What is endometriosis ?
Endometriosis is a chronic disease in which the endometrium or uterine lining is located outside the uterine cavity. The exact origin of endometriosis is not known to date.
Description
Each month prior to menstruation the endometrium thickens under the influence of hormones in preparation for the possible implantation of a fertilized egg. During menstruation, the lining is shed, which is accompanied by bleeding. In the womb, this is no problem, but if there are other places in the body also is endometrium, this will also be thicker and then bleeding. This is almost never life-threatening, but can be many symptoms - mainly pain - cause.
Endometriosis is mainly found in the abdominal cavity, but can also develop in other places in the body. The most common areas are the ovaries and the peritoneum of the pelvis. In the ovaries may form the endometrial tissue cysts, which are filled with old blood which gives a chocolate-like aspect. These cysts are called "endometriomas", but are also commonly called endometriosis cysts or "chocolate cysts". The bleeding in the abdominal cavity may in addition cause adhesions, with reduced fertility as a result. In addition, it can also occur in the myometrium (smooth muscle of the uterus); this is called adenomyosis uteri. In rare cases, for example, outside the abdominal cavity in the chest (thoracic endometriosis), this can cause a collapsed lung.
Estimates of the number of individuals with endometriosis vary, but generally is believed to occur in 7-10% of fertile women and in 20-25% of infertile women. It is thus one of the leading causes of infertility in women. Globally, 70 million people suffer from endometriosis.
Pathofysiology
Internal factors
How endometriosis occurs is not precisely known, but there are several possible mechanisms:
- Retrograde menstruation: during menstruation leaves the major part of the blood with endometrial tissue through the vagina to the body. But a small portion passes through the fallopian tubes into the abdominal cavity. This is in most women, but in principle will be cleared by the body. In subjects with endometriosis remain there endometrial cells in life, these can then endometriosis foci shapes that grow further under the influence of the hormones of the menstrual cycle.
- Lymphogenic: endometrial cells may spread through the lymphatic vessels.
- Hematogenously: endometriosis also occurs outside of the abdominal cavity, for example, in the chest cavity (thorax). The hitherto most widely accepted explanation is that endometrial cells move through the bloodstream.
- Direct transplantation: In operations can endometrial cells by means of the instruments to reach the wound edges, resulting in the surgical scar endometriosis.
- Metaplasia: Possibly, the cells of the peritoneum to be able to change into endometrial cells. It is not known what incentive may encourage the cells to do so.
External factors
- Stress: A Study of experts led by Dr Appleyard in the field of endometriosis which was presented at the 121st meeting of the American Physiological Society showed that stress is a major influence on the development of endometriosis. The study was carried out on rats which induced cells were washed with endometriosis. The animals were then exposed to chronic and stressful situations that the animals could not control themselves. The animals that were not induced endometriosis developed no blisters. The animals that were quite induced, but were not exposed to stress developed foci of endometriosis of about 0.96 mm per animal. The animals were induced and stress were exposed finally developed endometriosis average of 5,27mm per animal. The scientists thereby concluded that there is a correlation between the observed mast cells in the large intestine and the increased level of inflammatory cells into the peritoneum exists as a result of a reaction of the immune system since this is both was observed in the rats and in the human endometriosis patients.
- (Anti-) Conception: The disorder occurs in Third World countries less common than in Western society. Possibly plays the fact that one gets there on younger children and pregnant women are on average more common. In Western society women more control over their fertility, so they menstruate more in their lives and therefore increases the risk of endometriosis.
- Environmental pollution: Animal tests show that dioxins and PCBs are an aggravating factor for the development of endometriosis. However, there are as yet supplied no evidence that this is so in humans. There is however a study by German scientists in 1992 that shows that women with high blood levels of PCBs had a higher prevalence of endometriosis. The toxins tend to accumulate in animal fat, such as meat, fish and dairy products. There are also indications that a vegetarian diet - which products contain most organochlorines are avoided - has a positive effect on the condition. Given that there are also residues of pesticides (chlorinated hydrocarbons) can remain on non-organic fruits and vegetables is extremely important to wash it ever good.
- Power supply: Certain nutrients believed to have an influence on the development of the condition. Thus, researchers from the Harvard School of Public Health showed that women who use a lot of caffeine a higher risk to get endometriosis.
Endometriosis symptoms
Endometriosis can be entirely asymptomatic, the most common symptoms are:
- Infertility (infertility)
- Amenorrhea (lack of menstruation) / irregular periods
- Menorrhagia (profuse / prolonged menstruation)
- Secondary dysmenorrhea (abnormal menstrual pain)
- Ovulation Pain
- Abdominal pain and / or lower back sometimes radiating down the legs
- Dyspareunia (pain during intercourse)
- Abnormal bleeding (vaginal / anal / urine)
- Pain when defecating and / or urinating
- (Chronic) Fatigue / lethargy
- Insomnia
- Premenstrual syndrome (PMS)
- Depression / moodiness / irritability
Endometriosis treatment
The treatment is performed with medication, surgery, or by a combination of both.
Medical examination and investigation
When the speculum is sometimes a bluish spot in the crease between the vagina and cervix, the rectum visible. On vaginal examination, the doctor may feel that the ovaries are swollen if endometriomas sit in, or pain when imprinting the uterus. Endometriomas be with ultrasound visible on the screen as round gray structures. In order to definitively diagnosed endometriosis set a laparoscopy (keyhole surgery) is required. In the blood, the tumor marker CA-125 have been increased, while no tumor is present.
Medicines
- Painkillers, including NSAIDs (symptomatic)
- contraceptive pill (combined pill) without stop week (puts the menstrual cycle 'flat')
- Progestogen-only contraception Mirena IUD, Provera, Depo-Provera, Orgametril (be sure there is no menstruation occurs, in many cases, no ovulation)
- GnRH agonists (synthetic GnRH-hormone that will bring the patient into a temporary artificial menopause)
- Danazol, a hormone androgen (at) operation (ensures that the patient is in a temporary artificial menopause) or a synth ethical variant as gestrinone or Dydrogeserone.
Via a laparoscopy or laparotomy Here different techniques can be used, including coagulation, or laser-evaporisatie of the foci of endometriosis. Endometriosis cysts do not disappear by medication, so will be removed surgically in the rule. Adhesions that result from endometriosis, can be removed. In some cases, a portion of the intestines removed. In very rare cases, a (partial) cystectomy (removal of the bladder) occurs.
As a last resort: to remove the ovaries (oophorectomy), and in some cases, the uterus (hysterectomy).
Additional
Dietary changes, as far as possible animal proteins (meat, fish, dairy products), alcohol, wheat and soy products, caffeine, sugar and other sweeteners (including aspartame, sucrose, etc.), chocolate and fried foods are avoided. The emphasis is on an endometriosis diet dried and fresh fruits and vegetables (especially legumes and seaweed) and sugar-free beverages (such as herbal teas and fresh fruit juices).
Long-term effects
- Ovarian Cancer: In the long term endometriosis may lead to an increased risk of ovarian cancer. An investigation from 2012 to 7911 women - of which 738 with an endometriosis-background - showed that there is an increased risk of approximately 20.2% of women with this condition. This would not be due to medications for the treatment of infertility, but by the inflammation as a result of the endometriosis, so shows a study by researchers at the University of Pittsburgh - Graduate School of Public Health.
- Inflammatory bowel disease: A Danish study of 37,000 women with endometriosis over a 30-year period showed that there is an increased risk of 50% exists on the development of chronic intestinal inflammation. In the sub-group wherein the endometriosis was surgically established, there was even an increased risk of 80%.
- Fertility problems due to the adhesion of the fallopian tubes. Other possible consequences are the formation of cysts which prevented the implantation of the ovum or decreased movement of the tube as a result of the endometriosis. In the case of reduced infertility is frequently chosen for an AI or IVF treatment.