Endometriosis
What is Endometriosis?
Endometriosis is a disease that consists of the abnormal growth of intrauterine tissue outside the uterus. In 98% of cases it is chronic, progressive, painful and affects fertility.
Every month, during a woman’s fertile stage and due to the hormonal effect of the ovaries, the endometrial tissue thickens and is eliminated along with menstrual bleeding through the vagina.
In women with endometriosis, this endometrial tissue will grow in places where it does not belong.
Causes of Endometriosis
The endometrial tissue acts as a mattress whose mission is to protect and accommodate the embryo. As the cycle progresses, the endometrial tissue acquires a certain thickness and texture in order to facilitate the implantation of the fertilized egg and favor that initial gestation. If there has been no pregnancy, at the end of the cycle, the uterus expels the tissue in the form of bleeding.
Although the origin of endometriosis is completely unknown, it is widely accepted that its origin is that retrograde menstrual flow that, in most cases, circulates from the fallopian tubes to the pelvis causing the endometrial tissue to invade other organs or areas of the body.
This tissue acts as if it were inside the uterus, that is, each month it will thicken due to hormonal action and will suffer decomposition. However, since it is located in an area where it cannot be removed, the tissue becomes trapped, causing lesions that can vary in: superficial lesions, adhesions, fibrosis (scarring), ovarian cysts (endometriomas), etc.
In endometriosis, the woman experiences the usual hormonal changes during the cycle in the places where the tissue has been inserted, causing blood accumulation and inflammation and, consequently, pain.
Location of endometriosis
The most common places where the endometrium tends to adhere are:
The ovaries
The fallopian tubes
The ligaments of the uterus
The intestine
The vagina
The bladder
Although with less incidence, it is also possible to find foci of endometriosis in the urinary tract, in the ureter, the kidneys or, exceptionally, in the lungs.
Profile of a woman with endometriosis
It is estimated that endometriosis affects 10-15% of women of childbearing age, although isolated cases have been reported in girls before their first menstruation and in women in the menopausal phase.
The reality is that endometriosis is highly unpredictable and there is no profile of a woman prone to having endometriosis. This disease can affect any woman at different times in her life, regardless of her race, lifestyle or physiognomy.
Although there is no specific cause that determines the appearance of endometriosis, it is quite common, especially in cases where:
- The mother and/or sisters have endometriosis. There is a genetic predisposition to having endometriosis when other family members have it.
- Mature women without children
- Onset of menstruation at an early age
- Menstrual periods lasting 7 days or more
- Women with an immunological disorder
- Symptoms of endometriosis
Some of the symptoms of endometriosis are:
- Menstrual cramps
- Pain during and after intercourse
- Discomfort in the abdomen and/or intestine
- Discomfort when urinating
- Bleeding between periods
- Constant menstruation
- Painful fatigue syndrome
- Infertility
Endometriosis and infertility: what is the relationship?
Although not always, endometriosis can compromise a woman’s fertility to a greater or lesser degree. Tissue adhesions affect the reproductive organs, distorting them, blocking them or even destroying the pelvic structures.
However, there is also evidence that the impact of this disease on fertility is multifactorial and compromises the reproductive process at different times. It has been shown that the oocytes of women with endometriosis are of poorer quality since they live in an adverse follicular environment. As a consequence of this, the rates of achieving pregnancy are lower and, consequently, the development of lower quality embryos and therefore a lower probability of success in implantation.
Personalized stimulation treatments with antral enhancement can slightly increase the number of eggs, but substantially improve the quality of the recovered eggs. In addition to personalizing the protocols, monitoring and the ability to adapt to the evolution of the cycle of the patient with endometriosis is essential for the success of the treatment.
In other cases, the patient with endometriosis needs to resort to minor surgeries to improve the anatomy and functionality of the uterus and try to ensure maximum embryo implantation.
Different assisted reproduction techniques help to achieve pregnancy, however, an individualized strategy is necessary from the moment the disease is diagnosed and that lasts beyond achieving pregnancy.
