How Does Endometriosis Develop?
To date, there is no complete explanation for the development of endometriosis. Several theories exist, which are explained here in detail:
According to the transplantation theory, endometrial cells are flushed backwards through the fallopian tubes into the pelvic cavity during normal menstruation, where they can settle and continue to grow. The endometriosis lesions are then most often found deep in the small pelvis, around the intestine or the fallopian tubes. Or the cells migrate into the muscle tissue of the uterus, then it is referred to as internal endometriosis. Also, during surgeries, e.g., mostly during a cesarean section, the uterine lining cells can get into the abdominal wall and continue to grow there. Another path is the dissemination of endometrial cells via blood and lymphatic vessels into more distant organs, e.g., lungs or navel. During an ultrasound in the course of a normal menstruation, blood in the small pelvis is very often found. However, why endometriosis develops in some women and not in others cannot be explained by this theory.
The metaplasia theory suggests that cells lining the abdominal cavity during embryonic development can have the ability to transform into a different type of cell, in this case, into endometrium-like cells.
According to the archimetra or Tissue Injury and Repair Theory (TIAR), the development of endometriosis is based on a disturbed function of the cell layer between the inner uterine mucous membrane layer and the muscle. During menstruation, greater shearing forces occur in the muscle, leading to micro-injuries of this layer. During the wound healing processes, stem cells are then activated. Stem cells have the property of being able to transform into any tissue cell of the body. In this case, the activated stem cells migrate into the muscle or the abdominal cavity and partially transform into cells similar to endometriosis.
Desire for Children and Endometriosis
In today's time, the desire for children is postponed further back due to changed life planning of women. The first menstruation occurs at an average age of 12.5 years in Germany. According to the Federal Statistical Office, the average age of a woman at the birth of her first child in Germany is 31.7 years. Thus, more than 20 years often pass between the first menstruation and the first pregnancy. This means, these women have already menstruated more than 200 times. The risk of developing endometriosis increases with the increasing number of menstruations. Also, the associated changes through the growth of possible existing endometriosis lesions, such as adhesions to the fallopian tubes, ovaries, and intestinal loops, increase.
Many affected women turn to a fertility clinic or center after several years of unfulfilled desire for children. During the diagnostics, a laparoscopy is often performed. In about 20-50% of cases, endometriosis is found. The possibility of becoming pregnant normally with diagnosed endometriosis can only be increased through surgery. These elaborate surgeries, which today are almost all performed laparoscopically, i.e., through a laparoscopy, at specialized centers, can dissolve adhesions, cauterize endometriosis lesions, and, if necessary, make blocked fallopian tubes permeable again. Unfortunately, medications do not help here.
Therefore, early detection of this disease is all the more important. If some symptoms in young women provide hints of endometriosis, affected women and their treating doctors should consider endometriosis and initiate appropriate therapy early on to preserve fertility. Diagnostics today are increasingly focused on a conservative, i.e., non-surgical approach. If there is a suspicion, an MRI or a targeted examination of the entire small pelvis from vaginal or rectal, as well as a targeted urological examination, can provide sufficient certainty about the diagnosis without needing surgery.
Can Endometriosis Be Treated Without Surgery?
If endometriosis is suspected early on, the only sensible treatment would be hormonal therapy. We know that each menstruation can cause these benign endometriosis lesions to grow and multiply. The hormonal treatment aims to completely suppress the regular cycle and stop progression. This is best achieved with a pure progesterone therapy or a combined contraceptive pill.
Ultimately, however, every affected woman decides for herself which therapy is right for her. For the relief of menstrual pain, which is still the leading symptom of endometriosis, hormone therapy remains the gold standard. In case of contraindications or intolerances, affected women should also be advised about alternative treatment methods such as appropriate pain medication, anti-inflammatory diet, relaxation methods for pain reduction, or especially the possibilities of TENS therapy.