Endometriosis is a disease affecting the endometrium, the lining of the womb. Although it affects up to 15% of women of child-bearing age, little is known about its causes. Often complex, this condition can cause infertility and have serious physical consequences. In this article, we’ll explain the symptoms, causes, diagnosis and treatment of endometriosis.
What is endometriosis?
Endometriosis is a disease of the female reproductive system. It involves the lining of the uterus which spreads outside the uterus. During menstruation, menstrual blood is generally evacuated through the vagina. However, this blood can sometimes flow back up through the fallopian tubes and become lodged in the abdominal cavity, which is one of the most frequent causes of the development of endometriosis. Small islands are created, known as foci. These can attach to the ovaries, intestines, bladder and, in the most extreme cases, even go as far as the lungs. These foci bleed in the same way as the lining of the uterus. Blood is then released into the affected areas of the body. This can worsen the disease, as it allows other foci to form. These then accumulate in the abdomen.
The different types of endometriosis
Endometriosis is classified according to the location and depth of endometrial tissue implants outside the uterus. Here are the main types of endometriosis:
1. Superficial peritoneal endometriosis
The most common form where implants are found on the peritoneal surface, the membrane that lines the abdominal cavity. These implants are often small and flat, resembling superficial spots or lesions.
2. Ovarian endometriosis (endometriomas)
Manifested by cysts on the ovaries, called endometriomas or chocolate cysts. These cysts contain a thick, dark fluid resulting from recurrent bleeding from the endometrial tissue.
3. Deep infiltrating endometriosis
The implants penetrate deeper into the pelvic tissues, such as the uterosacral ligaments, rectum or bladder. This type is often associated with severe pain and can lead to more serious complications.
4. Diaphragmatic and thoracic endometriosis
Implants are located above the diaphragm, which can affect the lungs and lead to chest pain, pneumothorax or haemothorax. This type is rare but requires special attention.
5. Extrapelvic endometriosis
Very rare, where implants are found outside the pelvic cavity, such as on the liver, kidneys or even the brain. May cause unusual symptoms depending on the location of the implants.
Each type of endometriosis presents unique challenges in terms of diagnosis and treatment. A personalised approach is often required to effectively manage symptoms and improve quality of life for women with this complex disease.
What causes endometriosis?
Endometriosis is a disease that still raises a lot of questions. It is complex and the causes of its appearance have not yet been fully established. However, there are several hypotheses. The most common is that menstrual blood flows back up into the abdomen through the fallopian tubes. The most resistant uterine cells attach themselves to the tissue and develop into foci, which are usually painful.
Environmental pollutants such as dioxins can also contribute to the development of this disease. However, the causes of endometriosis, which are often multifactorial, cannot yet be completely defined.
In short, the exact causes of endometriosis are not fully understood, but several theories and risk factors are associated with its development:
- Retrograde menstruation: Menstrual flow that goes up through the fallopian tubes and settles on the pelvic organs.
- Transformation of peritoneal cells: Under the influence of hormones or immune factors, peritoneal cells (lining the abdominal cavity) transform into endometrial cells.
- Embryonic cell transformation: During puberty, hormones can transform certain embryonic cells into endometrial cells.
- Surgical implantation: After surgical interventions, such as caesarean sections, endometrial cells can attach themselves to surgical incisions.
- Transport of endometrial cells: Blood or lymph vessels can transport endometrial cells to other parts of the body.
- Genetic factors: A family history of endometriosis can increase the risk of developing it.
- Immune problems: A defective immune system may fail to recognise and destroy endometrial tissue outside the uterus.
- Environmental influences: Exposure to certain environmental toxins may contribute to the development of endometriosis.
- Hormonal factors: Excessive oestrogen production can promote the growth of endometrial tissue.
What are the symptoms of endometriosis?
The symptoms of endometriosis can be difficult to identify, as they are similar to ‘normal’ menstrual pain. This condition manifests itself as pain in the lower abdomen before or during menstruation, which makes detection slower and more complex. However, certain signs can be identified, including :
- Pain during sexual intercourse
- Difficulty urinating or having a bowel movement
- A constant lack of energy
- Back pain
If you have one or more symptoms similar to endometriosis, don’t hesitate to contact your gynaecologist so that he/she can carry out a full examination. He/she will be able to guide you if endometriosis is diagnosed.
How do you spot endometriosis?
Endometriosis can be detected by a simple gynaecological examination if the sites are located in the vagina. An ultrasound scan can also be carried out for those outside the uterus. If there is still any doubt, you can have an MRI or a laparoscopy, which is a minimally invasive procedure. A small tube fitted with a camera is inserted into the abdomen through a small incision. The doctor will then explore the area and take a tissue sample, which will then be studied under a microscope to confirm whether or not there are any foci, or to remove them if the diagnosis can be confirmed directly.
Can endometriosis be treated?
Several treatments are available to relieve or treat endometriosis. There are three main ways of achieving this:
1. Medication: the doctor prescribes anti-inflammatory drugs. This relieves the pain but does not cure the disease. This method is preferred for mild cases.
2. Hormone therapy: in the most serious cases of endometriosis, you will be prescribed hormone therapy. The endometriosis sites are sensitive to the body’s sex hormones, and the aim is to render them inactive by administering progestins. You may also be given the contraceptive pill, which will prevent these hormones from acting. If it is necessary to completely block ovarian activity, you will be prescribed synthetic progesterone, which dries out the foci and prevents them from growing. However, this treatment has significant side effects, similar to the menopause, and does not completely treat endometriosis.
3. Surgery: if foci are detected during laparoscopy, the surgeon intervenes and cuts out the foci using a laser, without damaging the surrounding tissue. This is a very precise but delicate operation! The uterus, ovaries and fallopian tubes can also be removed, but this will prevent you from having children. This operation is therefore recommended when the couple no longer wish to procreate or if the disease is such that there is no longer any choice. But don’t worry, it’s only in the most extreme cases! So it’s important to get diagnosed if you have the slightest doubt.
Can you have children if you have endometriosis?
Women suffering from endometriosis can find it difficult to become pregnant. In fact, 50% of infertile women suffer from endometriosis. But if you have this condition, there are still a number of remedies available. As mentioned above, medicinal treatments can stabilise or improve endometriosis. It is also possible to undergo in vitro fertilisation, which allows the egg to be fertilised outside the body. It is then reinserted. Pregnancy then begins, and the disease can even be curbed or reduced until the end of breast-feeding.
Sources
- L’endométriose, HUG
- L’endométriose, des réponses à vos questions, HUG
- Laparoscopie, Hirslanden
- Endométriose, Hirslanden
