Endometriosis is one of the most common pelvic diseases in women. The name is derived from the endometrium, the inner mucous membrane layer of the uterus. This mucous membrane is built up and broken down by regular hormonal fluctuations over the course of a female cycle and normally bleeds off in a monthly rhythm.
In endometriosis, such histologically similar islands of mucous membrane are found either in the muscle layers of the uterus (formerly internal endometriosis), or there are islands of uterine mucous membrane outside the uterus (external endometriosis). These tissue pieces are then often found in the small pelvis, on the ovaries, on the bladder, on the intestines, or somewhere on the internal peritoneum. In rare cases, external endometriosis, for example, can be found in the navel or in the abdominal wall, and in scars, for example, after cesarean section operations.
How common is endometriosis
There are no exact figures for the incidence of endometriosis. It is estimated that about 1.4 – 7.2 per 1000 women suffer from endometriosis, although the occurrence is likely higher due to an unknown number of unreported cases. Many cases of endometriosis are either misdiagnosed or not diagnosed at all. Reliable data exists from the Federal Statistical Office, which documents 28,000 hospital stays in 2017 with the diagnosis of endometriosis1 2
How does endometriosis develop
There are a number of theories that try to explain the cause and maintenance of this disease. Genetic factors, hormones, immune system factors, inflammatory reactions, oxidative stress, and various other factors likely play a role.
Symptoms of endometriosis
Since endometriosis is a hormone-dependent disease, it often becomes noticeable in very young women. With the onset of the first menstrual bleeding, very young women already suffer from severe menstrual pain. This so-called primary dysmenorrhea can be accompanied by excessive, cramp-like lower abdominal pain and digestive problems and pain during sexual intercourse. However, endometriosis can also cause very nonspecific complaints. Then women report about circulatory problems, headaches, nausea, back and flank pain.
The symptoms last over the entire time of a woman's reproductive phase, i.e., from the onset of the first menstrual bleeding to menopause. There are rare cases where symptoms persist even after the last menstrual period.
Consequences of endometriosis
All cells or islands of uterine mucous membrane react to the hormonal fluctuations during the female cycle. This means that this mucous membrane also builds up and bleeds outside the uterus regularly. These tissue bleedings then lead to, for example, blood-filled cysts on the ovaries, so-called chocolate cysts, adhesions between the bladder, uterus, fallopian tubes, and intestinal loops or in the peritoneum. In long-lasting, unrecognized and/or untreated cases of endometriosis, deeply infiltrating endometriosis lesions with scarring can occur, which sometimes require multiple surgical interventions.
Since endometriosis is a chronic disease, many women also suffer psychologically from the regular symptoms and are significantly restricted in their quality of life in everyday life and work.
The economic significance due to absenteeism, productivity losses, and reduced performance for this disease has been documented by data.3
Treatment of endometriosis
Since the cause of endometriosis is not clear, causal therapy is not possible.4
Depending on the severity of the disease, there are various options to temporarily or permanently relieve the pain. Since endometriosis is a chronic disease, a concept for long-term treatment must be developed with the gynecologist.
Pain therapy
For treatment, pain relievers, hormone preparations such as the pill or pure progesterone are recommended. A hormone spiral can also provide relief in some cases. Depending on the severity of the disease, an operation followed by hormone treatment may also be necessary.
Lately, however, many women are also looking for suitable alternatives to avoid long-term pain therapy with drugs or hormone treatment. These include methods of integrative medicine, traditional Chinese medicine, acupuncture, nutrition, to name a few. These methods are so diverse that they will be explained in detail in a further blog.
Pain relief through TENS devices
Another method is the treatment of chronic menstrual pain with a TENS device. This allows for continuous pain reduction, so that in many cases either pain relievers can be dispensed with or their use can be significantly reduced. Please note that the TENS device is intended only for pain relief and not as a treatment for endometriosis. An accurate diagnosis and professional treatment by a doctor are essential.
A special topic in this context is endometriosis and pregnancy. More on this will appear in a blog soon.
The goal of this blog is to recognize endometriosis as a chronic disease, to diagnose it correctly, and to treat it adequately. The goal of all endometriosis therapies is to reduce severe menstrual pain, alleviate accompanying symptoms or ideally eliminate them, and above all to avoid the consequences of untreated endometriosis.
Sources
1 Detailed diagnosis data of hospital patients
2 Data structure 2017, Destatis, as of 27.11.2018 (table)
3 Soliman et.al. The direct and indirect costs associated with endometriosis; a systematic lit. Review. Human reproduction (Oxford,England) 2016; 31:712-722
4 Guideline Endometriosis, Class S2k, as of August 2020