Endometriosis is a disease that can manifest itself at any time from the start of the first period until menopause. Its diagnosis has historically been “slow and difficult”, which is why it is a pathology in which it is necessary to listen to the patient and ask her “exhaustively” about the discomfort.
PHOTO EFE/Mauricio Dueñas Castañeda
They assure EFEsalut the head of the Gynecology Service and care coordinator of the Endometriosis Unit of Hospital de la Pau (Madrid), Alicia Hernández, and the doctor of this Unit, Cristina Redondoin an interview on the occasion of World Day of this diseaseMarch 14
Endometriosis is a disease where the endometrium – tissue that is formed every month inside the uterus and that if there is no fertilization is removed through menstrual bleeding – grows outside its usual place, which is the inside of the uterus
Doctors Hernández and Redondo take an X-ray of this pathology it affects approximately 10% of women and girls in reproductive age in the world and can cause infertility, according to data from the World Health Organization (WHO).
How does the disease of endometriosis begin to manifest?
The onset of symptoms is variable between patients and others, but very frequently the onset is with intense pain during menstruation. Sometimes it is accompanied by discomfort with intercourse or going to the bathroom, as well as pain and swelling of the abdomen during the menstrual cycle.
Another relatively frequent form of diagnosis is through a history of infertility.
How do you arrive at the diagnosis?
Diagnosis has historically been slow and difficult, as it is a disease with a heterogeneous presentation, as symptoms are often not correctly identified by medical personnel.
For the proper diagnosis, the most important thing is, first of all, to listen to the patient and question her thoroughly about her discomfort. In addition, physical examination and gynecological ultrasound in the office are the main tools we use.
Can symptoms appear before the first period?
In some women, the pain occurs from the beginning of menstruation, but in many others the disease manifests itself later. It can appear at any time in life between menarche (first menstruation) and menopause.
The most frequent age of diagnosis is between 32-35 years.
The clinical presentation is very variable, in some cases it is intense pain from the beginning, and in others, on the other hand, the first symptoms appear when the disease is advanced and has been present for a long time.
What is your treatment, doctors?
There are a number of treatments that women with endometriosis can benefit from.
According to the characteristics of each patient and, also, their preference, we can offer analgesic and hormonal treatments (contraceptive pill, IUD, implant, other types of progesterone…).
In some cases it is necessary to perform surgical interventions that can range from diagnostic laparoscopy to more aggressive surgery – removal of the uterus and ovaries, surgical procedures on the intestine or urinary tract, etc.
Many women also benefit from dietary changes and various complementary treatments.
On the other hand, since it is a largely systemic disease, it is common for other specialists to participate in the treatment, such as physiotherapists, anesthetists specialized in pain treatment, gynecologists specialized in pelvic floor…
Does it get worse over time?
It depends on the case. Today’s research tells us that not all cases progress or worsen. It is influenced by several factors: the treatments received by the patient, pregnancies, general state of health…
In many cases it disappears with menopause In the cases where it does not, what could be the reason?
When menopause arrives, due to the hormonal change that women experience and which leads to a decrease in ovarian activity, it is very common for symptoms to improve greatly or even disappear.
Can affected women suffer from the disease for life?
The disease can, and usually does, improve after medical and surgical treatments. It is true that we must warn patients that this is a long-term chronic disease.
How is it treated in these cases and what are the possible therapeutic options?
Medical or surgical treatments must be changed according to the patient’s age, reproductive wishes and, of course, the patient’s expectations.
Can certain organs be affected for so many years with the disease?
Endometriosis can affect organs other than the uterus and ovaries. The reason is that the disease can spread within the abdominal-pelvic cavity and implant itself on the intestine, ureters, bladder and even reach the pleura.