From adolescence to menopause, follow-up is essential.
It provides contraception, replacement therapy and cancer screening.
Endometriosis is characterised by the abnormal presence of menstrual tissue outside of the womb, most often in the small pelvis. It starts a chronic inflammatory process. This condition
affects 5% to 10% of the women of childbearing age.
There are different scientific theories that talk about retrograde menstruation, dissemination through the veins and the lymphatic system, or coelomic metaplasia when trying to understand this disease, but none of them can fully explain the origin and the behaviour of this enigmatic condition.
Many women who have endometriosis are asymptomatic (they have no symptoms), and the presence of lesions (tissue injuries) is discovered by chance, during surgery for another reason.
On the other hand, a large number of women present clear symptoms. The pain associated with endometriosis may take one of the following forms:
- painful menstruation
- painful sexual intercourse
- painful urination
- painful stools
- discomfort affecting the lower back or abdomen
- chronic pelvic pain (pelvic and abdominal pain that is not related to your periods and lasts for at least 6 months)
It is very important to note that the intensity of pain is not in direct relationship with the severity of the endometriotic disease. For this reason, patients with small lesions may experience strong pain and the other way round.
Your gynaecologist will carry out a classical clinical examination to exclude or confirm the presence of any palpable mass or sensitive area by vaginal examination. When there is a suspicion of endometriosis, intravaginal ultrasound is the first examination to carry out.
Certain complementary examinations may prove to be necessary, such as:
- MRI (Magnetic Resonance Imaging)
- Colonoscopy (examination of the colon)
- Cystoscopy (examination of the lining of your bladder and the tube that carries urine out of your body (urethra))
The diagnosis is proved by direct visual examination at the time of a surgery and the pathological findings of the biopsies (examinations of tissue removed from the body). Nevertheless, the pelvic pain is not always connected to endometriosis.
Hormonal contraceptives, more specifically the progestins (synthetic progestogens), ideally taken uninterruptedly, should be considered as the modalities of first-line treatment.
Another, more complex treatment (with a GnRH agonist) aimed at hormonal castration should be considered as a second-line therapeutic option.
– Surgical treatment:
Sometimes, it may turn out that surgical treatment is necessary. Your doctor will decide if it is needed and will explain you its goals.
It is true that endometriosis may reduce fertility. However, there are many options available to help patients if this is the case.