Endometriosis is a chronic disease, in which the mucosa, that covers the inside of the uterine cavity, is also found at locations outside the uterus. The exact origin of endometriosis is not yet known. The condition can cause inflammation and a lot of pain. Endometriosis can also contribute to reduced fertility.
Menstrual blood doesn’t only flow via the vagina to the outside; a small amount of blood also enters through the fallopian tubes into the abdominal cavity. Similarly, some endometrial tissue from the inside of the uterus ends up in the abdominal cavity. It can become inplanted there, causing endometriosis. In almost every woman, some blood enters the abdominal cavity during menstruation, but not every woman gets endometriosis. Apparently, other factors play a role, such as the immune system. Heredity also has influence: endometriosis is more common in women who have a mother or sister with this condition.
Factors that increase the chance of endometriosis are women who have had children after their thirtieth and women who have no children.
Endometriosis is often seen in the lower part of the abdomal cavity, at the front and/or back of the uterus, against the bladder and sometimes also the colon. Endometriosis can also occur in the ovaries. The blood that is released from the endometrial spots during the menstruation, then accumulates in the ovaries. Thus causing cavities filled with blood (chocolate cysts). Endometriosis is rarely located in or on the intestine or in the bladder. The size of the endometrial spots can vary significantly.
Endometriosis can cause symptoms, but not necessarily. Symptoms can be:
- Painful menstruations. The pain is sometimes so severe that the patient must stay at home.
- Pain during sexual intercourse. This could contribute to relationship problems.
- Problems with the stool. When endometriosis is located in the intestine, problems might arise with bowel movement, such as difficult and/or painful defecation.
- Urinating problems.
Severe forms of endometriosis, with cysts and/or adhesions, can affect the fertility of women.
In order to verify whether the symptoms are caused by endometriosis, the doctor performs a gynaecological examination. Ultrasound and blood tests may provide additional information. Internal exploratory examination (laparoscopy) with tissue research can clarify whether there’s indeed endometriosis. In some cases, the doctor recommends additional examination, such as a CT scan or an MRI. As with ultrasound, however, mild forms of endometriosis are not visible with these examinations.
For pain, drugs (painkillers or hormones) are prescribed or endometrial spots are burned away during keyhole surgery. Hormones generally suppress well mild forms of endometriosis, such as small spots on the abdominal mucosa. These sometimes even disappear, due to treatment. When there are problems with getting pregnant, the guideline applies: no treatment for mild forms of endometriosis.
In case of severe symptoms, the following interventions may be required:
- Laparoscopy. In a laparoscopy, the gynaecologist sometimes performs a treatment right away, such as cauterizing small endometrial spots or removal with a laser beam.
- Laparotomy. A laparotomy is surgery that takes place through an incision in the abdominal wall. During the operation, the doctor tries to remove any endometriosis and adhesions as much as possible. Another option is to remove a part of the ovary, in which one or more chocolate cysts are located. Sometimes it’s necessary to remove a whole ovary.
- If severe pain persists, surgery to remove both ovaries and/or the uterus sometimes offers a solution.
- In some women, the endometriosis is located in the back wall of the vagina. This back wall is located very close to the front of the rectum. Surgery in this area is technically very difficult. Sometimes it’s necessary to remove a part of the rectum then.
The course of the disease may vary from woman to woman. In some cases, it cures on its own, but it’s also possible that the patient keeps suffering and that it gradually becomes worse. Endometriosis enters a quiet phase after menopause, when a woman no longer menstruates. During pregnancy, a woman won't suffer from endometrial symptoms, because there are no menstruations.
- Watch the diet, avoid toxins. Some environmental pollutants, such as dioxins and polychlorinated biphenyls (PCBs) could play a role in endometriosis.
- Limit caffeine use and quit smoking. The use of caffeine may be associated with endometriosis and infertility. Smoking is very bad for endometriosis patients.
- Eat more fruits and vegetables. Especially organic fruits and vegetables are good to eat, as they contain no pesticides.
- Exercising ensures proper blood circulation. This is extremely important for removing toxic substances and endometrial cells.
- Stress affects the development of endometriosis.