tubes are responsible for carrying the eggs from the ovaries to the uterus. Both of these structures can be damaged by the inflammation that occurs in connection with endometriosis, and this can cause adhesions of the tissue. This can make it more difficult to get pregnant.

30-40% of all women with endometriosis experience problems conceiving. Surgical treatment can in some cases improve fertility. In case of continued infertility, in vitro fertilization (IVF - In Vitro Fertilisation) is a good treatment option. Many people do not know they have endometriosis until they try to conceive.

If you become pregnant, the pregnancy will progress like that of other women, and there is no increased risk of miscarriage or ectopic pregnancy. However, some will experience an increase in pain in the first months of pregnancy.

Treatment of endometriosis

Treatment of endometriosis usually takes place through collaboration between a GP and a gynecologist and is aimed at reducing pain and preventing and possibly treating infertility.

• Painkillers of the NSAIDs type, such as ibuprofen, are the first choice. NSAIDs should not be used if you are trying to get pregnant.

• If this does not provide good enough pain relief, hormone therapy is an alternative and birth control pills are usually the first choice. Birth control pills contain more progestagen than estrogen, and therefore reduce the effect of estrogen on the endometriosis tissue. This will reduce the discomfort as long as you use the contraceptive. You cannot become pregnant while using this treatment.

• Another hormone treatment is available if birth control pills do not have a good enough effect. These can be progestogens, which are used to stop menstruation, or GnRH agonists, which suppress the body's own production of sex hormones.

• In some cases of endometriosis, surgery is necessary to remove the changes, for example in the case of severe symptoms or if the changes are deep seated. This is often the best treatment if you want to have children in the near future. As a rule, peephole surgery is used.

• The effect of hormone therapy and surgery is usually good, but endometriosis is not a condition that can be cured as long as the body is still producing estrogen. There may therefore be a need for repeated treatments.