Definition of Endometriosis
Endometriosis is a condition when the endometrium grows outside the uterine wall. In this condition, the endometrium can grow on the ovaries, lining of the stomach (peritoneum), intestines, vagina, or urinary tract.
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| Endometriosis, Causes, Diagnosis, Treatment, Prevention, Complications |
The endometrium is the tissue that lines the uterine wall. Before menstruation, the endometrium will thicken to become a place for the fertilized egg to attach. If the egg is not fertilized, the endometrium will shed and then leave the body as menstrual blood.
In endometriosis, endometrial tissue that grows outside the uterus also thickens, but cannot shed and leave the body. This condition causes irritation or inflammation of the tissue around the endometrium.
Endometriosis is characterized by complaints of pain, especially during the menstrual cycle. Endometriosis can also cause long-term (chronic) pelvic pain to infertility.
Causes and Symptoms of Endometriosis
The cause of endometriosis is not known with certainty, but is thought to be related to disruption of menstrual blood flow, changes in other tissue cells into endometrial cells, and migration of endometrial cells through lymph flow.
The main symptom of endometriosis is severe pain or cramping in the lower abdomen or pelvis (dysmenorrhea). Other complaints that can arise are pain during intercourse, a large volume of blood during menstruation, and diarrhea.
Endometriosis Treatment and Prevention
Treatment of endometriosis is by administering drugs to relieve pain, hormone therapy to inhibit tissue growth, and surgery to treat endometriosis that does not improve with other treatment methods.
Meanwhile, to avoid the risk of endometriosis, you can exercise regularly, maintain an ideal body weight, and reduce consumption of caffeinated or alcoholic beverages.
Causes of Endometriosis
It's not known what causes endometriosis. However, it is suspected that endometriosis is triggered by the following conditions:
Retrograde menstruation
Retrograde menstruation is a condition when menstrual blood does not flow out of the body through the vagina, but reverses direction and enters the pelvic cavity through the fallopian tubes.
As a result, endometrial cells that are shed and contained in menstrual blood will stick to the pelvic wall and the surface of the pelvic organs. These cells will then continue to grow, thicken, and cause bleeding during the menstrual cycle. This will cause chocolate cysts.
Immune system disorders
In this condition, the body's immune system fails to recognize and attack endometrial cells that mistakenly grow outside the uterus.
Immature cell changes
Normally, immature (embryonic) cells grow as the human body grows. These embryonic cells can develop into organ cells according to the program of the gene.
In endometriosis, it is thought that these cells can turn into endometrial cells due to hormonal changes in the body, one of which is the hormone estrogen. This condition mainly occurs during puberty.
Peritoneal cell changes
The peritoneum is the membrane that lines the inside of the abdomen. It is suspected that peritoneal cells can turn into endometrial cells when influenced by hormones or disturbances in the immune system.
Endometrial cell migration
In this condition, endometrial cells can move to other parts of the body through the blood, as well as the lymph system, which is the main part of the immune system.
Operation
Procedures, such as caesarean sections and hysterectomies, can cause endometrial cells to stick to the incision area, causing endometriosis.
Endometriosis Risk Factors
Endometriosis can occur in every woman. However, there are several factors that can increase the risk of developing endometriosis, namely:
- Between 25–40 years old
- Having a mother, aunt, or sister who has had endometriosis
- Never given birth
- Give birth for the first time at the age of 30 years
- Suffering from uterine abnormalities
- Suffering from certain conditions that can block the flow of menstrual blood
- Have low body weight and iron deficiency anemia
- Starting menstruation at a very young age
- Experiencing short menstrual cycles, for example less than 27 days
- Experiencing menopause at an older age than normal
Endometriosis symptoms
Endometriosis symptoms can vary. Some women may experience mild symptoms, but others may experience moderate to severe symptoms. Some of the symptoms that generally arise are:
- Severe pain in the lower abdomen and around the pelvis, especially during menstruation
- Abdominal cramps for several days before and during menstruation
- Excessive blood volume during menstruation
- Pain in the lower back during menstruation
- Bleeding outside the menstrual cycle (metrorrhagia)
- Pain during or after sexual intercourse (dyspareunia)
- Pain when defecating or urinating
- Diarrhoea, bloating, nausea, constipation and fatigue during menstruation
- Difficult to get pregnant
Although women generally experience pain during menstruation, pain in women with endometriosis is much more severe and can increase over time.
Please note that the severity of pain does not indicate the severity of endometriosis. Mild endometriosis can cause severe pain. In contrast, severe endometriosis sometimes causes little or no pain.
When to See a Doctor
Immediately check with your doctor if you experience the above symptoms, especially if they interfere with your daily activities. Early examination needs to be done so that endometriosis can be diagnosed and treated more quickly.
Endometriosis diagnosis
To diagnose endometriosis, the doctor will ask questions and answers about the symptoms experienced by the patient, as well as the medical history of the patient and his family. After that, the doctor will carry out a physical examination, including a pelvic examination.
Pelvic examination aims to detect abnormalities in the female reproductive organs. In this examination, the doctor will examine the outside of the vagina by inserting two fingers into the vagina while pressing on the patient's abdomen.
Next, the doctor will carry out the following supporting examinations to establish a diagnosis:
- Ultrasound, to see the condition of the uterus, one of which is by inserting a tool into the vagina (transvaginal ultrasound)
- MRI, to see more clearly the condition of organs and tissues in the body
- Laparoscopy, to see the inside of the patient's stomach so that the doctor can detect the presence of endometrial growth outside the uterus
- Biopsy, to take tissue samples in the uterus for further examination in the laboratory
Endometriosis stage
Through the examination above, the doctor can find out the severity or stage of endometriosis. This stage depends on the location, number, size, and depth of the endometrial lining. The following is an explanation:
- Minimal endometriosis
At this stage, small, superficial endometrial tissue appears on the ovaries or ovaries. In addition, inflammation also occurs around the pelvic cavity.
- Mild endometriosis
Mild endometriosis is characterized by the appearance of small, superficial endometrial tissue in the ovaries and pelvic wall.
- Intermediate endometriosis
This stage occurs when there is some endometrial tissue deep enough in the ovaries.
- Severe endometriosis
Severe endometriosis occurs when there is endometrial tissue deep in the ovaries, pelvic wall, fallopian tubes, and intestines.
Endometriosis Treatment
Endometriosis treatment aims to relieve symptoms, slow the growth of endometrial tissue outside the uterus, increase fertility, and prevent endometriosis from recurring.
Endometriosis treatment methods will be adjusted to the patient's age, the severity of symptoms and disease, and the patient's desire to have children or not. Some of the treatment methods are:
Drugs
Doctors can give pain relievers to relieve pain due to endometriosis. Drugs that can be given are non-steroidal anti-inflammatory drugs (NSAIDs), such as diclofenac or ibuprofen.
Hormone therapy
Hormone therapy aims to slow the growth of endometriosis tissue, by limiting or stopping the production of the hormone estrogen.
However, hormone therapy cannot improve fertility and prevent complications such as adhesions or adhesions. Some of the hormone therapies used to treat endometriosis are:
- Hormonal contraception, such as birth control pills, implant birth control, injectable birth control, or a spiral (IUD), to inhibit the process of thickening endometrial tissue and relieve pain
- Medicines to lower estrogen levels, such as anastrozole, letrozole, and exemestane
- Gonadotropin-releasing hormone (Gn-RH) analogues, such as goserelin, to trigger a menopause-like condition by inhibiting hormone production
- Progestogens, such as allylestrenol, dydrogesterone, and norethisterone, to prevent the ovulation process, namely the release of the egg from the ovary into the fallopian tube thereby triggering shrinkage of endometriosis
- Danazol, to reduce the production of hormones produced by the ovaries, namely estrogen and progesterone, thus creating a menopause-like condition
Operation
Surgery is performed when the above methods are no longer effective in treating endometriosis. Surgery aims to remove endometrial tissue that grows outside the uterus. In addition, surgery can also increase the patient's fertility.
A number of surgical procedures to treat endometriosis are:
- Laparoscopy
In patients who still want to have children but feel severe pain, doctors will recommend laparoscopic or keyhole surgery. Through laparoscopy, the doctor will remove endometriosis tissue and burn the tissue using a laser or electric current.
- Laparotomy
Laparotomy is performed when the endometriosis is very severe and the size is quite large. In this procedure, the doctor will make a wide incision in the abdominal area to access the affected organs and remove endometriosis tissue.
- Hysterectomy
Hysterectomy is the surgical removal of the uterus, cervix (cervix), and both ovaries. Hysterectomy can trigger early menopause and prevent the patient from getting pregnant again. Therefore, this procedure is only performed as a last resort.
Endometriosis complications
If left untreated, endometriosis can develop and cause the following complications:
Impaired fertility or infertility
The main complication that can arise from endometriosis is impaired fertility. This happens because endometriosis can close the fallopian tubes, thereby blocking the meeting of the egg and sperm. In some rare cases, this disease can even damage egg and sperm cells.
One-third to half of people with endometriosis are known to suffer from impaired fertility. However, women with mild to moderate endometriosis still have a chance to get pregnant. Consult with your doctor regarding the right pregnancy program if you experience this condition.
Adhesion
In this condition, endometriosis tissue makes a number of organs stick together, for example the bladder and intestines which are attached to the uterus.
Ovarian cyst
Ovarian cysts are fluid-filled sacs that grow on the ovaries. This condition occurs when endometriosis tissue is located in or near the ovaries. In some cases, cysts can enlarge and cause severe pain.
Ovarian cancer
Although very rare, women with a history of endometriosis are at risk of developing ovarian cancer. In addition to ovarian cancer, women who suffer from endometriosis are also at risk of developing endometrial cancer.
Prevention of Endometriosis
Endometriosis is difficult to prevent, because the cause is not known with certainty. However, there are a number of efforts that can be made to reduce the risk of endometriosis, namely:
- Exercise regularly, at least 30 minutes every day
- Maintain body weight to remain ideal
- Lose weight if you are obese
- Reducing excessive consumption of alcoholic and caffeinated drinks
- Breastfeeding and exclusive breastfeeding after delivery, because breastfeeding has been studied to prevent endometriosis
- Consult with your doctor regarding the proper use of contraception
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