Endometriosis is a fairly common condition especially in women over 30 who have not had children yet , in which cells from the endometrium (the inside of the uterus) grow elsewhere in the body, usually around the uterus, the ovaries, the fallopian tubes. Endometriosis affects 1 in 10 women, especially during their childbearing age, and is one of the main causes of infertility.
What is the cause of endometriosis?
There are over ten theories about the etiology of endometriosis while none of these have been proven. The two most prevalent are either the theory of retrograde blood flow from the fallopian tubes during the period or the theory of the transfer of the foci via the lymphatic pathway.
Endometriosis has been staged in 4 categories (I-IV minimal to severe) depending on the location, extent and depth of the foci, the presence and severity of adhesions and the presence of cysts in the ovaries (chocolate cysts – endometriomas).
How do I know if I have endometriosis?
Symptoms of endometriosis include dysmenorrhea (painful periods), dyspareunia (pain during intercourse), and blood spots before the period or bleeding during the period. Several of the women who have endometriosis may have absolutely no symptoms other than infertility. Endometriosis is also detected during surgery for another reason, e.g. to remove a cyst from the ovary, or during an ultrasound.
If you experience these symptoms and you also have difficulty getting conceiving, you should see your gynecologist.
Treatment of endometriosis
Laparoscopy is the only official treatment for endometriosis. It is an invasive surgical operation in which the surgeon looks into the abdominal cavity through a small incision in the navel. Diagnosis is made via laparoscopy and treatment of endometriosis as well as of other gynecological conditions such as uterine fibroids or tubal or ovarian problems
Laparoscopy may be the only treatment needed in cases of endometriosis because it improves natural fertility on the one hand and increases the success rate of assisted reproduction and IVF treatments.
Endometriosis and fertility
The relationship between endometriosis and fertility is often contradictory. Endometriosis is the most common and most important cause of infertility in women, so one in two women with infertility problems is diagnosed with endometriosis. Instead, it is not necessary for a woman suffering from endometriosis to face infertility, especially if she has had her children at an early age.
Endometriosis causes infertility in many ways:
- it has a toxic effect on the egg reserves in the ovaries and leads to premature ovarian failure (it is the first cause of premature menopause),
- affects the implantation of the embryo into the endometrium through immune system substances,
- causes adhesions and occlusion in the fallopian tubes.
Endometriosis often presents no symptoms or imaging findings and its diagnosis is made when a woman is being examined for infertility or for having a poor response to IVF. If a woman becomes pregnant it has no effect on the pregnancy or the embryo.
It is necessary to surgically remove the foci of endometriosis, adhesions and endometriomas in the ovary when infertility is established, because this increases the probability of pregnancy. Surgical operations increase fertility by 40% for up to two years after surgery.
If endometriosis is extensive, post-surgical treatment is likely to be followed by a supplementary medication (Arvecap, Daronda, etc.) that is intended to temporarily suppress the woman’s cycle for 3-6 months.
Contraceptives have no place when endometriosis causes infertility and the couple are trying to conceive a child, as they do not improve fertility but only dysmenorrhea. It is therefore erroneous to be administered, especially to women over 35 years trying to have a child.
In women over 35 years of age with endometriosis, whose fertility is reduced anyway, we need to apply aggressive assisted reproduction strategies and immediately have them undergo IVF before they experience premature ovarian failure.
Ινομυώματα και γονιμότητα
Τα ινομυώματα είναι από τους συχνότερους καλοήθεις όγκους της μήτρας που αναπτύσσονται γύρω και μέσα στη μήτρα. Το 30% των γυναικών έχουν τουλάχιστον ένα ινομύωμα. Τα ινομυώματα πολύ σπάνια εξελίσσονται σε κακοήθεια και δεν είναι επιβλαβή για την υγεία της γυναίκας.
Τα ινομυώματα μπορεί να επηρεάσουν τη γονιμότητα της γυναίκας αναλόγως με τη θέση τους στη μήτρα. Αν το ινομύωμα βρίσκεται στο εσωτερικό της μήτρας (υποβλεννογόνια ινομυώματα), η γονιμότητα επηρεάζεται και συνιστούμε αφαίρεση. Ωστόσο, εάν το ινομύωμα δεν επηρεάζει την κοιλότητα της μήτρας έχει πολύ μικρότερη επίδραση στη γονιμότητά της και πιθανώς δεν θα γίνει σύσταση για αφαίρεση.
Πώς αντιμετωπίζονται τα ινομυώματα;
Τα ινομυώματα αφαιρούνται χειρουργικά είτε με λαπαροσκόπηση ή με υστεροσκόπηση.