What Is Endometriosis?
Endometriosis is a disease first described in 1860 whose causes are still not fully known and are still debated. Many different theories have been put forward to explain how the disease develops.
The best known of these proposes that during menstruation the endometrial tissue (the membrane in the innermost layer of the uterus in which the baby implants during pregnancy) flows back through the tubes into the peritoneal cavity, that is the abdominal cavity, and that as a result of an inadequate immune response this refluxed endometrial tissue forms endometriosis foci on the peritoneum lining the abdominal cavity and on genital organs such as the ovaries and the tubes.
Endometriosis remains a disease with much that is still unknown. The endometriosis foci that form grow and bleed in line with the changes of the oestrogen hormone during the menstrual cycle, spread deeper and, as a result, create pain and adhesions in the areas where they are located.
While the cells of the immune system try to remove the endometriosis foci, a non-microbial inflammatory state also develops, as in rheumatism; this can lead to scar tissue, severe adhesions, loss of function, abdominal bloating at the time of menstruation (the abdomen can swell as in pregnancy), severe pelvic pain, pain during defecation, pain during sexual intercourse, irregular bleeding, heavy bleeding and silent loss of the kidney.
What Happens If Treatment of Endometriosis Is Delayed or Omitted?
Endometriosis, a disease that can be observed far more often in women than is assumed, can cause cysts within the ovary when it settles there, and if these cysts are not treated in time they can lead to extremely serious health problems.
The health problem that arises when the tissue inside the uterus called the endometrium settles on other tissues inside the abdomen is called endometriosis (chocolate cyst disease).
In women with endometriosis, because this tissue also bleeds during menstrual bleeding, period pain can be far more severe. As a result of the damage caused by this bleeding, groin pain can occur during sexual intercourse or at other times (pelvic pain).
When endometriosis settles in the ovaries it can lead to the formation of cysts within them. Because a dark brown fluid resembling chocolate collects inside the ovary in this situation, endometriosis is also called the chocolate cyst.
If the chocolate cyst is not diagnosed and treated in time it can reach a much larger size and rupture. In that case the fluid inside it spreads into the patient’s abdominal cavity and can lead to extremely serious complications.
If endometriosis is not diagnosed and treated in time, the disease in the ovaries, the tubes and the uterus can result in infertility. If it tends to spread, the ovaries can be damaged.
Endometriosis can also cause the problem known as infertility. In advanced cases in particular, with the contribution of a reduced egg reserve caused both by the disease and by the surgical treatments performed, situations can arise that cannot be corrected even with IVF treatment. It is essential to determine carefully in which group surgical treatment should be performed.
When the chocolate cyst causes infertility, the egg cannot move into the tubes and can become trapped in this area. When the egg released from the ovaries cannot pass through the fallopian tube, infertility results; if the egg is fertilised in the tube but cannot move into the uterus, an ectopic pregnancy can occur.
If a chocolate cyst settled in the ovaries is not treated, the function of the ovaries and the egg reserve (the number of eggs) can be affected negatively. By involving and narrowing the ureter it can cause obstruction and silent loss of the kidney.
When deep bowel endometriosis obstructs the bowel, bowel obstruction can develop (in mild narrowing, a picture resembling irritable bowel syndrome). If the disease progresses and is still not treated, the point can be reached where the ovaries and the uterus have to be removed surgically.
Endometriosis Is an Important Health Problem That Must Be Taken Seriously
Endometriosis is found in one in every ten women of reproductive age. We estimate that two million women in our country have endometriosis.
In women with severe endometriosis the anatomical relationship between the reproductive organs is disturbed, and the blockage of the tubes caused by the resulting adhesions leads both to infertility and, because of the pain the disease causes, to very demanding treatments.
Endometriosis is found in about 40% of couples who have difficulty having children, and it is accepted that there is a very important relationship between endometriosis and infertility. Endometriosis is also the most common cause of chronic pelvic pain in women.
Although endometriosis is a benign disease, the need for continuous treatment, repeated operations, loss of working capacity, infertility, the possibility that endometriotic tissue turns into cancer and the deterioration of quality of life cause women of reproductive age, at the time when they should be most productive, to be cut off from social life, from school and from working life.