About the Disease
Endometriosis is a disease that consists of the presence of an endometrium in places outside the uterus. The endometrium is the inner layer of the uterus, which is renewed monthly by menstruation.
Endometriosis is a more common disease than people realize. It is estimated that 15% of women between 15 and 45 years of age have this disease. This percentage rises to up to 70% when the woman has a history of infertility or pelvic pain.
Most affected by endometriosis are: ovaries, Douglas cul-de-sac (behind the uterus), anterior cul-de-sac (in front of the uterus), ligaments that support the uterus, tubes, rectum-vaginal septum (tissue between the vagina and the rectum), intestine, bladder, and pelvis wall.
Endometriosis can have several signs ans symptoms, but the main one is menstrual cramps, which can disrupt social life and work; there may also be pain outside the menstrual period and in the back. Marital life can be impaired by complaints of pain during intercourse and by infertility, which is defined by the absence of pregnancy after one year of sexual activity without the use of contraceptive methods.
The most accepted theory for the development of the disease is that at the time of menstruation, part of the eliminated blood passes through the tubes and falls into the belly. This blood contains cells that have the ability to grow in different regions of the abdominal cavity. Hence, when the immune system – responsible for the organism’s defense – cannot eliminate these cells, they can settle and proliferate, leading to the establishment of the disease.
There are some tests available that help in the diagnosis of the disease, however one can only be sure of the presence of endometrial cells in non-physiological sites through histopathological study, which means tissue biopsy.
As already mentioned, endometriosis is one of the causes of infertility. Therefore, the treatment of the disease is able to increase the chances of pregnancy in those patients who had been unable to conceive due to the presence of this disease, both spontaneously as well as by assisted fertilization techniques, such as artificial insemination and in vitro fertilization.
Basically, there are two therapeutic modalities for this disease: hormonal methods and surgical methods. When it comes to improving fertility, surgical treatment is the best method, as it can significantly increase pregnancy rates at any stage of the disease by up to 50%, with the removal of all ectopic endometrial tissue present in the abdominal cavity.
In more severe cases, in which surgery may not be able to restore fertility, assisted reproduction techniques appear as the only plausible solution. It is important to emphasize that the older the patient is, the worse the results of the disease’s treatment. Therefore, patients over 35 years of age and who are infertile due to the presence of endometriosis, should not delay the time of therapeutic intervention.