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What is endometriosis?
Endometriosis is a chronic, benign disease that affects about 10% of fertile women. It means the appearance and proliferation of tissues similar to the endometrium outside the uterus, mostly in the lesser pelvis, in the ovaries, and on the surface of the peritoneum. These endometriosis islands are consistent with the menstrual cycle therefore, internal organ adhesions, immunological reactions and the release of cell-mediated substances can cause cyclic pain and infertility. Disorders caused by the disease can affect the uterine muscles, the ectopic abdominal and genital organs, such as the ovaries, the fallopian tubes, the vaginal wall, the colon, the rectum, and, less commonly, the small intestine; the bladder and the ureters, and even the liver, kidneys, lungs. When endometriosis is not only located on the surface of the tissues but also penetrates into their substance, we speak about deep infiltrating endometriosis. The exact cause of the disease is unknown. According to the generally accepted theory, retrograde menstruation (the reverse flow of menstrual fluid towards the abdominal cavity) causes the development of endometriosis in most women.
Main symptoms of endometriosis
– The most common symptom is painful menstruation
– Permanent, lasting chronic pelvic pain
– Pain during urination and defecation (in severe cases, bloody urine and bloody excrement)
– Pain during sexual intercourse
– It is common that the only symptom is infertility, which occurs in approximately 40% of patients.
Symptoms usually increase during menstruation. It is known that there is no close connection between the intensity of the pain and the extent of the disease: even very small deviations can cause severe pain symptoms, however, extensive endometriosis can be accompanied by complete absence of problems.
Endometriosis can be easily confused with other pelvic diseases, such as pelvic or intestinal inflammation, thus, it is strongly recommended to consult a specialist if symptoms occur. Its diagnosis is difficult, it can last up to 8-10 years.
The frequency of endometriosis
It affects more young women than you would think!
Endometriosis mainly affects young women between the ages 25 and 35. We emphasize that it is mainly the case, as the disease has already been diagnosed in very young girls (from the age of 10-12) and in women over the age of 35-40. The disease affects 10% of fertile women between the ages of 15 and 45 in Hungary today, i.e., more than 200,000 affected.
Establishment of the diagnosis
Nevertheless, these imaging procedures mentioned have different, often very low sensitivity for endometriosis islands in different locations, so surgery is currently the most effective diagnostic tool for suspected endometriosis. Surgical intervention can happen through an open abdomen (laparotomy) or by abdominal reflection (laparoscopy). During the laparoscopic surgery, all visible deviations are removed to eliminate pain symptoms and increase the chance of getting pregnant.
You can read more details and advantages of the laparoscopic surgery in the Endometriosis Booklet.
Treatment of endometriosis
The first step of the treatment of endometriosis is the laparoscopic intervention. Its aim is to remove all visible endometriotic deviations. Further medication is essential for the symptomatic treatment and for the prevention of the recurrence of endometriotic deviations. Before the laparoscopic intervention, it is possible to reduce the pain caused by the disease with non-steroidal anti-inflammatory drugs or birth control pills. There are several types of medication options available after the surgery.
The choice of the medication always depends on the patient’s intention to have a child. Its aim is to prevent the recurrence of the disease in all cases and to stop the growth of microscopic endometriotic deviations that are not removed during surgery.
In case of active childbearing intention, a different treatment is recommended depending on whether there is a possibility of spontaneous pregnancy after the surgery, or if there is no childbearing plan.
Since the longer the disease is present, infertility is more likely to develop, we recommend having children as soon as possible.
A közelmúltban klinikai szakértők csoportja kidolgozta az endometriózis kezelésének európai irányelveit annak érdekében, hogy javítsa az európai klinikai gyakorlatot, és ennek eredményeként az endometriózisban szenvedő nők életminőségét.
A betegek részére készült ESHRE (European Society of Human Reproduction and Embryology) tájékoztató célja, hogy bevonja a betegeket az egészségügyi ellátás javításába azáltal, hogy megismerjék az ellátás jelenlegi normáit, valamint hogy a rendelkezésre álló kutatási eredmények megismerésével lehetővé tegye a betegek számára a saját egészségükkel kapcsolatos tájékozott döntéshozást.
Az ESHRE tájékoztató anyag szerzői jogvédelem alatt áll, a dokumentum egészének vagy valamely azonosítható részének bármely formában történő felhasználása csak a szerzők engedélyével és a forrás megjelölésével lehetséges. Bármely jogosulatlan felhasználás polgári jogi és büntetőjogi következményeket vonhat maga után.
Az ESHRE irányelvek endometriózisban szenvedő betegek részére IDE KATTINTVA érhető el.
Fordította: Dabis Melinda, PhD
Szakmai lektorálás: Dr. Bokor Attila, PhD, MSc