Endometriosis - abdominal pain and other symptoms, pregnancy, treatment

Endometriosis affects up to 15% of women, mostly in their reproductive years, but also younger and post-menopausal women. It manifests as pain of varying degrees of severity, localized in the abdomen, often associated with menstruation. Menstrual bleeding is very painful and heavy. There is intermenstrual spotting and after intercourse. Often patients have back pain, abnormal bowel movements and soreness when urinating, and complain of pain during intercourse.

Unfortunately, there are big problems with the diagnosis of this disease, since similar pain is also present with other conditions. I often meet patients who have endometriosis, and are mistakenly treated for spinal disease, irritable bowel or urinary tract infections," says gynecologist Dr. Dariusz Swatowski. - The lack of treatment results in frustration and even depression. Painful relationships disrupt marital life. 

We are hearing more and more about endometriosis. What exactly is it and what symptoms should be of concern?

Endometriosis is the presence of tissue similar to the mucous membrane lining the uterine cavity, but located outside it. Ovarian hormones stimulate it to grow and flake off, similar to what happens in the uterine cavity. Thus, it can be said that there are minor menstrual bleeding at the site of endometriosis and in this way there is irritation of pain receptors. As the disease continues, there is more and more endometrial tissue and growing discomfort.

In the case of ovarian localization, cysts containing dark blood called "chocolate cysts" can form, destroying the structure of the ovaries. Endometriosis also causes adhesions, which can lead to the closure of the fallopian tubes and result in infertility.

There are quite a few symptoms. Is it actually that difficult to diagnose endometriosis?

In the diagnosis of endometriosis, the medical history is very important. The interview developed by the Endometriosis Section of the Polish Society of Gynecologists and Obstetricians can be helpful. The following information is important:

• pain occurring periodically turning into continuous pain
• painful menstruation
• pain during intercourse
• soreness of passing urine or stool
• The age at which the first menstrual period occurred
• length of menstrual bleeding
• number of births
• number of multiple pregnancies
• length of breastfeeding
• established hyperestrogenism, that is, an excess of estrogens - the female sex hormones estrone, estradiol, estriol and estetrol

Gynecological examination during menstruation increases the chance of finding foci of deeply infiltrating endometriosis.

Currently, there is no simple, non-invasive test with which to diagnose endometriosis unequivocally. Many centers around the world are looking for sensitive markers of the disease, but it turns out that finding them is not such an easy matter, because each woman is different and is accompanied by different diseases and ailments.

Making a diagnosis is possible after a gynecological examination supplemented by an ultrasound or an MRI - explains Dr. Swatowski. "The gold standard" in diagnosis is to perform laparoscopy for diagnosis and simultaneous treatment by excision of endometriosis foci, removal of adhesions and restoration of normal anatomical conditions.

So we already know that surgical intervention may be necessary to treat endometriosis. How then is endometriosis treated?

Hormonal drugs, anti-inflammatory drugs and painkillers have been used to treat endometriosis. The type of therapy is tailored to the severity of the disease and the patient's procreative plans. In my opinion," says Dr. Dariusz Swatowski, "once other causes of pain have been ruled out, treatment with birth control pills administered on a cyclic or continuous basis should be used. Obtaining improvement is a confirmation of endometriosis.

In conclusion, delaying the diagnosis of endometriosis results in its further development, thus increasing pain or even limiting fertility. Therefore, diagnosis of this disease and treatment as soon as possible is essential. 

Thank you for the interview.