Endometriosis affects up to 15% of women, mainly in the reproductive period, but also younger and after menopause. It manifests itself by pain of varying degrees of intensity, located in the abdomen, often associated with menstruation. Menstrual periods are very painful and heavy. There is spotting between periods and after intercourse. Often patients have back pain, bowel disturbances and pain on urination, complain of pain during intercourse.
Unfortunately, there are big problems with the diagnosis of this disease because similar pains occur in other diseases as well. I often meet patients who have endometriosis and are mistakenly treated for spinal diseases, irritable bowel or urinary tract infections - says gynaecologist Dr. Dariusz Swatowski. - The lack of effects of therapy leads to frustration and even depression. Painful relations disturb marital life.
We hear more and more about endometriosis. What exactly is it and what symptoms should worry us?
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 peel off, similar to what happens in the uterine cavity. Thus, it can be said that there are small menstrual bleedings at the site of endometriosis and in this way the pain receptors are irritated. As the disease progresses, there is more and more endometrial tissue and growing discomfort.
In the case of ovarian localisation, cysts containing dark blood called 'chocolate cysts' can form, which destroy the structure of the ovaries. Endometriosis also causes adhesions to form, which can lead to the closure of the fallopian tubes and result in infertility.
There are quite a few symptoms. Is it really that difficult to diagnose endometriosis?
The medical history is very important in the diagnosis of endometriosis. The interview developed by the Endometriosis Section of the Polish Society of Gynecologists and Obstetricians may be helpful. The following information is important:
- pain occurring periodically and changing into a constant pain
- painful menstruation
- pain during intercourse
- painful urination or defecation
- the age at which the first menstrual period occurred
- length of menstrual bleeding
- number of births
- number of multiple pregnancies
- length of breastfeeding
- known hyperestrogenism, i.e. an excess of the female sex hormones estrone, estradiol, estriol and estetrol
Gynaecological examination during menstruation increases the chance of finding foci of deeply infiltrating endometriosis.
Currently there is no simple, non-invasive test that can diagnose endometriosis unequivocally. Many centres in 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.
Diagnosis is possible after a gynaecological examination supplemented by ultrasound or magnetic resonance imaging," 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?
The treatment of endometriosis includes hormonal drugs, anti-inflammatory drugs and painkillers. The type of therapy is adjusted to the stage of the disease and the patient's procreation plans. In my opinion - says Dr. Dariusz Swatowski - after excluding other causes of pain, treatment with contraceptive pills administered cyclically or continuously should be applied. Obtaining improvement is a confirmation of endometriosis.
In conclusion, delaying the diagnosis of endometriosis results in its further development, and thus in increased pain or even reduced fertility. Therefore, the earliest possible diagnosis of this disease and treatment is essential.
Thank you for the interview.