Angela Ćorić for "Vijesti" about endometriosis: A common disease and an enigma for medicine

Despite the numerous knowledge about the causes, its origin and development, the possibilities of treatment, it is still unknown today... The disease most often affects women between the ages of 25 and 45, several dozen cases of endometriosis in men are also known in the world

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Chronic immunological and endocrine disease: Angela Ćorić, Photo: TV Vijesti
Chronic immunological and endocrine disease: Angela Ćorić, Photo: TV Vijesti
Disclaimer: The translations are mostly done through AI translator and might not be 100% accurate.

Endometriosis, a common and still mysterious disease for medicine, for women with this condition means that during the year they will have a large number of days when they cannot work, when they are even bedridden. And it can last, because the diagnosis is often made late.

"On average, eight to 10 years pass from the first symptoms, most often during the examination of the cause of infertility," a specialist in gynecology and obstetrics and a subspecialist in endocrinology told "Vijesti" Angela Coric.

The World Health Organization (WHO) estimates that endometriosis affects about one in 10 women during their lifetime.

"Approximately the same percentage of the global population that suffers from diabetes", announced the "Economist" at the beginning of February.

And while doctors understand why diabetes occurs and how to treat it, their understanding of endometriosis lags "30 to 40 years," the British weekly added.

In a conversation about endometriosis, the interlocutor of "Vijesti" talks about the history, symptoms that may indicate this condition, diagnosis, but also the possibilities for treatment...

What is endometriosis?

Endometriosis is a chronic immunological and endocrine disease, the basic characteristic of which is that endometrium-like tissue (uterine lining) exists and functions outside of its natural place of existence, i.e. outside the uterine cavity. Ectopic endometrial tissue is most often localized on the organs of the small pelvis, although it can also exist on other organs, practically anywhere in the body. The most commonly described in clinical practice are: endometriosis of the ovaries, fallopian tubes, back wall of the uterus, bladder, colon, appendix, but also any part of the abdominal tissue that covers the bottom of the pelvis and its organs.

Dr Karl von Rokitansky is credited with the discovery of endometriosis at the microscopic level, in 1860, although reports by doctors of young women whose monthly cycle is associated with pain and cystic formations in the stomach date back to the 17th century.

The term endometriosis, which unambiguously refers to pathological endometrial tissue that bleeds outside the uterine cavity, dates back to the 20th century. In 1927, dr John Sampson presented cases of female patients with hemorrhagic (so-called chocolate cysts on the ovaries), but also put forward the first theory about the pathogenesis of this condition, which explains the origin of endometriosis by the retrograde movement of endometrial tissue during menstruation, through the fallopian tubes into the space of the abdominal cavity.

Today, there are numerous theories about the origin of this disease, and the most prevalent is the cellular immunity defect theory, which explains the origin of endometriosis by the inability of the own immune system to recognize ectopic endometrial tissue, which in this case, ectopically implanted, survives, proliferates and creates chronic inflammation. Despite numerous findings about the etiology, pathogenesis and treatment options for this condition, endometriosis is still a medical enigma today.

Eight to 10 years pass from the first symptoms (illustration)
Eight to 10 years pass from the first symptoms (illustration)photo: Shutterstock

What are the main symptoms?

The most common symptoms are very diverse: painful periods, heavy menstrual bleeding, chronic pain in the small pelvis, pain during intercourse, bleeding between two cycles, cyclic intestinal irritability, cyclic bladder irritability, sterility, chronic fatigue...

How is endometriosis diagnosed?

The diagnosis of endometriosis is possible on three levels: clinical diagnosis, imaging and surgical diagnosis.

When, on the basis of anamnestic data and a gynecological examination, there is a justified suspicion of this condition, it is advisable to supplement the diagnosis with one of the "imaging" procedures, namely an ultrasound examination of the abdomen and small pelvis and, if necessary, a magnetic resonance imaging of the small pelvis. Clinical symptomatology and the prevalence (and size) of changes that are visible by ultrasound are often not correlated, so women with a very pronounced pain syndrome often do not have visible cysts during an ultrasound examination, as well as the opposite - large-scale cysts are often described without significant symptoms.

The diagnosis is often made late (on average eight to 10 years pass from the first symptoms) and most often during the examination of the cause of infertility.

Laparoscopy with pathohistological confirmation of a sample taken from the affected area (focus, focus or endometrioma) is the gold standard in diagnosing this condition.

What are the treatment options?

The treatment of endometriosis can be conservative or surgical depending on the clinical manifestations, which can most often be classified into two categories: pelvic pain and/or infertility.

Conservative drug treatment is based on the assumption that the ectopic endometrium in the focus of endometriosis responds to hormonal preparations in a similar way as the normal lining of the uterus. In therapy, estrogen-progestin contraceptive pills or progestins are most often used as first-line drugs; then, as second-line drugs, gonadotropin-releasing hormone agonists, and less frequently danazol and aromatase inhibitors.

Surgical treatment involves laparoscopic removal of cysts and release of adhesions. Complete therapy is often a combination of medication and surgery.

Endometriosis is a very heterogeneous condition for which medicine does not yet know the ideal cure. The latest research is focused on an individualized therapeutic approach and the use of selective modulators of estrogen and progestin receptors, as well as determining the receptor status of endometriosis foci in each patient.

Endometriosis is a chronic immunological and endocrine disease, the basic characteristic of which is that endometrium-like tissue (uterine lining) exists and functions outside of its natural place of existence, i.e. outside the uterine cavity...

How often does it occur and what are the risk factors for endometriosis?

Endometriosis is a common gynecological disease, which affects about 10-15 percent of women of reproductive age, but also 35-50 percent of women who have the problem of chronic pelvic pain and/or infertility. The disease most often affects women between the ages of 25 and 45. Sometimes endometriosis is associated with a genetic predisposition, in about seven percent of cases, there is a positive history of family occurrence of the disease.

It has also been described in men, but these are isolated cases, only a few dozen in the whole world, among men who have been treated with hormone therapy, most often for the treatment of prostate cancer. These rare cases are significant because they confirm that endometriosis, despite numerous theories of origin and development, is essentially a disease based on a hormonal disorder.

The risk of developing endometriosis is lowest in black women, and highest in Caucasian and Asian women.

Risk factors for the development of endometriosis are: early menarche (first menstrual cycle), short menstrual cycle (less than 27 days), not giving birth or planning a pregnancy in later years, low body weight, high body weight (obesity), alcohol consumption, cigarette consumption.

Surgical treatment involves laparoscopic removal of cysts and release of adhesions. Complete therapy is often a combination of medication and surgery...

How can endometriosis affect fertility and what can women do if they want to get pregnant?

About 50 percent of patients with endometriosis will experience infertility. Endometriosis impairs a woman's fertility at the anatomical and molecular level. Many women suffering from endometriosis have hemorrhagic cysts, chronic inflammation, and growths in the anatomy of the internal gynecological organs, which is the cause of pain in the small pelvis, as well as sterility. On the other hand, many women do not have visible changes (or these changes are very discreet and can only be seen during laparoscopy), and the cause of their sterility is: chronic inflammation, altered immune response, altered quality of the ovum, and disturbed hormonal microenvironment in which it should fertilization occurs, which disturbs the natural way of fertilization, as well as the implantation of the embryo.

Bearing in mind that endometriosis is often accompanied by infertility and that it is often diagnosed during the examination of the cause of infertility, patients who plan to become pregnant immediately after the treatment are referred to the procedure of assisted reproduction, with the idea of ​​getting pregnant as soon as possible.

Due to the lack of understanding of the disease itself, both among the general public and among health workers, four days of "healthy life" are lost per woman per year, the British "Economist" cited data from the report of the consulting firm "McKinsey". How important is it for society to be better informed about this condition and to support women who face it?

Endometriosis is a mysterious disease, but its prevalence is thought to be at least 10 to 15 percent in women of reproductive age. Taking into account this very high frequency, as well as the fact that women with endometriosis often suffer from severe pelvic pain and infertility, endometriosis ranks as a significant public health problem. Endometriosis is the third most frequent cause of hospitalization in the gynecology department. Also, this disease is among the leading reasons for operative treatment. There are a large number of days a year that women suffering from endometriosis spend unable to work, even bedridden, which has an impact on their work productivity, job satisfaction, earnings, and self-confidence.

Also, about 50 percent of women suffering from endometriosis face the problem of infertility, which is very challenging to treat, and very often they have a "thick" history of unsuccessful attempts at in vitro fertilization.

Given the negative impact on sexuality and fertility, this disease can deeply disrupt partner relationships.

That is why it is important that the general public is better informed about this condition, as well as that women suffering from endometriosis have support from experts - doctors, but also from their close environment, work environment and society as a whole.

Healthy diet, regular rest, no alcohol and cigarettes...

Can and how lifestyle, including diet and exercise, affect endometriosis symptoms?

Lifestyle plays a very important role in the prevention and slower development of endometriosis.

Consuming green vegetables and fresh fruit is proven to have the most benefits. This food contains antioxidants that play a very important role in the normal functioning of the immune system and cell repair from damage caused by free radicals. Also, vegetables are rich in fiber, which is important in maintaining the intestinal bacterial flora, and all together in maintaining the hormonal balance of the body.

On the other hand, red meat is rich in dioxins, hormones and unhealthy fats and has the opposite effect on the development of endometriosis compared to vegetables and fruits, so it should be avoided accordingly.

With the idea of ​​discovering this connection, many studies have been done to monitor the frequency of endometriosis findings in women depending on their dietary habits, and it has been confirmed that endometriosis is diagnosed more often in women who prefer meals with red meat more than twice a week.

A very important factor in the prevention and fight against endometriosis is adherence to a certain lifestyle, which includes a healthy diet, avoiding alcohol and smoking habits, regular rest and moderate physical activity.

Rowing of 6.000 kilometers dedicated to girls and women

In a boat only seven meters long, Ana Žigić, whose parents are from Serbia and Slovenia, rowed the route from Africa to America with three other friends at the beginning of the year. They covered a route of 6.000 kilometers in 39 days.

In several interviews, Ana told how she was diagnosed with endometriosis when she was 12 years old, and she dedicated that feat to girls in sports and girls struggling with endometriosis.

Bonus video: