During the period of the menstrual cycle, this inappropriate endometrial tissue (which takes the name of ectopic) undergoes, due to the estrogens produced by the ovary, the same changes as the physiological uterine endometrium: this is the cause of the symptoms and clinical signs that distinguish endometriosis.
Typical of women of childbearing age, endometriotic disease is one of the most common causative factors of chronic pelvic pain in women of childbearing age.
Despite the great clinical interest that endometriosis arouses, especially in recent years, this disease still remains largely unknown today, especially as regards its consequences on fertility.
The so-called lining epithelium, formed by a monolayer of ciliated columnar cells (most intimate portion), and the so-called lamina propria (or stroma), composed of highly vascularized loose connective tissue rich in muciparous glands (portion bordering the myometrium).
Due to the effect of estrogen and progesterone - the hormones secreted by the ovaries during the menstrual cycle - the endometrium is renewed regularly and this guarantees the constant presence of an environment suitable for the implantation of an embryo.
, characterized by the presence of the endometrium where this is not normally present, therefore outside the uterus or in inappropriate portions of the uterus.In medicine, the endometrium located where it shouldn't be is called ectopic endometrium or ectopic endometrial tissue.
Returning to "endometriosis, the latter" is a chronic, ie long-term, condition.
Internal Endometriosis and External Endometriosis: the differences
Experts in the field of diseases of the female genital system distinguish endometriosis into internal and external; in more detail, they speak of
- Internal endometriosis (or adenomyosis), when the ectopic endometrium is located in the thickness of the myometrium,
and of
- External endometriosis when the ectopic endometrium is located
- At the level of the pelvis(eg on the ovaries, rectum, vagina, vulva, fallopian tubes, bladder, ureters, sigmoid portion of the colon, descending colon and / or ligaments that hold the uterus in place) or
- Outside the pelvis (e.g. on the abdomen, ileocecal appendage, small intestine, kidneys, and / or lungs).
Between internal endometriosis and external endometriosis, the most common form of endometriosis disease by far is external endometriosis, in this case external endometriosis affecting the ovaries.
(or adenomyosis)
When the ectopic endometrium has "affected" the myometrium.
(or endometriosis proper)
Epidemiology: Incidence and Diffusion of Endometriosis
Endometriosis can affect women of any age; however, it proves to have a particular predilection for subjects of childbearing age between 30 and 40 years.
The incidence of endometriosis is quite high: according to the most reliable statistical research, in fact, the number of women suffering from endometriotic disease would represent 6-11% of the general female population.
Based on data on the prevalence of endometriosis, endometriosis is much more common in infertile women with chronic pelvic pain.
In Italy, women with endometriosis are more than 3 million; in the European Union, about 14 million; finally, around 150,000,000 in the world.
To better manage the disease it is useful to follow a specific diet. During this time, several fall foods are available that help control endometriosis and reduce associated pain.
Did you know that ...
Some clinical studies have observed that endometriosis can begin to develop as early as the age of 8, therefore very early.
Curiosity: does male endometriosis exist?
Recently, some studies have described the presence of endometrial tissue also in men, to be precise in the prostate.
According to experts, this presence would be the embryonic residue of sketches of female genitalia, whose development was interrupted very early to make room for the male genital apparatus.
To support this hypothesis is the fact that the sites of greatest frequency of endometriosis are the fallopian tubes, the ovaries and Douglas's excavation (ie the hollow created by the space between the back of the uterus and the anterior part of the rectum ), all anatomical elements of the abdominal-pelvic compartment.
Lymphatic and blood dissemination theory
According to this theory, the cells of the endometrium could reach other organs (eg lungs or kidneys), through the lymphatic system or the blood (through the pelvic veins).
The theory of lymphatic and blood dissemination is the most accredited hypothesis, to explain all the presence of endometrium outside the pelvic cavity and which cannot depend on retrograde transport.
Metaplastic theory
According to the metaplastic theory, the cells of the peritoneum would undergo, for unknown causes, a transformation into cells of the endometrium.
If true, the metaplastic theory would explain the exceptional formation of endometrial tissue in the bladder and prostate of male subjects.
Hormonal theory
This theory states that, in some subjects, endometriosis would depend on the activity of estrogens, which, during female puberty, would induce the transformation into endometrial cells of some cells, originally destined to become something else.
This theory has raised a debate regarding low-estrogen, high-progesterone oral contraceptives: the topic of discussion is whether or not these drugs can have a protective effect against endometriosis.
Genetic predisposition theory
This theory holds that endometriosis is a kind of hereditary condition;
The theory of genetic predisposition is based on the observation that a not negligible number of women with endometriosis have a first relative (obviously female) affected by the same condition.
Theory of the iatrogenic implant
This theory is the result of the demonstration that there is a possibility of implantation of endometrial tissue on surgical scars following a caesarean section or removal of the uterus (hysterectomy).
Endoperitoneal immune alteration theory
Normally, the immune system recognizes the cells of the endometrium that have flowed back into the abdominal cavity at the time of menstruation as foreign and eliminates them.
According to the theory of "endoperitoneal immune alteration," an abnormality of the aforementioned immune mechanism, induced by a genetic mutation, would allow some endometrial cells to survive and multiply.
Risk Factors: What Favors Endometriosis?
Some evidence suggests that the risk of developing endometriosis (and, more generally, the phenomenon of "endometriosis) is greater in the case of:
- Nulliparity. It is the medical term used to refer to women who have never given birth;
- Menarca (ie the first menstruation) at an early age;
- Menopause at a very old age;
- Short menstrual cycles (for example, lasting less than 27 days);
- Very prolonged menstruation (lasting more than 7 days);
- High levels of estrogen in the body or an "exposure to estrogen that adds to the amount of estrogen produced normally by the body;"
- Heavy consumption of alcohol;
- Family history of endometriosis;
- Presence of any medical condition that prevents the normal passage of menstrual flow outside the body;
- Presence of uterine anomalies.
Complications of Endometriosis
Briefly, endometriosis can cause the formation of one or more endometriotic cysts and / or adhesions; moreover, it can promote a condition of infertility (that is, affect the ability to conceive) and, in the event that it affects the ovaries, increase the risk ovarian cancer (occurs in 3-8% of patients with ovarian endometriosis).
To learn more: What is an Endometriotic Cyst?Sterility in Endometriosis
Several studies have shown that infertility (ie the inability to conceive) is a complication of endometriosis which affects about 30-40% of patients; this means that it is quite common.
, physical examination, gynecological examination, diagnostic imaging (transvaginal or transrectal ultrasound, magnetic resonance, CT) and, sometimes, a minimally invasive surgical procedure such as laparoscopy for diagnostic purposes.To learn more about the Diagnosis of Endometriosis
More details on how endometriosis is diagnosed can be found here.
Conservative treatment of endometriosis in brief
The conservative treatment of endometriosis is basically aimed at controlling pain and other symptoms that tend to affect the patient's quality of life.
It may include:
- A drug therapy based on painkillers and / or
- A hormone therapy with anti-estrogenic action.
