What is endometriosis? Causes and diagnosis

Endometriosis is a disease seen in women of reproductive age. The disease takes its name from the “endometrium”, which means the layer that covers the inner layer of the uterus and thickens and sheds every month during the menstrual period. In endometriosis, tissue resembling the endometrium, which should normally be found in the inner layer of the uterus, is also found in other parts of the body outside the uterus. These endometriosis foci outside the uterus can cause pain, infertility and some other problems.

The most common locations of endometriosis are in the abdominal cavity, especially in the ovaries, uterine tubes, ligaments supporting the uterus, the area between the uterus and anal canal, which we call the vagina, the outer surface of the uterus and the surface of the abdominal cavity called the pelvis. These endometriosis foci can sometimes be seen in the intestines, anal canal, urinary bladder, vagina, cervix, external reproductive organs or in the scars of previous abdominal surgeries.

Endometriosis foci or areas are generally not malignant or cancerous. Although outside their normal location, they contain a normal tissue type. Like the endometrium lining the uterus, endometriosis foci also respond to hormones that govern the menstrual cycle. During the menstrual period, thickening, destruction and bleeding occur in these areas as in the uterus.

Despite this, unlike the layer that covers the uterus, the endometrium outside the uterus does not have the opportunity to leave the body in the form of menstrual blood. For this reason, bleeding into itself and damage to the tissue and blood spilled from these foci result in inflammatory development and connective tissue formation in the surrounding tissues. Other unexpected damages that may occur depending on the location of the foci are rupture of these foci (causing the spread of endometriosis to new areas), formation of adhesions, bleeding in the intestines or intestinal obstruction, affecting the urinary bladder functions and other problems. Although the symptoms worsen over time, periods of improvement and recurrence are observed in some cases.

Symptoms

The most common symptoms of endometriosis are pain before and during menstruation (usually more severe than during menstruation), pain during and after sexual intercourse, infertility, irregular or excessive bleeding. Other symptoms may include fatigue, painful bowel movements during menstruation, pain in the lower back, diarrhea or constipation during menstruation, and other bowel disorders.

Some women with endometriosis may have no symptoms. Infertility is seen in 30-40% of patients with endometriosis and this is a common condition as the disease progresses. The severity of pain is not directly proportional to the prevalence of the disease and endometriosis foci. Very small endometriosis foci are more active in the production of a substance that we call prostaglandin, which causes pain in the body. This explains the presence of obvious symptoms even in small endometriosis foci. Prostaglandins have functions other than pain sensation and are thought to cause some other symptoms in endometriosis.

Causes of endometriosis

The cause of endometriosis is unknown. Although several reasons have been suggested, none of them can explain all endometriosis cases. One theory is that menstrual blood flows backwards into the abdomen through the uterine tubes. It is suggested that endometrial cells transported into the abdominal wall in this way can settle and grow here. It has been suggested that this type of reflux, albeit to a lesser extent, occurs in all women, but endometriosis develops in women with immune or hormonal problems. According to another theory, endometrial tissue spreads from the uterus to other parts of the body via blood vessels or lymph. According to the genetic theory, endometriosis is carried in the genes of certain families or there is a predisposition to endometriosis in some families. [Recent studies have shown that environmental toxins such as dioxin and PCBs, which act like hormones in the body and damage the immune system, cause endometriosis in animals]

According to another theory, tissue remnants formed when the woman is still in the embryo (fetal) period can turn into endometriosis in the adult period, or in some special cases, the tissues that are capable of forming reproductive system tissue during the embryonic period, but the tissues that are in the form of different structures in the adult period regain these abilities. Transplantation of these tissues during surgery is a theory put forward to explain endometriosis, especially in abdominal surgery scars. Endometriosis researchers are working on other theories as well.

Diagnosis

The diagnosis of endometriosis is not certain until it is diagnosed with a surgical procedure called laparoscopy, which requires anesthesia. During this procedure, the patient’s abdomen is inflated by giving carbon dioxide gas and a better view of the internal organs is provided. A lighted optical instrument called a laparoscope is inserted into the abdomen through a small incision made on the umbilicus, and the internal organs are carefully examined. During this examination, foci of endometriosis can be seen.

A gynecologist may feel the endometriosis foci with his hand while examining his patient, or the symptoms during the examination may suggest the presence of endometriosis. However, the definitive diagnosis of endometriosis is made by laparoscopy and it is not a good approach to treat without diagnosis. (For example, sometimes ovarian cancer can give the same findings as endometriosis). With laparoscopy, the locations, sizes, and prevalence of endometriosis foci can be seen, thus helping the patient and doctor to be better informed, and to decide on long-term treatment and pregnancy.

Treatment

Although different treatment methods are used for endometriosis, a definitive treatment has not been found yet. Studies have shown that the probability of the continuation or recurrence of the disease is high. Pain relievers are generally used for the pain seen in endometriosis. Treatment with hormones aims to stop ovulation for as long as possible. During this treatment, and sometimes months and years later, regression of endometriosis can be seen.

hormonal therapy; It contains birth control pills, progesterone drugs, testosterone derivatives (danozol), and GnRH agonists (gonadotropin-releasing hormone drugs). In all hormonal treatments, side effects can be a problem for some women.
It is recommended that patients with endometriosis do not delay pregnancy, as it is believed that pregnancy often causes regression in symptoms and the chance of conception decreases as the duration of the disease increases in those with a desire for a child. Women with endometriosis may have a higher chance of ectopic pregnancy and miscarriage. Studies show that there may be an inherited transmission in endometriosis. Therefore, the risk of endometriosis and related health problems in the children of patients increases.

It is possible to remove or destroy the endometriosis lesions with surgery performed with laparoscopic or classical methods, and it is possible to alleviate the symptoms or to achieve pregnancy. However, as with other treatments, the possibility of recurrence of the disease is frequent. Surgical treatment with the laparoscope is rapidly replacing classical open abdominal surgery. In operative laparoscopy, the surgical procedure is performed through the laparoscope, using laser, echotrocoter, or small surgical instruments. Radical surgery involves the removal of the uterus, ovaries, and all endometriosis foci, and is only necessary in cases of long-term severe endometriosis that do not respond to other treatments.

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