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What is it about ?
The inside of the uterus is lined with a lining, called the endometrium. Under the influence of estrogen, a type of female hormone, this lining develops during the menstrual cycle. She thus prepares for implantation of the fertilized egg for a possible pregnancy. In the absence of pregnancy, estrogen production decreases, and the mucous membrane is shed during menstruation. This cycle repeats as long as the woman is fertile, and it stops at menopause.
Endometriosis is the presence of endometrial cells elsewhere than in the uterus. They can be present on the peritoneum, in the belly between the vagina and the rectum, in the bladder, the intestine or the ovaries. These foci of cells, under the influence of estrogen, follow the same cycle as the uterus. These foci become thicker and can cause (small) bleeding every month. They disappear at menopause.
The cause of endometriosis is not known. We do not know if the endometrial cells originate from the uterus and end up in the womb via the fallopian tubes, or if cells in the womb change into mucous cells under the influence of hormones, or if it is rather a problem related to a weakened immune system.
Where and how often?
Endometriosis affects 1 in 10 women of childbearing age. Among women who have infertility problems, it is found in 1 in 2 women.
The risk of endometriosis is 7 times higher when a family member has it.
How to recognize it?
The two main symptoms are stomach pain and difficulty getting pregnant.
The most common symptom is pain, usually in the pelvis, sometimes severe. The pain is sometimes continuous, but usually it only occurs at certain times, for example during the days before menstruation and during menstruation, during sex, when passing urine and having a bowel movement. There may be blood in the urine or stool.
Women with endometriosis can get pregnant naturally, but in 1 in 3 cases this does not work without treatment. This is often the reason why they see the doctor.
Among women with endometriosis, about 1 in 3 will recover on their own, while in 2 in 3, symptoms remain stable or worsen. In most women with endometriosis, the complaints go away after menopause.
How is the diagnosis made?
The doctor thinks of endometriosis in view of the nature of the symptoms. The disease usually cannot not be diagnosed from a simple pelvic examination. That is why the doctor will always send you to the hospital for an ultrasound and an endoscopic examination of the belly (laparoscopy).
What can you do ?
Often the pain can be relieved with paracetamol or an anti-inflammatory drug (for example, ibuprofen or naproxen). Local heat, such as a hot water bottle on the stomach, can provide relief.
What can the doctor do?
There are different treatments depending on the symptoms. If pain is the main problem and the usual painkillers are not enough, the doctor will consider hormone therapy. It may be a classic birth control pill, hormonal IUD, or other hormonal treatment.
Sometimes the main problem is not only the pain, but also infertility. The usual treatment is then contraindicated. Therefore, in women with endometriosis who want to become pregnant, the endometriosis foci are surgically removed during a laparoscopic operation; this procedure decreases pain and increases the chances of pregnancy.
If the symptoms reappear after the procedure, the doctor may consider hormonal treatment after this procedure. If pregnancy does not occur despite these treatments, artificial fertilization will often be necessary.
Pregnancy relieves symptoms, and in some cases, they even go away completely after childbirth.
Want to know more?
- Ultrasound here Where to find on this page of Saint-Luc University Clinics (UCLouvain)
- Laparoscopy – Erasme Hospital
- Paracetamol – CBIP – Belgian Center for Pharmacotherapeutic Information
- Non-steroidal anti-inflammatory drugs – CBIP – Belgian Center for Pharmacotherapeutic Information
- Ibuprofen – CBIP – Belgian Center for Pharmacotherapeutic Information
- Naproxen – CBIP – Belgian Center for Pharmacotherapeutic Information
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