Endometriosis is defined as the presence of endometrial mucosa implanted in locations other than the normal ones, i.e. the uterine cavity (or endometrium). Endometriosis is a chronic condition. It is estimated that it affects around 2-10% of reproductive-age women (15-45 years).
Unfortunately, it is a condition characterized by delayed diagnosis, with an average of about six years from the onset of symptoms up to the appropriate treatment (e.g. when endometriosis affects teenage women, the symptoms may sometimes be overlooked by the pediatrician or the gynecologist, because they are considered as “normal”). Endometriosis is usually promptly diagnosed if the patient is referred to gynecology specialists with experience in both mild and more severe types of endometriosis. Quite often the milder forms of the condition are discovered accidentally during infertility investigation on diagnostic laparoscopy or ultrasound imaging.
Main endometriosis symptoms:
a) Pelvic Pain. This pain occurs in the low pelvic area; it is usually recent (6 months) or exacerbated existing pain (which was tolerable and constant, in general). Endometriosis pain is often described as unbearable.
The most common types are: pain during the period (dysmenorrhea); painful intercourse (dyspareunia); permanent pain in the pelvis (chronic pelvic) and a combination of the above. Finally, pain may have localized symptoms depending on the organ affected, e.g. pain during urination, with or without blood in the urine (bladder endometriosis) or pain during bowel movement, with or without blood in the stools (bowel endometriosis);
b) Infertility. Usually due to damage to the fallopian tubes and/or ovaries, but also because of other more complex mechanisms;
c) Menstrual Disorder (usually due to ovarian endometriosis);
d) A combination of a, b and c cases.
Endometriosis Treatment:
Current treatment of endometriosis is mainly based on surgery, and mostly laparoscopic surgery.
Since the more severe forms of endometriosis mimic serious conditions that require surgery, such as oncological conditions, it is not uncommon for a patient with endometriosis to have undergone already more than one or two endometriosis procedures due to incomplete initial treatment and recurrence of the initial symptoms, even within a short period of time.
On all accounts, it is best that surgical treatment is left to the specialists who deal with such cases on a regular basis.
Gynecology specialists are better equipped to remove all foci of endometriosis, eventhose at obscure sites, such as vessels and nerves, and/or other organs e.g. the colon, the bladder, and less common sites.
How is endometriosis caused?
Normally during each period, in most women, a small quantity of blood (containing the endometrial mucosa) retrogrades from the uterine cavity and flows through the fallopian tubes into the abdomen and pelvis. This small quantity of blood, in most women, is eliminated by the body itself. However, some women, for reasons not known, cannot eliminate this small quantity of blood and mucosal tissue.
In these women, the tissue is directly implanted (causing endometriosis), then formed and partially “synchronized” with the female hormonal cycle. As a result, it bleeds during the normal period, but in the wrong organs where it has been implanted, usually the ovaries (endometriotic cyst), the fallopian tubes, the lateral pelvic walls, the colon and the small intestine, the bladder, the liver, the lungs etc. (Endometriosis has been histologically confirmed almost everywhere in the body, including the heart, the brain, and even rarer sites).
With each new menstrual period, “new” endometrium retrogrades and is implanted in the same or new abdominal sites, thus triggering a vicious cycle of bleeding and healing, leading to chronic inflammation. This gradually results in the viscera being stuck together (adhesions), such as the intestine with the ovaries and uterus, or the fallopian tubes with the ovaries etc.
NOTE: It is well known that our team is a point of reference for surgical treatment procedures when it comes to complex benign and malignant gynecological conditions. Every year we perform minimally invasive surgery to treat the most severe types of endometriosis with an emphasis on stage IV endometriosis and invasive forms of endometriosis in any abdominal organ.
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