Endometriosis

Endometriosis is the abnormal presence of functional tissue from the lining of the uterus (endometrium) outside the uterine cavity. This tissue develops mostly in the fallopian tubes, the ovaries and the peritoneum.

Symptoms

Endometriosis varies from patient to patient. There might be similar cases but exactly the same signs of the condition have not been observed. A major symptom of endometriosis is abdominal pain, specifically during the first days of menstruation. Intense pain in the vagina is also possible during sexual intercourse.

Nevertheless, there is a chance that patients with advanced endometriosis do not feel any pain, while others with endometriosis in the first stages may suffer. Besides pain, common symptoms may include:

  • Cramps during menstrual period
  • Pelvic pain
  • Constipation
  • Painful bowel movements
  • Low back pain
  • Pain during urination
  • Urinary frequency
  • Infertility

Diagnosis

The only way to officially diagnose endometriosis is surgical biopsy. Monitoring the symptoms, though, can lead a health care provider to an early diagnosis. A magnetic resonance imaging (MRI) session plays a prominent role in defining the depiction of the disease and pinpointing any bleeding areas in the ovaries or the recto-vaginal septum.

A transvaginal ultrasound may identify endometriotic cysts, while a Pap test can detect pain areas possibly caused by endometriosis. On the contrary, blood tests for the measurement of CA125 biomarker do not provide reliable information.

Treatment

Laparoscopy is the most effective way to treat endometriosis. A surgeon performing a laparoscopic procedure has the following options:

  • cauterization by laser beams or fulguration of endometriotic lesions
  • removal of (chocolate) cysts from the ovaries
  • ablation of endometriotic lesions from the ovaries and the fallopian tubes
  • restoration of the fallopian tube function

Medication can relieve the patient’s pain but it does not cure the disease. Oral contraceptives suspend ovulation and offer a regulated and low-concentration combination of estrogens and progesterone.

This way, mild endometriosis can remain in low levels for a long time. In addition, subcutaneous administration of GnRH analogues (ARVECAP) contributes substantially to the treatment of endometriosis. Administering oral contraceptives or GnRH agonists for 3 to 6 months after surgical treatment often reduces the risk of recurrence considerably.

Due to the fact that patients may have recurrences, women wishing to conceive should start trying immediately after completing the treatment of endometriosis.

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