Endometriosis is a disease that is characterised by the endometrium situating itself in other places within the organism than normal. The endometrium is the ‘skin’ that normally lines the uterus, and where usually the already fertilised embryo should become implanted to generate a pregnancy. In patients suffering from endometriosis, this lining can appear practically anywhere, although most commonly this is in the pelvic region, and above all, in the area of tubes and ovaries.
What is the problem with endometriosis?
Very frequently, patients suffer period pains. However, not all patients suffer these pains and the majority of patients with painful periods do not suffer from endometriosis. Likewise, there may be problems to achieve pregnancy, although many women with endometriosis achieve normal pregnancy without any problems.
How is endometriosis treated?
Endometriosis is a disease that normally evolves through ‘outbreaks’. This means there are moments of high activity when the lesions advance rapidly and moments of low activity, when the lesions do not progress. So far, there is no cure for endometriosis. The aim of the treatments however, is to make sure the disease is inactive most of the time.
Is surgery always needed?
On ovarian level, the endometrium implants usually provoke cysts with a very typical aspect on the ultrasound and a consistency like that of ‘chocolate’. Historically, these cysts were surgically removed almost systematically. Nowadays, the idea is that those cysts should be removed only if they are very large or growing fast, to preserve the rest of the healthy ovarian tissue, or to guarantee a correct diagnosis. In general it is known that where possible, surgery should be avoided because the intervention could damage the healthy ovarian tissue even further.
How does endometriosis affect fertility?
With this disease, the same as when the normal endometrium bleeds when menstruation appears, this also happens with endometriosis implants. These little haemorrhages cause quite some pain in patients during menstruation, as well as some tissues adhering to others. This way, with the tubes getting stuck to other organs like the intestines, the uterus or ovaries, these cannot function properly and capture the egg cell when the patient ovulates. This is one of the factors that complicates gestation in some patients suffering from endometriosis. But apart from that, the endometriosis implants in the area of the tubes may destroy them, which complicates the correct functioning even further. On ovarian level, unfortunately endometriosis does not only affect ‘what can be seen’. Sometimes, ‘what cannot be seen’ is worse. Endometriosis may cause an immunological lesion in the ovaries that affects the amount and above all, the quality of the egg cells more or less depending on the case.