Facts About Endometriosis
- Endometriosis is the presence of endometrium outside the uterus.
- It occurs in 6-10% of women of childbearing age and disappears associated with menopause
- The symptoms depend on the location (the muscle layer of the uterus, fallopian tubes, ovaries, colon, urinary bladder)
- The most common symptoms are menstrual pain, painful intercourse and reduced fertility
- The pain can be reduced by both medical and surgical treatment
- There are frequent relapses. Therefore, the condition can be described as chronic
What is endometriosis?
In many cases, patients with endometriosis have no symptoms, and the disease is discovered by chance in about 20%. Approximately 2-3% of all women develop symptomatic endometriosis during life.
How common is endometriosis?
It is estimated that 6-10% of women of childbearing age have endometriosis. The condition exists in approximately 30% of women examined for infertility. Experts estimate that endometriosis is diagnosed.
What causes endometriosis?
The cause of endometriosis is unknown. However, there are two main theories. One is that endometriosis arises of its own accord, as the peritoneum some sites converted to the endometrium. Others believe that parts of the uterine lining becomes detached menstrual and instead of flowing into the vagina, some of the tissue fed up and out through the fallopian tubes into the abdominal cavity. The tissue then attaches to the ovary, peritoneum or bowel and waxes. Bleeding from the uterus into the abdominal cavity occurs in most women, but only in individual allows the body’s immune system that the lining grows in the wrong place.
A prerequisite for the development of endometriosis is the female sex hormone estrogen. Hence arises endometriosis not before puberty, and change back formed usually after menopause.
Hereditary conditions appear to be related to the development of this disease. If the condition is found in mother or sister, the risk for endometriosis about 7 times greater.
What are the symptoms of endometriosis?
The woman’s hormones affect endometrial tissue in the same way as the lining inside the uterus. The blood – which are formed in the endometriosis – can not come out as menstrual blood, and collects as small cysts of blood under the peritoneum.
The most common symptom of endometriosis is period pains. The pain can range from mild menstrual pain to severe strong and debilitating pain. It is not certain that ordinary painkillers are enough. It is also plain that there may be pain before your period and at ovulation. Chronic pain can cause fatigue, sleep disturbances and changes in appetite.
Other typical symptoms are:
- Intercourse pain, typically there is pain in deep shock. The pain can persist for some time after intercourse
- Infertility can be a problem. 30-40% of patients with endometriosis have difficulty becoming pregnant. We do not have a full understanding of the cause of infertility by endometriosis, but one explanation could be an “unfavorable” environment in the basin, where fertilization of the egg takes place, or that scar tissue as a result of endometriosis changes the anatomy
- By endometriosis in the intestine or urethra may cause pain in these organs, for example. painful bowel movements. These pains will vary through the menstrual cycle
- Endometriosis of the bladder can cause painful urination, possibly frequent urination
- Bleeding before menstruation and heaviness feeling in the abdomen may also occur
- More rarely, women may experience pain throughout the month, possibly with periodic aggravation
It is unclear why some women experience pain and others do not. It may be related to the localization or with features of the endometrial tissue. The relationship between the amount of endometriosis and the degree of pain is not clear. There can be large endometriosecyster, without causing symptoms. In other cases there may be severe pain at quite modest changes.
What symptoms should you pay particular attention to?
Persistent severe pain related to the menstrual cycle.
How is it diagnosed?
In addition to receiving a thorough medical history will be a gynecological examination. This is usually normal. There can sometimes be blood tests (eg. anemia. lowering, CA 125 and CRP) to rule out other diseases.
Compared to the case history, various x-rays and ultrasound provide a suspicion that there is endometriosis. Laparoscopy (Keyhole surgery) of the abdominal cavity or surgery is currently the only sure way to diagnose on. A colonoscopy is done under general anesthesia, where you keep a telescope-like instrument through the navel into the abdominal cavity. The gynecologist is thus a good overview of the ovaries, fallopian tubes, parts of the intestine and peritoneum. A tissue sample for microscopy will confirm the diagnosis. By bowel symptoms may MRI be considered.
It is very common that there may be pain during menstruation in healthy women who do not have endometriosis. Before you suspect endometriosis, treat it with painkillers for example. ibuprofen and oral contraceptives. If this is enough to soothe the pain, further studies are not normally required.
What treatment is there?
The aim of treatment is to reduce pain and prevent or treat infertility. In pain you can try prescription painkillers. Physical activity can also help. During pregnancy, the pain will be reduced.
Treatment of endometriosis is generally made through a collaboration between the gynecologist and the practitioner. Analgesics of the type NSAIDs, eg. with ibuprofen, is the first choice for pain. Is this treatment is not sufficient, hormonal therapy arise.
Hormone Treatment intends to stop menstrual bleeding and thus also the activity in endometriosis. You treat for 6 months or longer. After that menstruation come back. In some cases the pain can also come back, in other cases, the pain subsided. There are several methods of treatment with hormones. In most cases, the pill be first choice. The pill can be given as usual – with three weeks of birth control pills and a week’s break. They can also be provided with fewer breaks.
If the pill is not enough for use, among other GnRH agonists . These are medicines that stop ovarian production of sex hormones, almost as effectively as the removal of the ovaries. This is creating an artificial menopause. Endocrine The ratios are as after menopause, and there can be side effects, such as hot flashes, headache, dry mucous membranes and in some reduction in the bone mass in the backbone by more than 6 months of treatment. GnRH agonists can be taken as a nasal spray or as monthly or three-monthly injections. When treatment stops, get your period again.
Surgery . In some cases of endometriosis, it is necessary for an operation, for example. at a higher ovarian cyst, there is pain compliant, or by closing the fallopian tube. It typically uses keyhole surgery (laparoscopy). Surgery is also relevant if the endometriosis grows into such. the intestinal wall or the urinary bladder. In many cases, there is need of treatment to achieve pregnancy, either by hormone stimulation and insemination or in vitro fertilization (in vitro fertilization).
How good is the treatment?
When treated with hormones will pains get better at 80-90%. Most people experience significantly less pain, and some will be completely pain free. Unfortunately, the symptoms often come back after treatment is completed, but it may take several years. It may then be necessary with a new treatment. Endometriosis is considered a chronic condition, but after menopause, the woman’s production of estrogen and menstruation stops, most asymptomatic.
Lack of efficacy may be due to endometriosis in some cases, very little sensitive to treatment. It can also be due to the absence of endometriosis. In these cases, the treatment is stopped.
Treatment of infertility
Surgery is sometimes better fertility, while HRT has no such effect. Hormone therapy will serve to provide contraception and expose the natural possibility of pregnancy. In some cases, just more patience before pregnancy occurs. By continuing infertility is artificial insemination using test-tube method (IVF) good treatment.
Special problems with endometriosis
Pregnancy and childbirth
During pregnancy pregnancy will proceed as in other women. There is no increased risk of miscarriage or ectopic pregnancy. Some will experience more pain in the first few months, but in most people the pain will completely disappear during pregnancy.
The pain-free period will usually continue to menstruation comes back. Frequent breastfeeding menstruation postponed. Some feel that it is easier to get pregnant the second time.
Becomes the currently with natural hormone replacement therapy after menopause or after removal of the ovaries, one can try this. Some relapse, and then you can either stop hormone supplements or switch to a different drug. There are several hormone treatments to choose from, and some have less tendency to stimulate endometriosis than others. The doctor will give advice on the choice of treatment.
How is long-term prospects?
Endometriosis develops as hover in the 20-30 age, the genes in the 30-40 age and disappears after menopause. The effect of hormone therapy and surgery are very good. During pregnancy, the condition will go something back. It is often necessary to repeat treatments if necessary. both surgical and medical, as there are often relapses. The disease is therefore described as chronic and recurrent.
How do I avoid or aggravate endometriosis?
Pregnancy and breast-feeding reduces the incidence of endometriosis, therefore, it may be advantageous not to delay the time of pregnancy.