Endometriosis is a condition when the nerves that form the inner lining of the uterine wall grow outside the uterus. This tissue called the endometrium can grow in the ovaries, intestines, fallopian tubes ( oviduct ), vagina or in the rectum ( the end of the intestine that is connected to the anus ). Before menstruation, the endometrium will thicken as a place for attaching fertilized eggs. If you are not pregnant, the endometrium will collapse, then out of the body as menstrual blood.
In the case of endometriosis, the endometrial tissue outside the uterus also thickens, but cannot be shed and out of the body. This condition can cause pain complaints, it can even cause infertility.
Endometriosis is divided into four levels, which depend on the location, number, size, and depth of the endometrial layer. The following are four levels of endometriosis and their characteristics:
- Minimal endometriosis. Small and superficial endometrial tissue appears in the ovary. Inflammation can also occur around the pelvic cavity.
- Mild endometriosis. There is small and shallow endometrial tissue in the ovaries and pelvic wall.
- Medium endometriosis. There are several deep endometrial tissues in the ovaries.
- Severe endometriosis. There is deep endometrial tissue in the ovaries, pelvic wall, ovary canal and intestine.
Endometriosis is thought to be associated with a breakdown of the immune system, or a reversal of menstrual blood flow. This condition is generally characterized by several symptoms, such as:
- Pain in the lower abdomen and pelvis.
- Excessive blood volume during menstruation.
- Pain when defecating or urinating.
The choice of treatment method depends on the severity and whether the patient still wants to have children. Endometriosis treatment includes:
- Provision of nonsteroidal anti-inflammatory drugs (NSAIDs).
- Hormone therapy to stop the production of the hormone estrogen.
- Surgical procedures, such as laparoscopy, laparotomy, hysterectomy.
The main symptoms of endometriosis are severe pain in the lower abdomen and around the pelvis, which is associated with menstruation. Although in general women will experience menstrual pain, but pain in women with endometriosis feels much more severe, and can increase over time.
Other symptoms of endometriosis include:
- Abdominal cramps, one to two weeks during menstruation
- Excessive blood volume during menstruation
- Pain in the lower back during menstruation
- Bleeding outside the menstrual cycle
- Pain when defecating or urinating
- Diarrhea, bloating, nausea, constipation, and fatigue easily during menstruation
Note that the severity of pain does not indicate the severity of endometriosis. Some women who experience mild endometriosis can experience severe pain. Conversely, women with severe endometriosis can feel little or no pain at all.
Causes of Endometriosis
Not yet known what causes endometriosis. However, experts suspect endometriosis is triggered by the following conditions:
- Retrograde menstruation . Retrograde menstruation is a condition in which menstrual blood flow reverses. In this condition, menstrual blood does not flow outside the body through the vagina, but into the pelvic cavity through the fallopian tube (ovarian duct). Endometrial cells in menstrual blood will stick to the pelvic wall and the surface of the pelvic organs. These cells will then continue to grow, thicken, and cause bleeding during the menstrual cycle.
- G immune system approvals. There is a suspicion that there is a failure of the immune system, so it cannot destroy endometrial cells that erroneously grow outside the uterus.
- Immature cell changes. These immature cells can turn into endometrial cells, one of which is influenced by the hormone estrogen.
- Changes in peritonium cells. Peritonium cells are cells that line the inside of the stomach. Allegedly peritonium cells can turn into endometrial cells when affected by hormones or the immune system.
- Transfer of endometrial cells . Endometrial cells can move to other parts of the body through the blood or lymphatic system.
- Surgical procedure. Caesarean section and hysterectomy can cause endometrial cells to stick to the area of the incision.
Risk Factors for Endometriosis
Experts believe that there are several factors that can increase a woman's risk of endometriosis. Among others are:
- Aged 25-40 years old
- A history of endometriosis in a mother, aunt or sister
- Never give birth
- Experiencing uterine abnormalities
- Suffering from certain conditions that can block the menstrual blood line
- Eating alcoholic beverages
- Start menstruation at a too young age
- Short menstrual cycles, for example less than 27 days
- Having menopause at an older age than normal.
Diagnosis and Treatment of Endometriosis
The doctor can suspect the patient has endometriosis if there are a number of symptoms described earlier. But to make sure, the doctor will do a laparoscopy . In laparoscopy, the doctor will give general anesthesia or half the body to the patient, then make a few small incisions around the navel area.
Next, the doctor will insert a small tube equipped with a camera (laparoscope) to see the inside of the patient's stomach. Through laparoscopy, the doctor can take tissue samples (biopsies) to be examined in the laboratory.
Laparoscopy is the only method used to diagnose endometriosis. In addition to diagnosing, laparoscopy can also be used as a method of treatment.
Endometriosis treatment aims to reduce symptoms, slow the growth of endometrial tissue outside the uterus, increase fertility, and prevent endometriosis from recurring. Treatment methods include drug administration, hormone therapy, and surgical procedures, depending on the severity of the symptoms and whether there is still a desire to have offspring.
The doctor will provide painkillers to reduce pain symptoms in endometriosis, namely nonsteroidal anti-inflammatory drugs (NSAIDs) , such as diclofenac or ibuprofen.
Hormone therapy aims to slow the growth of endometriosis tissue, by limiting or stopping the production of the hormone estrogen. However, hormone therapy cannot increase fertility and prevent complications such as adhesion or adhesions.
Hormone therapy used to treat endometriosis includes:
- Hormonal contraception. Birth control pills , implantable birth control, injectable birth control, or spiral (IUD) can inhibit the process of thickening endometrial tissue to stop menstruation, so that pain can be felt to decrease.
- Aromatase inhibitors. For example, Anastrozole, Exemestane, and Letrozole, function to reduce levels of the hormone estrogen in the body.
- Gonadotropin releasing hormone analogue (Gn-RH) . This drug triggers a condition that resembles menopause, by inhibiting the production of the hormone estrogen. As a result, menstruation stops and the size of endometriosis will shrink.
- Progestogens . Progestogens are synthetic hormones that resemble progesterone. This drug prevents the ovulation process, which is the discharge of the egg from the ovary to the fallopian tube, thereby triggering shrinkage of endometriosis. One example of a drug containing synthetic progesterone is norethisterone .
- Danazol . It is a drug that resembles testosterone, and works by reducing the production of hormones produced by the ovaries, namely estrogen and progesterone, so as to manifest a similar condition of menopause.
Surgery will be performed if the above method is not effective in treating endometriosis. A number of procedures for treating endometriosis are:
In endometriosis patients who still want to have offspring but feel severe pain, the doctor will recommend a laparoscopic procedure or keyhole surgery. Through laparoscopy, doctors can remove endometriosis tissue, and can also burn the tissue using a laser or electric current.
Laparotomy is performed if endometriosis is very severe and the size is large enough. This procedure is done by making a wide incision in the abdominal area, so that the doctor can access the affected organs and remove endometriosis tissue.
Hysterectomy is the operation of removal of the uterus, cervix, and both ovaries. Removal of the ovary will trigger early menopause. However, hysterectomy also does not guarantee that endometriosis will not recur.
Note that this procedure is only done as a last resort. This is because patients who undergo hysterectomy cannot get pregnant again, and have a higher risk of suffering from heart and blood vessel disease. Therefore, consult with your obstetrician before deciding to undergo a hysterectomy.
Endometriosis which is left to develop untreated can cause several complications, such as:
- Fertility disorders or infertility
Endometriosis can cover the fallopian tube, preventing the egg from meeting sperm. In rare cases, this disease can damage the egg and sperm.
A third to half of people with endometriosis are known to suffer from fertility disorders. However, women with mild to moderate endometriosis are still likely to get pregnant. Doctors will advise patients not to delay having children, before their condition becomes more serious.
- Ovarian cancer
Several studies show that the risk of ovarian cancer (ovary) is slightly increased in patients with endometriosis. In addition to ovarian cancer, women with a history of endometriosis are also at risk of developing endometrial cancer, although it is very rare.
Endometriosis tissue can make a number of body organs stick together. For example, the bladder and intestines can attach to the uterus.
- Ovarian cysts
Ovarian cysts are fluid-filled bags that grow in the ovary. This condition occurs when endometriosis tissue is located inside or near the ovary. In some cases, the cyst can enlarge and cause severe pain.