ENDOMETRIOSIS
Helena Corleta, MD., Obstretics & Gynecology Specialist. General Surgery Specialist. Ph.D. in Human Reproduction by Ludwig Maximilian University-Germany.
What is it?
Endometriosis is a benign condition characterized by the presence of endometrial tissue (the tissue that covers the womb internally) outside the uterine cavity.
How does it develop?
The exact cause is unknown. A theory suggests that during menstruation endometrial cells pass through the Fallopian tubes to the peritoneal cavity, in which they implant. The most common sites of implantation are the ovary, Fallopian tubes, womb's external surface, and rectovaginal septum (region between the vagina and the rectum). Other theories suggest changes in the immune system, and even genetic heritage.
What does one feel?
The most common symptoms include:
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severe dysmenorrhea (cyclic pelvic pain that takes place before and during menstruation) |
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dyspareunia (pain during and after the sexual intercourse) |
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chronic pelvic pain |
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infertility |
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urinary symptoms with painful urination |
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pain in the lower lumbar region (back) |
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abdominal discomfort |
How is the diagnosis achieved?
The diagnosis usually includes laparoscopy, which is a surgical procedure performed in an outpatient unit, consisting of a camera inserted into the abdominal cavity through the navel, allowing the identification of lesions and determining the extension of the disease. The removal of a small piece of suspect tissue (biopsy) to carry out an anatomopathological exam will provide a reliable diagnosis.
How is it treated?
Treatment will depend upon patient age, extension of the disease, symptom severity, infertility duration, and the couple's reproductive plans.
The treatment may include surgery, which can be conservative, removing areas of endometriosis by means of laparoscopy with the purpose to decrease pain or allow gestation, or aggressive, removing the ovary, and even the womb. In the therapy with medicaments, several drugs can be used aiming at the establishment of an unfavorable situation to ectopic implants, suppressing hormones and causing amenorrhea (absence of menstruation).
How can it be prevented?
There's no way to prevent the endometriosis that affects women in their reproductive years, but those taking oral contraceptives to control pregnancy have a lower incidence of this disease.