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Endometriosis

 

A hidden illness

A common illness among women, in which the uterine mucous membrane—the inner lining of the uterus—grows outside of the cervix and causes cysts and/or scarring. There are various theories why the uterine lining ‘migrates’ and causes damage. Often, ‘retrograde menstruation’ occurs—a portion of the menstrual blood does not exit the body via the vagina, but rather flows backwards through the Fallopian tubes into the abdominal cavity. This is a normal phenomenon; it is also normal that live mucous membrane cells are found in the blood.

 

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It is not normal, however, if these mucous membrane cells migrate, reproduce, and participate in the woman’s menstrual cycle. If this occurs, waste products which cannot exit the body are formed during the next cycle. These waste products cause a sort of inflammatory reaction in the body, resulting in increased blood flow, pain, and scarring.

 

Red and brown endometriosis lesions at a typical location on the posterior round ligaments. This results in internal bleeding during menstruation and scarring of the peritoneum.

 

 

 

It is estimated that 10 to 15 percent of all women suffer from endometriosis. The extent of endometriosis is not parallel to the symptoms—some women don’t perceive their endometriosis at all, while others experience intense pain or struggle to conceive children.

 

 

Symptoms of endometriosis

  • increased pain before and during menstruation

  • Pain during sexual intercourse, in particular, painful areas deep within the woman’s pelvis (not to be confused with pain when a partner penetrates you, which is generally associated with cramping or insufficient lubrication))

  • Infertility (sub-fertility/sterility). Endometriosis can close off the Fallopian tubes, cause ovarian cysts (which inhibit ovulation), and disrupt the chemical environment in the woman’s lesser pelvis, as well as the function of the cilia in the Fallopian tubes. Some women do not become pregnant because they have sexual intercourse infrequently due to a fear of pain. See the chapter on Fertility for more information.

 

Close-up of a typical deep endometriosis lesion behind the left ovary. Easily visible growths of new blood vessels on all sides.

 

Klick auf Bild zeigt höhere Auflösung vor und nach Laseroperation an.

 

Additional possible symptoms of endometriosis are:

  • Feeling unwell, migraines, fever

  • Too frequent or too-heavy menstrual flow (especially if endometriosis affects the uterine muscles)

  • Blood in urine or stool during menstruation (may indicate that the bladder and intestine are affected)

  • Chronic lower abdominal pain (not based on menstruation)

 

 

Diagnosing and treating endometriosis

Endometriosis is an illness of the peritoneum. A diagnosis can only be made if the abdominal cavity is examined and samples are taken; this occurs during an abdominal endoscopy (laparoscopy) under sedation. Important: the abdominal endoscopy should be performed in an appropriately equipped hospital in order to allow you to receive a targeted, gentle laser treatment while still under sedation. During this procedure, the lesions are partially removed and sent to be examined, while the remaining lesions are vaporized.

 

Above: Advanced endometriosis (stage III) with typical chocolate cysts on the left ovary. This is clotted menstrual blood. The cyst is opened, rinsed ...

 

 

 

... and, depending on the situation, removed fully or treated using a laser. Healthy ovarian tissues heals quickly; the patient listed above conceived naturally within six weeks!

 

 

 

Follow-up treatment after laser surgery

Based on current knowledge, it is only possible to obliterate the residual endometriosis after laser surgery in a few rare cases. This is best performed with a GnRH analogue, which is given as an injection every four weeks and inhibits the function of the pituitary gland (hypophysis). This induces a state similar to menopause for two to three months. To prevent the patient from experiencing any bothersome menopausal complaints (sweats, hot flashes, vaginal dryness), she will also receive a low, constant dose of oestrogen in the form of pills or a patch (known as add back therapy). Following this ‘down regulation’, IVF treatment can begin immediately.

 

Microscopic tissue exam (histology) of an endometriosis lesion with gland hoses and stroma.

 

 

 

For young women who do not wish to have children, a special type of contraception be of benefit (e.g. continuously taking the pill or a hormonal IUD). The development of endometriosis is unpredictable. Some women are healed (often after a pregnancy), and some have numerous, painful occurrences over the course of years.

 

Patients with supplementary hospital insurance can receive laser treatment from Dr. Niklaus Lang in the Hirslanden Klinik and the Klinik im Park.