Pain, discomfort during the menstrual period and discomfort during sexual intercourse. These are some of the symptoms of endometriosis, a disease characterized by the presence of tissue similar to the endometrium (the lining of the uterus) outside the organ. On the other hand, about 25% of women have no symptoms.
The disease affects about 190 million women worldwide, according to the World Health Organization (WHO) and causes a chronic inflammatory reaction that can result in the formation of scar tissue (adhesions and fibrosis, for example) in the pelvis and elsewhere. of the body, besides being one of the main causes of infertility.
According to the chairman of the committee specializing in endometriosis of the Brazilian Federation of Gynecology and Obstetrics Associations (Febrasgo), Julio Cesar Rosa e Silva, in most cases the disease affects women of reproductive age.
The origin of endometriosis remains controversial and there are several current theories to explain it, explains Rosa e Silva. “The most accepted theory is that the presence of viable endometrial cells (a group of cells that cover the uterus from the inside) in the retrograde menstrual flow, into the abdomen, as the cause of the lesions. However, practically 90% of women have patent tubes and have retrograde menstrual flow and most will not have endometriosis,” says the doctor.
The representative of Febrasgo points out that there is also the theory of coelomic metaplasia, which is the transformation of the cells that cover the pelvic cavity into endometriosis.
Another theory is the immunological one. “There would actually be a retrograde menstrual flow associated with a genetic and immunological predisposition that would facilitate the implantation of viable and implantable endometrial cells.”
Discovery of the disease
Many women only discover endometriosis when they want to have children and are having trouble getting pregnant.
That was the case of journalist Caroline Salazar, 42, who discovered endometriosis at age 30. “I had been suffering from very strong cramps since my first period, at age 13. At that time, I started having all the symptoms, such as very severe cramping, leg pain, lower back pain, and fatigue,” she told CNN.
Pain is not common
Caroline says that since she was a child she already felt pain in the sides of the abdomen, understood today as in the region of the ovaries. She recalls an episode in which it was necessary to interrupt her physical activities due to fainting and constant pain.
The coordinator of Gynecology at the BP hospital (Beneficência Portuguesa de São Paulo), Mauricio Abrão, the pain can be caused by an inflammatory response that the organ ends up doing by a tissue out of place.
“This inflammation can not only cause pain, but can generate adhesion and changes in the functioning of Organs pelvic organs, generating infertility”, he said.
As Rosa e Silva explains, there is no age for the onset of pain.
“We know that the vast majority of the disease appears in women of reproductive age, while menstruating, from adolescence to menopause. However, there are cases of this disease appearing even after menopause,” she said.
Usually, the pain begins in adolescence with a mild dysmenorrhea (menstrual cramps) with progressive worsening over time.
Abram assesses that there are six “Ds” to identify the main symptoms of endometriosis. “Pain during menstruation, pain in sexual intercourse, pain between periods, pain to have a bowel movement and to urinate during menstruation and difficulty in getting pregnant”, says the doctor.
A review by US researchers found that more than 60% of women diagnosed with endometriosis report chronic pelvic pain (CPD), with endometriosis patients 13 times more likely to experience abdominal pain.
“We start to think about the correlation between pain and disease, usually when the pain is severe or disabling. In the projection from zero to ten, when the pain is greater than seven, it can mean endometriosis”, explains Abrão.
He also highlights that clinical manifestations are not always the only parameters to identify the disease, since some women may not have symptoms.
Infertility and endometriosis
A woman’s menstruation is already a preparatory cycle for pregnancy. And when there is endometriosis, this period is interrupted or disturbed.
Importantly, while endometriosis impairs fertility, it usually does not completely prevent conception — like sterility.
Infertility is a difficulty getting pregnant after 12 months of trying. A survey by the American College of Obstetricians and Gynecologists found that for every ten women who are infertile, four of them have endometriosis.
According to Rosa e Silva, endometriosis “has been observed in 5% to 10% of patients undergoing gynecological surgeries, 20% to 50% of women with infertility, difficulty getting pregnant, and 60% to 70% of patients with chronic pelvic pain. ”.
The symptoms of endometriosis can generate a lot of stress. Psychologist Adriana Mara Leopold, master in psychology of human development at USP, explains that “psychotherapy can help to deal with such symptoms, and in more serious cases, in which the person is having some damage in their interpersonal or work relationships, for example, a psychiatrist evaluation should be considered”.
In a 2020 study that evaluated the impact of endometriosis on quality of life and the incidence of depression, it showed that 15.1% of women with endometriosis were diagnosed with depression.
The expert adds that, historically, the female sex has been associated with fertility and the ability to generate new lives. “Society, in general, tends to demand that the fact that a person has a uterus, therefore, must ‘use it’. When they don’t have children, people with a uterus are frowned upon, as if they haven’t fulfilled their role on Earth,” she said.
That was the case with Carolina. She says that she was more concerned with questions about her quality of life than with the pregnancy itself.
“I never worried about pregnancy and I wasn’t afraid of not having children. I had my daughter at age 37. I was worried about getting better from an illness I suffered for 21 years. I always had for myself that if it had to be, it would be.”
Rosa e Silva points out that, although the association between endometriosis and infertility is well established, it has not yet been possible to determine the true influence of this disease on the different stages of the fertility process.
Abram also says that “despite being one of the main causes of infertility, some women manage to get pregnant and even abort or even carry the pregnancy forward”.
As with Caroline. “I had a blocked tube so I had to do IVF. [tratamento de reprodução humana assistida que consiste em realizar a fecundação do óvulo com o espermatozoide em ambiente de laboratório]. I had a single egg and my daughter was born,” she says.
There is no specific cause for endometriosis. Rosa e Silva, a member of Febrasgo, says that the “study of the disease attributes endometriosis to a set of associated elements, including mechanical interference by obstruction of the tubes in the most severe cases. This appears as the most accepted phenomenon, and may be linked to changes in the processes of ovulation, fertilization and embryo implantation.”.
treatment and diagnosis
There is currently no known way to prevent endometriosis and no cure for the condition, according to the WHO.
Early awareness, diagnosis and treatment can slow or stop the natural progression of the disease and reduce the long-term burden of its symptoms, including the risk of central nervous system pain sensitization.
Abram says that 40% to 50% of teenagers who have disabling colic may have endometriosis. According to the gynecologist, it is necessary to be aware of the signs and symptoms.
“Today there are even apps to identify and classify the symptoms of endometriosis. Even if she is not a doctor, the patient herself can download the app”, said the gynecologist.
Treatment can be done with medication or surgery, depending on the symptoms, injuries, evolution of the condition and patient choice.
As there is no cure for the disease, Mauricio Abrão, from BP, points out that “we are at a time when women need to take the lead in their own treatment”. says.
Source: CNN Brasil
