Endometriosis: Myths and Facts

Endometriosis is a complicated disease that affects about 10% of individuals who have a uterus and are of childbearing age. It is one of those diseases that are often delayed in diagnosis and are often given ineffective treatments. This lack of information complicates the lives of those who have the condition.  The clinical picture of endometriosis is characterized by chronic pain in the pelvic region and infertility. There may also be changes in the digestive and urinary rhythm during the menstrual period.

Is endometriosis simply a strong menstrual cramp? Cramps are only one of the symptoms of endometriosis. Although some people do not experience any pain, many women with endometriosis have severe cramps before, during, and after menstruation. Endometriosis is a condition in which a tissue resembling the endometrium (lining layer inside the uterus) is found outside the uterus. This "shifted" tissue induces an inflammatory response that can result in severe pain and scarring. In addition to cramps, endometriosis can cause pain when urinating, chronic pelvic pain, as well as back, leg and shoulder pain. In some cases, the pain can be so intense that it prevents daily activities such as sitting and walking.

This disorder manifests itself in women who are in their reproductive period and it may first appear soon after the first menses, but the strongest symptoms are usually expressed between the ages of 25 and 35 years old. The disease has no definitive cure, but the treatments can allow for a better quality of life. Physical exercise and healthy eating help in the overall treatment as well.

There are genetic factors involved in the manifestation of endometriosis: women with relatives with endometriosis have an increased risk (of approximately 7%) of developing it. The disorder may also occur as a result of anatomical or biochemical changes. It is an example of endometriosis related to anatomical alterations. There are cases of young women with obstructions that hinder the menstrual flow, as such the remains of the endometrium are forced to travel the retrograde path, towards the uterine tubes, the ovary, and the abdominal cavity. Examples of biochemical alterations that have occurred are women who were exposed to high doses of estrogen administered by their mothers during their intrauterine life .

There are three main forms of the disorder: peritoneal (when implants settle on the inner surface of the pelvic cavity and ovaries), endometriomas (when complex ovarian cysts are coated with endometrioid tissue), and rectovaginal nodules (when endometrioid tissue forms solid nodes). The diagnosis is made from complaints, gynecological examination (which can reveal the existence of nodules as well as enlarged and painful ovaries), and through an ultrasound examination. Smaller implants placed in the abdominal cavity can also be visualized by laparoscopy.

Clinical treatment can be done by using the contraceptive pill (containing estrogen and progesterone or progesterone only), by inhibiting ovarian function, or by using drugs belonging to the aromatase inhibitor group, an important enzyme for estrogen formation. Surgical treatment is almost always done by laparoscopy, which allows the implants to be removed or vaporized by means of laser beams or the application of electric current. Conventional surgeries are indicated only in selected cases.




Nathalia Schettino