endometriosis

21 October 2017

© Jupiter Images / iStockphoto

Endometriosis occurs when tissue is resembling the uterine lining (endometrium) outside the inner cavity of the womb locates and rampant there - for example in the deeper layers of the wall of the uterus or completely outside the uterus in other organs. Pain occurs then especially during menstruation. 

Depending on where the displaced endometrium is located, the following forms of endometriosis can be distinguished:

Basically, endometriosis can occur in all organs. Most often, however it concerns the organs in the pelvis close to the uterus (such as the fallopian tubes and ovaries). They can be located in a peritoneal cavity between the gut and the back of the uterus (Douglas space).

Facts about Endometriosis

If uterine lining (endometrium) outside the inner cavity of the womb occurs is that as endometriosis designated.

If endometriosis symptoms prepares, these are the Hormone cycle of women depending on: the hormone cycle controls the innermost layer of the uterus, the endometrium (endometrial), and repeats approximately every 28 days. During this period, the uterine lining builds up under the influence of female hormones (such as estrogen and progesterone), so that in case of pregnancy can settle the fertilized egg in it.

If after ovulation (ovulation) there is no fertilization of the egg, the menstrual period begins and ensures that the endometrium is shed. Next, the structure of the uterine lining begins in a new cycle.

Since the displaced tissue the hormone cycle of women as well as the subject "normal" Endometrium, endometriosis can be particularly associated with menstrual discomfort. Accordingly, making the endometriosis during pregnancy and after the onset of menopause with little or no more noticeable - so if no menstruation occurs.

The exact endometriosis incidence is unknown because many of the affected women are asymptomatic. Nevertheless, the endometriosis is considered one of the most common diseases of women: In Germany fall ill each year an estimated 40,000 new cases of it. The likelihood of developing endometriosis increases with age until the onset of menopause and then falls rapidly.

Often these symptoms occur in endometriosis:

The symptoms are caused by endometriosis linked to the hormonal cycle of women, because the displaced endometrium in endometriosis as the normal endometrium responds to the hormones in the blood. So she takes part in the menstrual cycle. This means:

How strong the symptoms caused by endometriosis are not necessarily indicated on the extent endometriosis out: About half of all women with endometriosis free from typical complaints. What symptoms occur with endometriosis depends primarily where the endometrial implants are. In some cases, endometriosis also trigger any particular complaints and so remain for a lifetime unnoticed.

The exact processes that lead to the development of endometriosis, but are so far unknown.

Woman holding on for endometriosis the lower abdomen, the place is tor highlighted. © iStock

Endometriosis causes pain in the lower abdomen.

To diagnosis endometriosis, it may take a while - even if a woman has symptoms and therefore early medical visits. The symptoms can vary widely from case to case and are very characteristic. 

The first step in diagnosis is made in a detailed talk on the complaints. This is followed by a thorough gynecological check: The physician can detect endometriosis lesions in the vagina and on the cervix may. Imaging techniques as an ultrasound (sonography) or computed tomography (CT) are rarely used in the endometriosis diagnosis.

That it is endometriosis, only one Laparoscopy (laparoscopy) show: For this, the doctor takes two small incisions in the abdominal wall before: by a cut he pushes a small camera with a lamp, by the other he leads a means by which it can directly remove tissue. Then the doctor can not only view the changes, but take tissue samples simultaneously in order to subsequently evaluate microscopically (so-called. Biopsy).

endometriosis does not always a necessary therapy: When endometriosis causes no symptoms, no treatment should be necessary. Whether a therapy in an individual case makes sense and what measures are most appropriate depends on the following factors:

What treatment comes in endometriosis question every woman must decide individually on their complaints dependent. To relieve pain and cramping, there are drugs and hormones. The latter, however, are not suitable when a child desire. Also, an operation in which the excess tissue is removed, is possible. In some cases, both treatment approaches are combined.

Some women also take individual action against complaints Endometriosis: You can, for example, change their diet, ensure regular exercise and reduce stress (for example, through relaxation exercises). While such measures do not show as analgesic endometriosis therapy in all women effect. they can not usually damage.

Which surgical technique is best suited for the operational endometriosis treatment depends on how big the endometrial implants are and where they are located. Endometriosis, which are accessible via the vagina, the surgeon can directly cut out (so-called. Excision). Smaller herd within the abdominal cavity to be removed or during a laparoscopy (laparoscopy) with the laser electrosurgically deserted.

Shows the endometriosis widespread or unfavorably situated herd, is a major operation with a laparotomy necessary. In this case and in the absence or already-satisfied desire for children, it may be wise to remove the ovaries completely to stop the hormonal cycle and the associated symptoms of endometriosis.

Remains within the framework of endometriosis, a desired pregnancy for an operation may increase the chances of pregnancy.

For endometriosis therapy are also drugs to disposal. Drug endometriosis treatment, in addition to surgery or alone are used - depending on the extent of the disease and target treatment. To relieve pain in the short term, are suitable for low-grade endometriosis Painkiller. The cause of the complaints, however, this does not disappear.

If until now could not be met because of endometriosis of the Infertility is a Hormone therapy not suitable to solve the problem: Rather is eligible laparoscopy, in which the endometrial implants are completely removed. However, a additional drug endometriosis treatment after surgery be useful to support its action. Are of the endometriosis neither ovaries nor ectopic concerned, it is not certain whether fertility is at all affected by the flock elsewhere.

Endometriosis Therapy by hormone preparations aims to block the hormonal cycle: This causes the endometrial implants rasked uhig become. Suitable for this drug endometriosis treatment are estrogen-progestin combinations, different progestins or so-called GnRH agonists such as goserelin. Thus the hormone treatment of endometriosis long-term effect achieved, it is necessary medications three to six months long take. Different side effects can occur:

In addition, it is possible that endometriosis following the drug treatment recurs.

The course of endometriosis very individual and depends on many factors, including age, location of endometrial implants or treatment measures.

If endometrial implants are and cysts in the ovaries removed by surgery, this can ease the pain. A removal of endometriosis lesions by laparoscopy also can easily have a positive effect on fertility possibly.

However, the likelihood that form after surgery again endometriosis is relatively high: Nearly four out of five operated women they occur after some time again and again can cause pain.

Endometriosis can be in the further course various complications result: The bleeding in places repeatedly occur in endometriosis, in which the blood can flow only with difficulty, irritate the surrounding tissue. The result can Adhesions and scarring Be that result in severe pain and interfere with organ function. If the fallopian tubes affected by endometriosis, so there arise, for example bloody cysts that, after the color of the deposited blood chocolate cysts lists. They can lead in the fallopian tubes by scarring processes to narrowing (stenosis).

A common complication of endometriosis is the infertility. One possible reason for this is that by the endometriosis in the key for getting pregnant organs - leads to adhesions and scarring - as fallopian tubes and ovaries.

Exists due to endometriosis infertility, it may make sense to have remove the endometriosis by laparoscopy: In studies, there is evidence that this increases the chance of a spontaneous pregnancy.

It is not known whether endometriosis ever take an effect on fertility when they are away from ovaries or fallopian tubes. A surgical procedure to remove endometriosis lesions on the ovaries, the probability of getting pregnant, but probably increase.

If one successfully treated endometriosis in the course occurs again (that is, when a recurrence forms), but artificial insemination can (for example, an In Vitro Fertilization) having children usually meet rather than a (further) operation.

A young woman is thinking about having (symbolized by a thought bubble) a baby. © iStock

Endometriosis does not preclude a desire for children.

Especially in a treated only with medication endometriosis often leads to a relapse. Safe protection against a recurrent endometriosis history offers only the complete removal of the ovaries. Even with the onset of menopause endometriosis does not occur again because the monthly menstrual periods stop.

Endometriosis can Not prevent, as the causes of its origin is unknown. Accordingly, there is no treatment or measures that can prevent endometriosis occurs.

Endometriosis Association Germany e.V.Informationen for endometriosis with addresses of support groups


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