There are at least three million women (even very young) who suffer from this disease in Italy. In severe cases, the disease is disabling and can compromise fertility. It can be controlled with hormone therapy
The first cure is information. But for endometriosis in all these years, not enough has been done. To promote a culture of symptoms and treatment pathways, the National Agency for Regional Health Services (Agenas) has created an online portal entirely dedicated to this disease (Endometriosis.agenas.it), which affects at least 3 people in Italy alone. millions of women of childbearing age (almost as many as there are diabetic patients), with a peak incidence between 25 and 35 years, but who still suffer from a serious diagnostic delay, of 7-10 years, with important consequences on the quality of life and reproductive health. “The aim of the project is to raise awareness among citizens about the disease and train through fad courses (distance learning, ed) the professionals, in particular general practitioners, paediatricians, gynecologists in clinics, outpatient and hospital, as there are still difficulties in making diagnoses “explains Marcello Ceccaroni, one of the experts who developed the platform and director of the operational unit complex of gynecology and obstetrics of the Irccs Don Calabria in Negrar (Verona), the national reference center for the treatment of endometriosis. There is a cultural obstacle within families that must be overcome. “Parents are inclined to consider dysmenorrhea as a normal symptom, so they resign themselves with endurance. But chronic and disabling menstrual pain, which forces you to skip several days of school, is not physiological and should not be neglected – warns Ceccaroni -. According to European studies, 25 to 50 percent of adolescents who stay home from school due to menstruation have already developed the disease “. Greater awareness in society can change the course of the disease, thanks to earlier diagnoses and more effective interventions. “The project also provides for the national mapping of specialized treatment centers,” says the doctor.
What is Endometriosis
Endometriosis consists in the presence of endometrial tissue (the mucosa that in normal conditions covers only the uterine cavity and every month flakes and renews itself with the menstrual cycle) outside the uterus. “It is localized in the ovaries and tubes and over time it can invade the ligaments of the uterus, the bladder, the intestine and the ureters to cause serious organic complications – continues the expert -. The extrauterine tissue is subject to micro-extractions, therefore to bleeding and scarring that can cause adhesions, cysts and nodules, and that inflame the pelvic cavity “Endometriosis is very widespread, it affects about 176 million women in the world, of which 14 millions in Europe, and has a family component. “Women who have a mother or a sister affected by the disease have a 7 times greater risk of developing it” recalls Ceccaroni.
I sintomi
The main symptom of endometriosis, being a chronic inflammatory disease, is worsening menstrual pain, which worsens with the passing of months and years, and can also appear during ovulation (it is a sign of adhesion, i.e. scar tissue that joins the walls of the pelvic organs). “Pelvic pain is chronic when it occurs for more than six consecutive months,” explains the gynecologist. It can be associated with premenstrual bleeding and pain during sexual intercourse (dyspareunia) in 50 percent of patients. While 30 percent of patients become infertile. If endometriosis involves the bladder and intestines, pain during urination (dysuria) and accentuated evacuation (dyschezia) may occur near menstruation. Abdominal swelling, constipation alternating with diarrhea, headache and fatigue may accompany the clinical picture described. But there is also a 20-25 percent who are asymptomatic despite endometriosis spreading to multiple organs.
The diagnosis
In the presence of persistent intense menstrual pain, it is necessary to contact the gynecologist. At a family or youth clinic (dedicated to minors in fact), where access is direct, without a doctor’s prescription, and free (or at the cost of a ticket in some regions). Or, on prescription, you can make an appointment with the gynecologist in the outpatient clinic of the health district or hospital. «For a first diagnostic classification, a careful medical history and pelvic ultrasound is required – explains Ceccaroni -. In more complex clinical situations, or to confirm the suspicion with in-depth investigations, the patient must be sent to the specialized reference center for adequate treatment. In many cases, however, there is an underestimation of symptoms and a poor ability to recognize nodules through ultrasound. So these women are not really believed or find themselves carrying out useless tests ».
The cure
To counteract the expansion of the endometrium (and inflammation of the tissues) and reduce pelvic pain, hormone therapy (progestins or low-dose estrogen-progestins) and supplements are prescribed. “The therapy must be combined with a correct lifestyle, and therefore physical exercises, to strengthen the pelvic muscles tired from the contracture caused by pain, and an anti-inflammatory diet personalized by the nutritionist” specifies the expert. Surgery is used “when medical therapy fails and only in the most serious cases, if the endometrium has infiltrated the intestine or ureter, creating occlusions for example,” concludes Ceccaroni. The support of a midwife (to perform pelvic floor gymnastics), a physiotherapist, an osteopath or a psychologist may also be indicated. In the Lea In 2017, endometriosis in the most advanced levels (third stage or moderate and fourth stage or severe) were included in the list of chronic and disabling diseases that fall within the Lea (the essential levels of assistance that the National Health Service is held to provide) and therefore give the right to exemption from the health ticket for specialist control services (gynecological examination and abdominal ultrasound).
March 31, 2022 (change March 31, 2022 | 19:35)
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