Endometriosis Definition, Reason, Symptoms, Treatment & Prevention

Endometriosis

Medical specialist	Obstetrics and gynecology specialist
Symptoms	Severe menstrual pain, heavy menstrual volume, lower back pain or around the pelvis, pain during bowel movements, difficulty getting pregnant
risk factor	Never given birth, first menstruation before the age of 12, family history, immune system disorders, reproductive organ disorders
Diagnosis	Medical interview, physical examination (pelvic examination), supporting examinations (ultrasound, laparoscopy, MRI, biopsy, laboratory)
Treatment	Medicines and surgery
Drug	Hormonal contraception (eg birth control pills, injectable birth control), progestin therapy, aromatase inhibitors, GnRH agonists, and antagonists
Complications	Infertility, ovarian cancer, adhesions
When to see a doctor?	Immediately if you experience complaints of severe menstrual pain accompanied by excessive menstrual volume, interfering with daily activities

Symptoms 

Endometriosis symptoms can vary. Some women can even feel symptoms so severe that they cannot carry out normal activities, even to depression. However, many also do not feel any symptoms.

Some of the symptoms of endometriosis in general, namely:

• Menstrual pain that is intense  and doesn’t get better with painkillers
• Menstrual blood that is a lot to the point that you need to change pads frequently
• Pain in the lower back or pelvis area that can be felt only during menstruation or continuously
• Pain during and after sexual intercourse (dyspareunia)
• Pain or discomfort when defecating/urinating
• Nausea, gas, diarrhea, or constipation during menstruation
• Bleeding outside the menstrual cycle
• Feeling tired all the time
• Difficult to get pregnant

Menstrual pain is very common. However, for women who have endometriosis, menstrual pain that is experienced is severe and increases in intensity over time.

However, the severity of menstrual pain does not determine how severe the endometriosis is. Sometimes, mild endometriosis can cause severe pain and vice versa.

Reason

Until now, the cause of endometriosis is still not known with certainty. Several theories reveal several things that contribute to endometriosis, such as:

1. Retrograde Menstruation

Is a condition when menstrual blood containing endometrial cells flows back through the fallopian tubes (ovary canals) and into the pelvic cavity. This menstrual blood should leave the body through the vagina.

As a result, endometrial cells adhere to the pelvic wall and the surface of the pelvic organs. These cells eventually continue to grow, thicken and cause bleeding during the menstrual cycle.

2. Peritoneal Cell Transformation

Known as the induction theory, where the cause of endometriosis is thought to be due to changes in hormones and the immune system that encourage changes in peritoneal cells.

The peritoneum itself is the membrane that lines the inside of the stomach.

3. Embryo Cell Changes

Hormonal changes, such as estrogen, can transform embryonic cells, i.e. immature cells, into endometrial cells at puberty.

4. Immune Disorders

Immune system disorders or immune problems can also be one of the causes of endometriosis.

In this condition, the body’s immune system fails to recognize and attack endometrial-like tissue that grows outside the uterus.

5. Endometrial Cell Movement

Other causes of endometriosis are also suspected of the migration of endometrial cells to other parts of the body through blood vessels and the lymphatic system (lymph nodes).

6. Result of Operation

After surgery, such as a hysterectomy or cesarean section, endometrial cells can stick to the incision. As a result, endometriosis can occur.

Risk Factors

Several risk factors can increase a person’s experience of endometriosis, including:

• Never gave birth
• First menstruation at a young age (before 12 years of age)
• Late menopause
• Short menstrual cycle
• Experiencing long menstruation, more than 7 days
• Have high levels of the hormone estrogen or have been exposed to estrogen for a long time
• Family history of endometriosis
• There are medical conditions that prevent menstrual blood from leaving the body
• Abnormalities in the reproductive organs
• There is a disorder of the immune system

Diagnosis

Endometriosis is quite difficult to diagnose because the symptoms are varied and there are many other diseases with similar symptoms.

For this reason, an obstetrician and gynecologist (ob-gyn) will conduct a detailed medical interview to find out what symptoms appear.

After that, the doctor will carry out a physical examination in the form of a pelvic examination. This pelvic examination is useful for detecting whether there are problems with the reproductive organs.

The doctor will use gloves that have been given lubricant, then insert his two fingers into the vagina, while one hand feels the patient’s stomach.

At the end of the examination, the doctor will simultaneously examine the rectum and vaginal area.

Several supporting examinations are also needed to help establish the diagnosis of endometriosis. The supporting examinations that can be carried out include:

1. Laboratory Examination

Laboratory tests, such as a complete blood count, can be done to rule out other diseases, such as pelvic inflammatory disease, and see how severe the blood loss is.

In addition, a urinalysis and urine culture can be done to rule out a urinary tract infection.

A gram and cervical culture can be done to rule out pelvic pain and fertility problems due to sexually transmitted infections.

2. USG Transvaginal

Examination using transvaginal ultrasound can help to see whether there are endometrial cells growing outside the uterus.

As the name implies, this examination uses an ultrasound device that is inserted into the vagina.

3. MRI

An MRI examination helps provide a more detailed picture of the condition of organs and tissues in the body, including helping to provide information regarding the location and size of endometrial cells.

4. Laparoscopy

Laparoscopy is used as one of the main investigations carried out to help establish the diagnosis of endometriosis.

This action is included in an invasive procedure, although in general, it has a sensitivity rate of 97 percent but a specificity of only 77 percent.

Laparoscopy helps to see the condition of the patient’s stomach so that the doctor gets information regarding the location and size of the endometrial cells outside the uterus.

In addition, laparoscopy can simultaneously take tissue samples for a biopsy.

5. Biopsy

A biopsy examination of the tissue samples taken is done to help establish the diagnosis of endometriosis.

In the histological picture of endometriosis, a combination of endometrial glands and stroma is found.

Treatment

Endometriosis treatment generally involves administering drugs and surgery.

This therapy is to help reduce symptoms, help increase fertility so that you can get pregnant, and prevent complications.

Endometriosis treatment can differ from one person to another. For this reason, you should consult with your doctor first so that the treatment can be more appropriate.

Some medications that are commonly used in endometriosis patients include:

Painkillers

Doctors can give painkillers to reduce complaints of pain during menstruation.

Some examples of over-the-counter pain relievers, for example, ibuprofen and paracetamol.

Hormone Therapy

Hormone therapy can sometimes help reduce pain due to endometriosis. Hormone therapy helps slow the growth of endometrial tissue and inhibits the growth of new tissue.

However, hormone therapy does not always help treat endometriosis. You may experience the same complaint if you stop this therapy.

Several hormone therapies are used for endometriosis, including:

• Hormonal contraception,  such as birth control pills, injectable birth control, and implants. Hormonal birth control can help slow the growth of endometrial cells and relieve pain
• Gonadotropin-releasing hormone (GnRH) agonist and antagonist.  This is a drug to inhibit the production of ovarian stimulating hormone thereby lowering estrogen levels so as to mimic menopause
• Progestin therapy helps stop menstruation thereby inhibiting the growth of endometrial cells while helping to relieve symptoms of endometriosis
• Aromatase inhibitors.  This class of drugs helps reduce estrogen levels in the body. Usually, doctors will give this drug and combine it with progestin therapy or hormonal contraception

Operational Action

If people with endometriosis want to get pregnant, surgery to get rid of endometriosis tissue can be done to increase the chances of pregnancy.

There are several options of operational actions that can be performed:

Laparoscopy

In general, endometriosis can be treated by laparoscopy. This procedure is performed by inserting surgical instruments through three small incisions around the navel.

Using this instrument, the doctor will remove endometrial tissue. After that, the small incision will be closed.

After surgery, doctors can provide hormone therapy to help reduce pain.

Laparotomy

If it is not possible to use a laparoscopic technique, a laparotomy procedure can be performed.

Usually, this method is used in cases of more severe endometriosis, such as large endometriosis.

In a laparotomy, the doctor will make a larger incision in the abdominal area to help remove endometriosis tissue that is stuck in the affected organs.

Hysterectomy

Hysterectomy, which is the removal of the uterus, cervix, and both ovaries (ovaries) is the last resort for treating endometriosis.

This action helps reduce complaints of heavy bleeding during menstruation and reduces pain.

However, having a hysterectomy can cause premature menopause and prevent the patient from getting pregnant again.

Prevention

Endometriosis is difficult to prevent. However, the risk of developing endometriosis can be reduced by doing a number of things, such as:

• Exercise regularly
• Avoiding bad habits such as consuming alcoholic beverages, consuming too much caffeine
• Maintain an ideal weight
• Consult with a doctor regarding the contraception to be used

Complications

Endometriosis can cause complications if not handled properly. The following are complications of endometriosis that often arise.

1. Infertility problems

Fertility or infertility problems are one of the most common complications of endometriosis.

Infertility can occur because the fallopian tubes are blocked due to endometriosis, which is why egg cells and sperm cannot meet.

2. Ovarian Cancer

Women who have endometriosis are at increased risk for developing ovarian cancer.

3. Tissue Adhesion or Adhesion

Endometriosis tissue can create adhesions between one organ and another.

4. Formation of ovarian cysts

Ovarian cysts are fluid-filled cysts on the ovaries and can be large and painful.

This condition may occur if endometriosis tissue grows around the ovaries.

When to See a Doctor?

Immediately see a doctor if signs and symptoms appear that are suspected of leading to endometriosis, especially if severe pain during menstruation interferes with daily activities.