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Endometriosis Causes, Symptoms and Treatment

The endometrium is the lining of the lining of the uterus . At the end of the menstrual cycle, if there is no fertilization, part of the endometrium (which is constantly renewed) is evacuated with menstruation .

The Endometriosis is characterized by the formation, outside of the uterus , from fabrics formed of endometrial cells. Thus, the endometrium begins to form elsewhere in the body.

Endometrial tissue, no matter where it is in the body, responds to the hormonal fluctuations of the menstrual cycle . Thus, just like the uterine lining, it is formed and then “bleeds” every month. However, when this tissue is located outside the uterus , as is the case in women with endometriosis, the bleeding has no outward exit. Blood and endometrial cells that come loose may irritate surrounding organs and the peritoneum (the membrane that encloses the organs of the abdomen). It can also lead to the formation of cysts (pin-sized to grapefruit), scar tissue , and adhesionswhich connect the organs together and cause pain .

Where are the endometrial tissues formed?

Most often:
– on the ovaries;
– on the fallopian tubes;
– on the ligaments supporting the uterus;
– on the outer surface of the uterus.
More rarely, they can develop on nearby organs, such as the intestines, bladder or kidneys. Finally, exceptionally, they are found in places far removed from the uterus, such as the lungs, arms or thighs.

This gynecological disorder is among the most common: 5% to 10% of women of childbearing age are affected. Endometriosis is usually discovered about 25 years to 40 years, due to pain unusually intense in the lower abdomen or a problem of infertility . Indeed, 30% to 40% of women with endometriosis are infertile. But in many cases, endometriosis is not accompanied by any pain and does not affect fertility. It is then detected by chance, for example at the time of a laparoscopic intervention in the abdomen.

Causes of Endometriosis

Currently, no one can explain why some women have endometriosis . It is possible that a malfunction of the immune system and certain genetic factors are involved. Here are some advanced hypotheses .

The most accepted hypothesis involves the notion of retrograde flow . During menstruation, blood and superficial layers of the endometrium are normally expelled outward by muscle contractions. Occasionally, blood flow may be reversed (hence the term retrograde flow) and blood containing endometrial cells may be directed to the pelvic cavity through the fallopian tubes (see diagram). This reflux would occur occasionally in most women, but it would be accompanied by rooting endometrial cells in some of them.

Another hypothesis is that endometrial tissue may migrate out of the uterus through lymph or blood.

Finally, it is also possible that some cells normally located outside the uterus become endometrial cells under the influence of genetic and environmental factors.

Evolution

The degrees of severity of endometriosis vary. This disorder usually tends to get worse over time if not treated.

However, two situations have the effect of reducing his symptoms: menopause, which usually provides definitive relief, and pregnancy , which relieves them temporarily.

Possible complications of Endometriosis

The main risk associated with endometriosis is infertility . About one in three women who have difficulty becoming pregnant have endometriosis. Moreover, the diagnosis of endometriosis is often made during exploratory (laparoscopic) tests conducted because of infertility problems.

The adhesion of endometrial tissue can reduce fertility by preventing the release of the ovum or by hindering its passage to the uterus through the fallopian tubes. Nevertheless, 90% of women with mild or moderate endometriosis manage to become pregnant within a 5-year period. However, the more time passes, the more fertility is likely to be compromised. Also, it is better not to delay a desired pregnancy.

The symptoms of endometriosis

The symptoms, when they exist, vary considerably in intensity from one woman to another.

Main symptoms

  • Lower abdominal pain that sometimes radiates to the lower back. The pain caused by endometriosis has the distinction of being progressive and often appearing on one side of the abdomen more than on the other. Pain caused by endometriosis can be difficult to distinguish from menstrual cramps (dysmenorrhea).
  • Pains increase during menstruation, when urinating, when bowel movements are disturbed (diarrhea, constipation), and at the time of intercourse (dyspaneurie). Sometimes they intensify at the time of ovulation.
  • Difficulty getting pregnant

Other symptoms

  • Fatigue, irritability or depression, usually due to the fact that the pain is chronic.
  • Brownish premenstrual losses or spotting.
  • Blood in the urine.
  • Blood in the stool or rectal bleeding during menstruation.
Remarks

Endometriosis does not increase the menstrual flow.

The intensity of the pain does not make it possible to judge the extent or gravity of the disease. The severity of the symptoms depends more on where the endometriosis lesions are located, as well as their size.

People at risk for Endometriosis

  • Women never having children
  • Women with a close relative (mother, sister, daughter) suffer from endometriosis.
  • White women or Asian women.
  • Women with a congenital malformation that narrows the cervix or makes it narrow, which hinders the evacuation of the menstrual flow.
  • To a lesser degree, women who have had early menstruation or have a short menstrual cycle.

Prevention

Can we prevent?
Researchers are interested in the effect of exercise and diet on the risk of endometriosis. These are hypotheses  still under study.

  • Studies that have retrospectively compared women with endometriosis and others who do not have endometriosis (case-control studies) suggest that exercise  is associated with a reduction in the risk of endometriosis from 40% to 80%. % 1 . However, it is not certain that this is a causal link. Women with endometriosis may be less likely to be active because of their pain, even years before being diagnosed.
    Analysis of data from a large epidemiological study, the Nurses’ Health Study II, noted a  slight endometriosis risk reduction by comparing the most active women to those who were least 1. The researchers conclude that the exercise could have a modest protective effect.
  • The food  could also influence the risk of suffering from endometriosis. For now, the results of the studies are variable and this remains a hypothesis.
    Experts are particularly interested in the  type of fat  consumed, since some fatty acids are precursors of pro-inflammatory molecules (omega-6) and could thus exacerbate pain, while others have an anti-inflammatory effect (omega-6).
    – Data from the Nurses’ Health Study II indicate that women who consumed the most omega-3 fatty acids  were less likely to be diagnosed with endometriosis than those who consumed the least 3 .
    – According to an analysis of the results of 2  case-control  studies conducted in Italy 4 , women consuming  the most green vegetables and fresh fruit  were less likely to suffer from endometriosis than those who ate the least. In addition, those who ate a lot of beef, other red meats and ham were at a higher risk of suffering from this disorder. The other components of the diet do not appear to be related to endometriosis. For example, the consumption of alcohol  and  coffee  has not been associated with the disease.

Medical treatments for endometriosis

Currently, there is no definitive treatment for endometriosis. The hysterectomy does not guarantee the final disappearance of the symptoms, as endometriosis may occur “spontaneously” in other parts of the body.

It is important to seek medical attention promptly when symptoms of endometriosis become apparent, because the sooner the disease is diagnosed, the better it is treated. It also decreases the risk of infertility. You should know that the symptoms mentioned above may indicate another disorder of the reproductive system, the presence of ovarian cysts, for example. A pelvic ultrasound will detect them quickly.

The following treatments are often used in complementarity with each other.

Analgesic drugs

Of acetaminophen (Tylenol) or anti-inflammatories , such as aspirin or ibuprofen (Advil, Motrin) can be used to relieve pelvic pain caused by endometriosis. If necessary, anti-inflammatory drugs may be prescribed by the doctor (eg, Naprosyn).

Sometimes a hot bath or heating pad is enough to reduce the pain.

Hormonal treatments

Hormonal treatments can help relieve pain . However, they do not treat the problem and do not influence fertility. They work by blocking the production of hormones by the ovaries, which reduces bleeding.

Here are the most frequently used hormonal treatments.

With contraceptive effect

Contraceptive pill. The contraceptive pill taken continuously (daily, without the usual interruption week) relieves pain in a number of women, reduces the amount of menstruation, prevents estrogen deficiencies and provides a means of contraception, while being generally well tolerated. The hormones released by the pill block ovulation and prevent the release, by the pituitary gland , of stimulating hormones for the ovaries.

Mirena IUD. It is an intrauterine device covered with a progestin . It fits into the uterus like an IUD. It significantly reduces menstruation and pain associated with endometriosis. It only needs to be changed every 5 years.
Possible side effects: Spotting can occur during the cycle, especially during the first months of use.

Medroxyprogesterone acetate (Depo-Provera). A progestin is injected into a muscle of the buttock every 3 months. The injected hormone inhibits ovulation and reduces or abolishes menstruation and pain associated with endometriosis.
Possible side effects: sometimes significant weight gain is observed in some patients, as well as spotting during the cycle. The use of medroxyprogesterone acetate is sometimes associated with mood changes, and the return of ovulation may be delayed in some women at the time of discontinuation.

Without contraceptive effect

Danazol (Cyclomen). Danazol causes an artificial menopause by blocking the secretion of estrogen by the ovaries. It is used to relieve pain. It causes a cessation of menstruation in the majority of women who resort to it. The treatment usually lasts 6 to 9 months.
Possible side effects: mild weight gain, hot flushes, vaginal dryness, sometimes androgenic effects (acne, facial hair). These effects disappear when the treatment is stopped.

Analogues of Gn-RH (Lupron, Zoladex, Synarel). These hormones block the activation of the pituitary gland by the hormones of the hypothalamus (Gn-RH, for “gonadotrophin releasing hormones”). They also cause menopause. They are given by injection every month. Usually, the duration of treatment does not exceed 6 months.
Possible side effects: hot flushes, headache, vaginal dryness, mood swings, short-term bone mineral loss.

Physical exercise to reduce the side effects of drugs?

A clinical trial of 4 weeks indicates that exercise is an effective way to minimize the androgenic effects (acne, facial hair) treatment to danazol. For the purposes of the study, the researchers formed 2 groups of patients: one received danazol, the other received danazol and 4 exercise sessions each week (40 minutes per session). While all women – 39 participants with endometriosis – saw their symptoms decrease, those who trained had fewer androgenic side effects.

Another study of 12 months duration indicates that exercise training helps women who take an analogue of GnRH to reduce bone mineral loss caused by this medicine.

Surgical treatments

Conservative surgery.In order not to jeopardize the chances of pregnancy for women wanting children, to increase fertility or in the case where the pain is refractory to drug treatments, so-called “conservative” surgery (which preserves the uterus and ovaries) is often performed. It consists of removing the endometrial growths, scar tissue and adhesions that are often the cause of infertility. If endometriosis is not too formed, surgery can be performed laparoscopically. During a laparoscopy, a small incision is made near the belly button, and a thin, flexible tube (the laparoscope) is inserted into the abdomen. It is a microscope equipped with a light source and capable of being equipped with an electric current or a laser to burn tissue . However, the pain reoccurs over the years in the case of many women.

If endometriosis is widespread, the procedure is sometimes done with a larger incision in the lower abdomen.

Radical surgery. In extreme cases, it may be necessary to remove the uterus (hysterectomy) and ovaries to prevent hormonal stimulation. However, this treatment causes menopause and permanent sterility. It must be considered as a last resort.

Assisted reproduction techniques. When conservative surgery does not allow a woman to regain fertility, assisted reproductive technologies can be used.

Support group

Recurrent pain, fatigue, worry and sometimes difficulty getting pregnant are irritants, and sometimes anxiety and depression. Participation in a support group allows women to share their experience with other people in the same situation and to be comforted. See the Support Groups section (below).

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