Endometriosis mainly affects women of child-bearing age, and unfortunately, from several points of view it is still not fully cleared in nature.
The endometrium is the inner layer of the cavity of the womb, which will gradually thicken during menstrual cycle, then detach during menstruation (period). In endometriosis, such endometrium is found in other parts of the body, outside the womb. Abnormally located endometrium islands may lead to lower abdominal pains, infertility and other problems.
Theoretically, they may occur in any part of the body, however, there are some places in the abdominal cavity where they are really frequent. These include the pelvic peritoneum, ovaries, Fallopian tubes, the outer surface of the womb or the muscular layer of the womb, and the deepest point of the abdominal cavity (Douglas pouch). They are less frequent in the urinary bladder, on the bowels, in the navel, or on the external genitals. Really exceptionally, such endometrial islands may occur outside the abdominal cavity.
The essence of endometriosis is that an otherwise normal tissue is found in an abnormal location. These endometrial islands react to hormonal changes in the female body the same way as normally located endometrium. Approaching period, they will enlarge, bleeding may occur in them resulting in variable sized cysts. Sometimes these cysts may rupture, their contents spill over the abdominal cavity. This way, endometriosis will spread, and the contents of the cysts will result in adhesions between surrounding organs leading to several problems.
There are several possible explanation for the development of endometriosis, but one thing is sure that an excessive estrogen effect always exists. In addition, psychic (psychosomatic) factors and other gynecological/endocrinological hormones should also not be disregarded.
What are the likely symptoms?
The most frequent symptom of endometriosis is painful/crampy period. Lower abdominal pain/cramp may be especially strong immediately prior to, and during period, and pain may also occur during sexual intercourse.
Bleeding disorder and infertility are also freqent. However, it is important to know that endometriosis does not necessarily mean infertility. The relation of the two conditions is much more complex. Infertility is a problem in 30-40% of women with endometriosis, however, childlessness may have several other causes.
Additional symptoms are affected by the localisation of endometrial islands: lesiosn near to bowels may lead to bowel dysfunction, obstipation, or bloody stool, for example. In general, symptoms are characterized by a correlation with menstrual cycle: they are stronger during and immediately prior to the period. The degree of pain is not necessarily proportional to the extent of endometriosis. Sometimes a really tiny lesion leads to severe complaints, in other cases the patient is completely complaint-free even with significant endometriosis.
Treatment of endometriosis
Currently, most physicians apply pharmaceutical and surgical therapy for problems caused by hormonal alterations. Pharmaceutical therapy includes pain killers, spasmolytics, and various synthetic hormone products. Unfortunately, pharmaceutical treatment may have really severe side effects, and contraceptive pills provide only temporary, practically “false solution”, as they will only suppress symptoms and not solve the problem. In addition, most contraceptive pills show an estrogen dominance, and even worsen the problem in the depth, and after discontinuation symptoms will immediately exponentially return.
Administering synthetic pharmaceutical progesterone would be a good direction theoretically, however, it cannot provide permanent hormonal balance as it is not able to enter the body and help to excrete excess estrogen from the body, therefore, it is not suitable for a causal therapy of the basic condition.
The essence of surgical therapy is removal of abnormal areas. In many cases, this will not involve major surgery with abdominal incision any more, and may be performed by laparoscopy. In more severe or complicated cases, abdominal surgery is the choice. In addition to usual surgical complications, surgery does have the disadvantage that on one hand not all endometriosis islands may be accessed (e.g. islands lurking under the peritoneum), on the other hand endometriotic mucosa attached to the urinary bladder and bowel wall cannot be burnt due to risk of perforation of urinary bladder or bowel wall. Of course there are cases when surgery is inevitable in case of a chocolate cyst or bowel wall involvement, for example, but hormonal evaluation is always essential. Because surgery resolves only the consequence of the hormonal disorder (i.e. endometrosis) rather than the cause of it, the disease will recur without restoring the hormone system.
Endometriosis is a consequence of hormonal change!
IN EVERY CASE COMPLETE HORMONAL EVALUATION IS REQUIRED AND CAUSES OF THE DISORDER SHOULD BE TREATED!
Prior to applied therapy, determination of progesterone/estrogen rate and, depending on the result, further gynecological and endocrinological hormone evaluation is elemental. The time point of hormone evaluation depends on the cycle of the given person, and it will never be determined based on the reference range seen on the laboratory report, whether a hormone normal or abnormal is, we always have to look at their proportion and the influence upon each other.
You may receive information about these methods and application possibilities in person – based on previous appointment (+36 70/23 89 689).