English
Ελληνικα
When the tissue lining of the endometrium, that is the inner lining of the uterus that causes a woman’s period, migrates outside the uterus, endometriosis occurs.
What causes Endometriosis?
There are disagreements concerning the initial cause of this disorder. It is known that, in almost all women, during menstruation there are cells that “fall” from the endometrium into the lower abdomen. However, this is a very common symptom, in contrast to the small number of women who suffer from endometriosis, so there must other factors that are involved (e.g., immunological and genetic factors).
What problems does Endometriosis cause?
Endometriosis is related to fertility disorders, pain during menstruation and, occasionally, a small amount of blood before the woman gets her period. This pain may lead to accompanying symptoms such as migraines, chronic fatigue syndrome, irritable bowel, constrictions of the pelvic floor and recurrent cystitis. Involvement of the ovaries in endometriosis leads to the formation of a chocolate or endometriotic cyst.
Why is Endometriosis painful?
Some women suffer from mild or severe endometriosis without pelvic pain. However, endometriosis in itself is a factor that causes pain via several mechanisms. It creates inflammation and may result to scarring and neuralgia (nerve pain). As a result, the brain constantly, or only during menstruation, receives pain signals.
Which is the best therapeutic approach?
As mentioned, many women who are affected by endometriosis are not in pain. Thus, no analgesic therapy is necessary. However, when the patient suffers from chronic painful endometriosis, analgesic and symptomatic therapy go hand-in-hand.
Therapy may involve drugs or surgery. Most commonly, a combination of the two is required. We may use contraceptive pills, gonadotrophin agonists, progesterone, or danazole. These are anti-inflammatory drugs that reduce regional oestrogen action and, thus, alleviate the related pain. What is more, they act as sedatives on oestrogen receptors of the spinal cord. This explains why these therapeutic approaches inhibit pain of different causes, besides that of endometriosis.
Use of all these drugs (which often come with severe side-effects), inhibits the disorder without treating it; nevertheless, the pain is alleviated. Often, when fertility is not the issue, this is sufficient.
There is a drug category, called aromatase inhibitors, which are used to treat breast and ovarian cancer. These block the production and action of oestrogens. Studies have shown that aromatase inhibitors reduce the total anatomical volume of endometriosis. This is important because, often, the reason for intense pain is the anatomical deformity of the area caused by the disorder.
Surgical management of Endometriosis
This is often carried out by surgical removal of every prominent site of endometriosis found in the ovaries, the cul-de-sac (a space behind the cervix) or any other organ that seems to be involved and is detected during the surgical procedure. Our aim is to remove endometriosis in order to restore fertility and treat the pain.
