What is endometriosis?

Endometriosis is a disease that affects women of reproductive age and the cause of which has not been fully understood. It takes its name from the word endometrium, which is the tissue that develops and sheds during menstruation each month and covers the inside of the uterus. In endometriosis, endometrium-like tissue is found in other parts of the body outside of the uterus. Endometrial tissue develops in these areas outside the uterus. These growths can cause pain, infertility and other problems.

The most common sites of endometrial growths in the abdomen are the ovaries, uterine tubes, ligaments of the uterus, the outer surface of the uterus and the peritoneum. Sometimes these growths can be found in the incision site of operations performed on the abdomen, intestines, bladder, vagina, cervix and vulva. Endometrial growths can be found in the lungs, arms, hips and other localizations outside the abdomen, but they are not common. Endometrial growths are not usually cancerous tissues. It is the presence of a normal tissue outside of the places where it should be present. Just like inside the uterus, endometrial growths respond to menstrual hormones. Each month the tissue grows, sheds and causes bleeding.

Unlike the normal tissue that lines the inside of the uterus, endometrial tissue outside the uterus has no route to leave the body. As a result, bleeding into the abdomen, changes in the properties of tissue and blood developed as a result of growth, changes in the surrounding areas, and hard connective tissue develop. Other complications depend on the localization of the growths. The growths may burst (endometriosis may spread to new areas), and if the growths are in or near the intestines, adhesions may develop, bleeding or obstruction may occur, and if on the bladder, it may interfere with urinary function or cause other problems.

What are the symptoms of endometriosis?

The most common symptoms of endometriosis are pain before and during menstruation (often more severe than normal cramps), pain during or after sexual activity, infertility, and excessive or irregular bleeding. Other symptoms are fatigue, painful bowel movements, periodic lower abdominal pain, diarrhea and/or constipation, and other bowel disorders. Some women with endometriosis have no symptoms. Infertility is seen in 30-40% of women with endometriosis and it occurs due to the progression of the disease.

The severity of the pain is not related to the volume or size of the growths. If the small growths are overactive in the production of a substance called prostaglandin, symptoms may develop severely. Prostaglandins are substances produced by the body that have various functions and are thought to be the cause of the symptoms in endometriosis.

Theories about the occurrence of endometriosis

The cause of endometriosis is unknown. Although many theories have been put forward, none seem to explain all cases.

As a result of the backward flow of menstrual bleeding, the settlement of endometrial tissue in the abdomen, the spread of endometrial tissue from the uterus to other parts of the body via lymph or blood, and the transmission in the genes of some families are possible causes.

How is endometriosis diagnosed?

Before the invention of laparoscopy, the diagnosis of endometriosis could not be made definitively. Laparoscopy also determines the location, volume, and size of the growths, gives more information to the doctor and patient, and makes long-term decisions for pregnancy and treatment.

How is endometriosis treated?

Treatment for endometriosis has changed over the years, but no definitive treatment has yet been found. Hysterectomy (removal of the uterus) and removal of the ovaries may be considered as definitive treatment.

Painkillers are often prescribed for endometriosis pain. Treatment with hormones aims to stop ovulation for as long as possible and sometimes puts endometriosis in remission during treatment and for months or even years after treatment. Hormonal therapy includes birth control pills, progesterone hormone derivatives, testosterone derivatives (Danazol), and GnRH agonists. For some women, the side effects of hormonal therapy can be problematic.

Women with endometriosis are often advised not to delay pregnancy, as pregnancy often provides temporary remission and it is believed that the disease results in infertility in the long term.

However, there are numerous problems with achieving pregnancy in the treatment of endometriosis. The person may not have made the decision about "having a child", which is one of the most important decisions in her life. She may not have the elements (partner, financial livelihood, etc.) that are important for having and raising children.

Other factors can make the pregnancy process more difficult. The rate of ectopic pregnancy and miscarriage is increased in women with endometriosis, and one study found that they have a more difficult pregnancy process and delivery. This study also demonstrated familial transmission and linkage in endometriosis. Children of women with endometriosis have an increased risk of endometriosis and related health problems.

Organ-sparing surgery, which includes removing and destroying implants by laparotomy or laparoscopy, can be performed and in some cases relieve symptoms and allow pregnancy to occur.

Surgery with laparoscopy (called operative laparoscopy) has rapidly replaced major abdominal surgery.

Hysterectomy (removal of the uterus) which is the radical surgery, removal of all foci and ovaries (to prevent subsequent hormonal stimulation) may be necessary in some cases of chronic and severe endometriosis.

Regardless of how the treatment is done, the probability of re-activation of the disease is high until menopause. Studies in postmenopausal women are scarce, as menopause is believed to be the end of mild or moderate endometriosis.

What we have learned about endometriosis

Endometriosis is undoubtedly one of the most incomprehensible issues affecting women. As time goes on, more is learned about endometriosis, and this information dispels past predictions that have now been refuted.
It was previously reported that endometriosis was not observed in very young women. In the past, adolescent and young women had to endure dysmenorrhea silently and did not undergo pelvic examination unless the pain became unbearable.

Also, in the past, it was believed that endometriosis often affected women with higher education level. We now know that this belief was rooted in the fact that highly educated women received good medical care and were more stubborn to learn the explanation of symptoms.

Another acceptance is that endometriosis is not a serious disease since it is not a fatal disease such as cancer. However, when talking to many women with endometriosis about their daily life, even in situations that do not affect some women's lives relatively, many women suffer from severe pain and emotional stress, cannot do their normal activities on time, and experience financial and familial problems due to the disease.