Endometriosis is believed to affect around 10-15% of women, which would be about 170 million women in the world and 2 million women in Spain.
We have spoken with Dr. Isabel Sánchez Magro, director of the Merck Medical department, to learn more about this disease that affects the quality of life, health and professional projection of those affected.
What is endometriosis?
Endometrial tissue is made up of glands, blood cells, and connective tissue. It normally grows in the uterus, to prepare the lining of the womb for ovulation. Endometrial implants are collections of endometrial tissue that grow in places outside the uterus. When they grow outside the uterus, it is called endometriosis. They can develop anywhere on the body, but generally occur in the pelvic area. They can affect the ovaries, fallopian tubes, peritoneum, or lymph nodes.
Normally, this tissue is expelled during menstruation, but the displaced tissue cannot be expelled. This leads to physical symptoms, such as pain. As the lesions grow, they can affect bodily functions. For example, the fallopian tubes can become blocked, causing female infertility.
What are the symptoms?
Symptoms of endometriosis include:
– Severe menstrual cramps
– Long-term lumbar and pelvic pain
– Periods lasting more than 7 days
– Heavy menstrual bleeding in which it is necessary to change the pad or tampon every 1 to 2 hours (dysmenorrhea)
– Intestinal and urinary problems including pain, diarrhea, constipation, and bloating.
– Bloody stools or urine
– Nausea and vomiting
– fatigue
– Pain during intercourse (dyspareunia)
– Spotting or bleeding between periods
Pain is the most common indication of endometriosis, but the severity of pain does not always correlate with the extent of the disease. This pain usually subsides after menopause, when the body stops producing estrogen. However, if hormone therapy is used during menopause, symptoms may persist. Pregnancy can provide temporary relief from symptoms.
Other medical conditions, such as pelvic inflammatory disease, ovarian cysts, and irritable bowel syndrome, can mimic the symptoms of endometriosis.
How is the diagnosis of the disease made?
The main diagnostic tests are the pelvic exam, MRI, ultrasound, and laparoscopy. In addition, the doctor will assess the symptoms described above such as dysmenorrhea or dyspareunia or other non-gynecological symptoms such as bleeding or pain in other parts of the body, such as the back.
Infertility is the most relevant consequence of this disease. It is estimated that 25-50% of women with endometriosis find it difficult to have children.
“It is important that the woman and the specialist remain attentive to these symptoms to avoid delaying the diagnosis and, therefore, worsening the health and quality of life of the patient. From the onset of symptoms to the diagnosis of endometriosis, 7-8 years may pass and there have even been cases of up to more than 10 years and there is also a high underdiagnosis due to the fact that it presents in a very variable way (sometimes without symptoms ). However, some women with endometriosis do not present symptoms and are diagnosed during an abdominal surgical process of another cause, ”explains Dr. Sánchez Magro to VERY.
What causes endometriosis?
Endometriosis is a chronic gynecological disease in which an abnormal situation occurs: implantation and benign growth of endometrial tissue outside the uterus, which generates a chronic inflammatory reaction, as we have discussed.
Causes
Although the cause that triggers it is not known with certainty, there are possible explanations that include:
– Problems with menstrual flow: menstrual blood enters the fallopian tubes and pelvis instead of leaving the body in the normal way.
– Embryonic cell growth: Sometimes the embryonic cells that line the abdomen and pelvis become endometrial tissue within these cavities.
– Fetal development: Data shows that endometriosis may be present in a developing fetus, but pubertal estrogen levels are believed to trigger symptoms.
– Surgical scar: endometrial cells can move during a procedure, such as a hysterectomy or cesarean section.
– Endometrial Cell Transport: The lymphatic system transports endometrial cells to various parts of the body.
– Genetics : There may be an inherited component. A woman with a close relative who has endometriosis is more likely to develop endometriosis.
– Hormones: endometriosis is stimulated by the hormone estrogen.
– Immune system: problems with the immune system can prevent the destruction of extrauterine endometrial tissue.
“Although the exact cause is not known, some factors that can trigger endometriosis have been identified, such as the behavior of menstruation (they influence menarche or first menstruation at an early age, menstrual cycles of less than 27 days that recur frequently and long periods, of 7 days or more), the reproductive component (it seems that not having been pregnant can never increase the risk of suffering from it) and genetic factors (several cases have been identified in the same family) ”, specifies the expert.
What injuries does endometriosis cause?
“Injuries have an uncertain prognosis, since they can remain stable, progress and even regress,” says Sánchez Magro. “From a physical perspective, the reproductive structures that can be most frequently affected by endometriosis are the ovaries, but we can also find it in the fallopian tubes, vagina and even in the peritoneum or the gastrointestinal and urinary tract (although with less frequently). One of the most serious consequences is infertility. Similarly, it can lead to other affectations and diseases, depending on the areas where the endometrial tissue is implanted. For example, if it is in the urinary tract it can cause hematuria, pain and urinary infections ”.
Without forgetting the psychological side
“It is essential to consider the psychological perspective. The chronic pain that accompanies this disease in many cases generates depression and anxiety disorders. For this reason, it is very important that treatments are complemented with strategies focused on reducing stress, ”explains the doctor.
Is it a stigma for women?
Endometriosis is a disease that continues to be very unknown, so that the people around the patient often do not understand what it is and do not notice the pain it presents. In many cases, pain is associated with menstruation, even on the part of the patient herself, which generates an absence of normalization that leads many women to try to endure it without externalizing it despite the damage it entails, ”Sánchez Magro clarifies.
Risk factor’s
Anyone can develop endometriosis, but some factors increase the risk such as:
– Age: it is more common in women between 30 and 40 years old.
– Nulliparity: Never give birth.
– Genetics: one or more relatives who have the condition
– Medical history: having a pelvic infection, uterine abnormalities or a condition that prevents the expulsion of menstrual blood.
– Menstrual history: periods that last more than 7 days or menstrual cycles of less than 27 days.
– Caffeine, alcohol consumption and lack of exercise: which can increase estrogen levels.
Some health conditions have been linked to endometriosis, such as allergies, asthma, and some chemical sensitivities, certain autoimmune diseases, chronic fatigue syndrome, and ovarian and breast cancer.
Researchers have found links between endometriosis and exposure to certain chemicals, including phthalates.
Treatment and medication for endometriosis?
“Treatment must be individualized, taking into account the symptoms and their severity. It is important to assess whether there is a desire for pregnancy, previous treatments, if any, age, as well as the location and extent of the endometriosis ”, says the expert.
The treatment is medical, surgical and in some cases psychological and, according to Dr. Isabel Sánchez Magro, it will seek to achieve four objectives:
1) Eliminate symptoms. For this, hormonal therapy and analgesics will be used. These drugs decrease the effects of estrogens on the endometrium, reducing the number of endometrial cells that need estrogen to survive. In this way, this suppression directly influences the reduction of pain.
2) Eliminate visible endometriosis: laparoscopy allows more accurate diagnosis and complete operation of lesions, improving subsequent fertility.
3) Restore fertility
4) Act on the progression of the disease
Does what we eat affect the development of endometriosis?
“Currently, there are very few studies confirming which foods may help improve endometriosis symptoms. However, there are eating habits that help you feel better by reducing symptoms, inflammation, and estrogen levels in the body. On the other hand, it is necessary to limit simple sugar and fats as much as possible so as not to increase body fat, since this also increases the possibility of increasing the amount of estrogens in the body and aggravates the problems associated with endometriosis ”, he explains. Sanchez.
A 2004 study published in the journal BMC Complementary and Alternative Medicine suggested that a Norwegian seaweed called bladderwrack might have an estrogen-lowering effect in women. This can slow the growth rate of endometriosis.
On the other hand, a 2011 study published in the British Journal of Nutrition suggested that fruit intake increased the risk of endometriosis and that a higher total fat intake decreased the risk. Dairy products were also shown to reduce the risk of endometriosis, although these results were not statistically significant.
Eating yogurt, sauerkraut, and pickles or finding a good source of probiotics can help reduce gastrointestinal symptoms and increase digestive activity.
Avoiding caffeine can help reduce pain, as caffeine can make symptoms worse.
What advice would you give women for prevention?
“It is difficult to prevent a disease of unknown origin, but it is important to act quickly. It is advisable to make an early diagnosis and start treating the patient as soon as possible. For this reason, it is important that women do not assume intense and continued menstrual pain as normal, but should understand it as a signal to see a doctor ”, concludes the expert.
