What is endometriosis and how it affects body?

Endometriosis is a disorder that affects women and typically is characterized by the presence of endometrial cells (the cells that originate from the lining of the womb or uterus outside the uterus). Endometriosis has been found in many parts of the female body not just in the pelvis and which gives the hypothesis that there are many causes of endometriosis. Endometriosis most commonly involves the ovaries, the fallopian tubes and the pelvis and causes significant distortion of the anatomy of the pelvis and in some cases that unfortunate result in subfertility. Women that experience symptoms of pelvic pain, painful intercourse and painful periods and also some irregular bleeding should be investigated for endometriosis. The problem with endometriosis is that the final diagnosis of the disorder is only possible by an invasive procedure called laparoscopy, unless of course the endometriosis is present on the outside of the pelvis in areas that can be visualized easily on inspection. I have seen women with endometriosis around the belly button and around the nipples and on other parts of the skin but that is not very common. Most of the time, endometriosis affects the pelvic organs and that’s the reason why the laparoscopy is the only way to ascertain the presence of the condition. Endometriosis can cause subfertility but there is no strong evidence to suggest that women that have endometriosis, if they undergo assisted conception, will have a poor outcome.

Let’s talk about the diagnosis at first a little bit and we’ll start with the linguistics. Endometrium, endometriosis is the uterine lining of the uterine cavity from the Greek “endos” meaning inside and “metros” is the uterus. So this is the lining or the layer of cells that have a very specific ability by reacting sensitively to the hormonal levels and the hormonal changes during the menstrual cycle. Under the influence of estrogen these cells grow, under the influence of progesterone they get an increased blood flow and eventually during menstruation they necrotize (they get washed away) and the whole process starts again. When these cells appear elsewhere in the organism and this could be in the belly, in the pelvis, in the ovaries, in the rectum, in the bladder, then they can cause problems because they still react the way we just described: they grow under the influence of estrogen, they eventually can bleed during the menstruation but there is no room actually for that blood to go and for the tissue to go. So they usually create a locus that can be painful or that can bother the patient.

I think it is the problem that it is more frequent nowadays but we also pay lots of attention. I have noticed that women with high levels of stress and in general, being in difficult situations have much higher chances to develop all these types of problems, to have a flare up of these problems because I think the flare up is the one that makes the difference. The low degree of endometriosis can be found in every woman without giving physical symptoms. The big problem with endometriosis is when the endometriosis is uncontrolled. When it is totally uncontrolled and exceeds some limits then what happens is anatomical problems, creating other imbalances in the body – this is what the biggest problem is. Mild endometriosis that we gave so much importance to in the past few years, I don’t believe that deserves so much importance. It is more an indication of how the body is moving, the immune system, and balance rather than to pay attention to mild endometriosis that they will find during the laparoscopy.

Endometriosis is a very strange disease, it happens when cells from the lining of your womb (endometrium) appear outside the womb itself and this means that every month with the period, these cells will start to bleed, and once it started to bleed inside your tummy your body will deal with it like a wound in your hand and then start to secrete some inflammatory markers, some healing tissues, fibrous tissue to heal it, leading to scars in the pelvis and the tummy. This can cause pain, affect the pelvis anatomy, has a toxic effect on the ovary and the uterus, in addition to many chronic symptoms depending on the place where it is implanted in general. The most common places for this endometriosis cells/islands are the ovaries, uterosacral ligament, tubes, between the rectum and the vagina, inside the womb muscle (adenomyosis), or even it may be on the bladder, and in 10% could travel very far to the diaphragm and the lung.

Endometriosis is actually a very enigmatic disease. We do not know yet what endometriosis is but we assume some things. What we actually see happening here is that we see that the the same glands which are at the lining of the womb otherwise so, they are also present at places other than the lining of the womb and then under the effect of hormones, they get active because they do have active receptors called estrogen and progesterone receptors. They are found to be anywhere in the body at very very odd places also sometimes which is very rare but in general, the most common place outside the lining is actually in the muscle of the womb and in the ovary so, when it is in the muscle of the womb we call it adenomyosis which is generally present in association with endometriosis. Endometriosis is actually a pelvic disease so the lining of the whole tummy that can have patches of those glands and because of that regular activity, they look like as if the blood has collected so in, for example, in the ovary there’s a cyst it looks like the blood is collected or query we do not probably know what is the origin but it is like a chocolate cyst when we actually take it out. So the most common place of the endometriosis is the ovaries or the peritoneal lining or in the muscle of the womb but it can be actually rarely seen to be present as far as long sometimes, very rarely. Endometriosis is present in 10 to 15% depending on the ethnicity and the local populations may have different numbers but roughly around that. The percentage is pretty significant and March is an endometriosis awareness month, we’re talking about that in this month, I’m glad. Symptomatologically it is mainly, it is pain during sex, pain during bleeding and pain during the passage of the stools. It is because of the scarring so, because of this activity the the organs or the tissues stick to each other and this scarred or the adhesions nature of the pelvis causes pain, especially with the movement during sex or passage of stools or during the examination by a doctor. Typically if the cervix is moved it can really be very painful and there is a very severe variety of endometriosis which is called deep infiltrating endometriosis DIE and it is a very big challenge for the surgeon definitely. The first surgery is the most important surgery because it’s a chronic illness, it’s a chronic disease so, it keeps coming back but when we do it the first time that means in the pelvis with the least amount of scarring, if we remove the low the focus of the endometriosis properly then, the repeat scaring is less but if the first surgery is not done properly or less completely then, women sometimes undergo recurrent repeated surgeries because then the healing creates more scarring and it’s like a vicious circle happening.

Endometriosis is a common gynaecological problem which happens in about 7 to 10% of the female population and it’s a condition where the lining of the womb which is made mainly of glands and stroma is present outside in the endometrial cavity or the lining of the outside the normal place, in different places and the pelvis is the communist and can be on the ovaries, on the tubes, behind the womb, it can be on the bowel and can be also in in the muscle of the womb itself and we call this condition adenomyosis. It can also be a remote place outside the pelvis which can be even in the lungs or anywhere in the body but the commonest place for the endometriosis to be is actually the pelvis and that’s why it causes problems.