Endometriosis is a common health problem that occurs when the lining of the uterus (the endometrium) grows outside the uterus. Frequently, this tissue grows in the ovaries, the fallopian tubes and outside the uterus, and also in the abdominal organs.
Endometrium: is the innermost layer. It is a mucosal layer with glands, which varies according to hormonal changes, and is in turn made up of two layers: the basal layer and the functional layer, which is the one that is desquamated in each menstruation to regenerate again in each cycle menstrual.
The most frequent location of endometriosis is the ovary. Cysts are often formed, which fill with blood and take on a dark color that looks like chocolate, so they are called chocolate cysts .
Other lesions we can find other than cysts are the nodules (bluish and without liquid inside) and adhesions (dark red or whitish, which give rise to fibrosis causing pain).
Approximately 1 in 10 women of reproductive age have endometriosis.
Endometriosis can occur in any woman who has a uterus, but it is diagnosed more frequently in women between 30 and 49 years old. A higher risk may also be involved if someone has had endometriosis in the family.
Risk factors:
. Fertile age.
. Short cycles (less than 27 days), with heavy menstrual bleeding. (more than seven days).
. Previous surgical interventions on the uterus.
. Presence of anatomical alterations in the genital tract.
The symptom most common of endometriosis is pain. chronic; usually in the pelvic area, and more commonly during menstrual periods. Some women with endometriosis have severe pain, while others have no pain. Other signs or symptoms may include the following: small intestinal pain, bleeding or bleeding between periods, pain during intercourse, and infertility.
How is it diagnosed?
All this will be detected primarily by physical examination: with bimanual palpation (technique in which the uterus and ovaries are explored with one hand in the gut and the other in the vagina) pain can be demonstrated, the presence of a mass a level of the ovary, roughness of the ligaments of the sacrum, uterine fixation, ...
The ultrasound serves mainly to see in the ovaries the cystic formation.
The nuclear magnetic resonance ] will be used in cases of deep endometriosis and with involvement of the rectum.
Laparoscopy is the test that will give the definitive diagnosis of endometriosis. This technique allows to see the inside of the abdomen through a pair of holes, observe the lesions directly, and take samples to analyze them with the microscope. In addition, surgical resection of the lesions can be carried out at the same time.
Treatment
Nonsteroidal antiinflammatory drugs or analgesics are used to control minor pain . Also useful is the administration of oral contraceptives to delay the progression of the disease and prevent pregnancy if they do not wish to.
A mechanism used for the treatment of this disease is to carry out an induction of the menopause or a false pregnancy, that is, get a hormonal situation in the body similar to the one produced in these two circumstances. For this reason, it will not be possible to become pregnant during medical treatment, since ovulation is inhibited. Different drugs are used.
The surgery is indicated for severe, incapacitating or acute symptoms, and when the disease is advanced.
Two types of interventions can be distinguished:
- Conservative surgery: The uterus and as much ovarian tissue as possible is maintained. It consists of the fulguration or laser ablation of endometriotic lesions, and the removal of associated adhesions or fibrosis. The objective is to recover the normal characteristics of the pelvis.
- Radical or definitive surgery: involves the removal of the uterus with removal also of the tubes and ovaries if they are affected. It is performed in severe cases, and in those in which the clinic persists despite medical treatment or conservative surgery. The choice of this method also influences a woman's desire to have children or not, since later pregnancy will not be possible.
The objectives of treatment regardless of the option chosen, will be the pain relief, the elimination of endometriotic lesions, and the restoration of fertility when the woman wishes to become pregnant.
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