Endometriosis affects between 5 and 10 percent of women of reproductive age, peaking between the ages of 25 and 35. If in the past the diagnosis occurred with considerable delay compared to the onset of symptoms (even 7-8 years later), today there is more attention both by the medical profession and by women themselves. Recognizing it in time allows us to avoid unnecessary suffering and significantly improve the quality of life of patients.
What is endometriosis?
Endometriosis a chronic inflammatory disease in which endometrial tissue, which physiologically covers the inner wall of the uterus, is found in abnormal locations, especially in the ovaries, tubes, uterus, bladder and rectum – he explains Paolo Vercellini, full professor of Obstetrics and Gynecology at the University of Milan and director of gynecology at the Mangiagalli Clinic of the Milan Polyclinic -. The arrival and settlement of endometrial cells in the pelvic organs related to the so-called retrograde menstruation. In practice, when the endometrium detaches from the uterus to be expelled together with the unfertilized egg and blood during menstruation, it may happen that some cells are pushed in the opposite direction by the uterine contractions. In some cases these cells succeed in implant in the pelvis and multiply, thus giving rise to “islands” of the endometrium.
What are the red flags?
Like the original tissue, the endometrial fragments outside the uterus also respond to fluctuations in sex hormones, multiplying and producing inflammatory substances that irritate the nerve fibers of the peritoneum, causing pain. They also produce substances that cause the uterus to contract even more (prostaglandins), causing severe pain, usually in correspondence with the menstrual cycle. Depending on where the endometrial tissue is located, you can also have pain when defecating, urinating or during sexual intercourse. Endometriosis inoltrand often associated with infertility: it is found in 30-40 percent of infertile women. Still, 70 to 80 percent of women with chronic menstrual pain do that does not respond to analgesics, suffers from endometriosis.
How can it be diagnosed?
All the symptoms that occur repeatedly in conjunction with the menstrual period must lead to suspicion of endometriosis, says Vercellini. In the past, the diagnosis was surgical and was based on a laparoscopic procedure capable of identifying endometrial tissue in the pelvic area. Today, however, in most cases the diagnosis it is based on a careful analysis of medical history, symptoms, and physical examination by an experienced gynecologist able to detect the physical signs typical of this condition. Again, the use oftransvaginal, and sometimes transrectal ultrasound, allows you to accurately identify a series of pelvic injuries, making the use of magnetic resonance less necessary than in the past.
What can be done to counter it?
Endometriosis is a chronic inflammatory disease, so it cannot be resolved with a single surgical or pharmacological treatment. a condition with which, if well managed, you can live together and have a decent quality of life. They are mainly used to relieve pain hormone therapies (very low dose birth control pills or progestogens). They have also been recently introduced drugs that block ovarian activity (GnRH antagonists). Another therapeutic option is laparoscopic surgery, both as a remedy for pain and to counteract infertility. The use of laparoscopy to relieve pain should be proposed with the understanding that symptoms may not resolve completely in all women. In addition, the pain relapse rate after a few years after surgery is high. In most cases, combining surgery and medical treatmenthowever, there is the possibility to better manage the disease.
The associations that help to orient oneself
A valuable support for women with endometriosis represented by patient associations, such as APE onlus (apendometriosi.it) e Aendo (aendoassociazione.com) APE Onlus founded in 2005 by the will of a group of women with experience of the disease, Aendo born in 2012 to promote information and training for doctors, patients and young women.
May 14, 2021 (change May 14, 2021 | 18:57)
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