Endometriosis is a common disease in women. Annemiek Nap, professor of Gynecology and Obstetrics, and specialized in endometriosis, answers five questions about this condition.
1. What is Endometriosis?
We speak of endometriosis when tissue that resembles the mucous membrane that lines the inside of the uterus (endometrium), also occurs in places outside the uterus. This can be in the abdominal cavity, for example on the peritoneum, on and in the ovaries, but also on and in the intestine and on and in the bladder. In addition, we see endometriosis in scars after a caesarean section, or in the navel after keyhole surgery. And more rarely, it also occurs in the chest cavity.
2. How do you get it and what are the symptoms?
There are several theories about this. One of the theories is the so-called retrograde menstrual theory. This means that a part of the endometrium, which is shed by the body during menstruation, does not come out through the vagina, but ends up in the free abdominal cavity via the fallopian tubes. There it is normally cleared by the immune system. If for some reason that doesn’t happen, endometriosis can develop. Whether or not you as a woman also suffer from this depends on several factors. Hormone sensitivity, the occurrence of an inflammatory reaction, genetic predisposition and environment play a role in this.
So we think that several factors play a role in the development of endometriosis, namely immunological, hormonal, inflammation-related, genetic and environmental factors.
The symptoms are:
a. Severe abdominal pain around menstruation, which can later become chronic
b. Pain when defecating, when urinating and when having sex
c. Possible infertility
d. Cyst formation in the ovaries
3. How is endometriosis discovered?
The diagnosis is made by ultrasound, MRI or keyhole surgery. Due to the variety of symptoms, it is often difficult to identify the correct diagnosis. It takes an average of more than 7 years before it is set! We would like this period to be shorter. That is why there is a multidisciplinary center for endometriosis at Radboudumc, where people can go for diagnosis and treatment. Together with the primary care department, we are investigating how we can make the time to diagnosis as short as possible.
4. Is there a cure for it?
The symptoms of endometriosis can be suppressed with the help of medication. For example, with hormones that reduce the activity of the endometriosis foci, or by means of painkillers.
If this does not help, or if the foci of endometriosis threaten to damage organs in the abdominal cavity (for example, the bowel, bladder or ureters), the endometriosis can be removed with the help of surgery. It is important to know that until now there is no treatment that cures endometriosis. We are actively looking for this worldwide and also at Radboudumc.
5. As a person with endometriosis, what can you do to reduce your symptoms?
As long as we do not yet have a definitive treatment for endometriosis, we will look at Radboudumc for treatments that women can use themselves to relieve their complaints. For example, women can adjust their diet themselves. We are starting with a study in which we look at whether an anti-inflammatory diet has a beneficial effect on the complaints, and also what exactly this changes in the body. We also see promising effects of cognitive behavioral therapy, ie psychological intervention, in which women learn to deal with the complaints in such a way that they hinder your functioning less seriously.
Read Majotte’s story: “Endometriosis is fighting against a wall of incomprehension”.
Read more about endometriode here.