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>Timely treatment of endometriosis can mean fertility preservation.
In endometriosis, the lining of the uterus is spread outside the uterine cavity, most commonly to the ovaries, peritoneum and the surface of the organs it covers. The function of the mucosa outside the uterus is the same as that of the mucosa inside the uterus, i.e. it thickens during the first half of the cycle and then detaches during menstruation. The ectopic mucosa cannot escape to the outside during the detachment and remains in the abdominal cavity or inside the affected organ. These pieces of mucous membrane begin to organise, causing inflammation and later, a tough adhesion in the abdominal cavity. This is the explanation for abdominal pain, bowel or urinary dysfunction. Most often, the endometrial islets migrate to the ovaries, where they form fluid-filled tubes called chocolate cysts, which, as they grow, impair the circulation of blood to the intact ovarian tissue. If left untreated, these endometrial cysts can penetrate the walls of the affected organs (colon, bladder, ovaries) and penetrate deep into the uterus due to inflammation and adhesions. In addition to the pain, there is also bleeding (bloody stools, bloody urine).
– Severe abdominal pain before menstruation
– Vaginal or abdominal pain during sexual intercourse
– Pain during sexual intercourse or vaginal discharge
– Irregular bleeding – intermittent bleeding with pain in the 2nd half of the cycle
– Infertility
– Other symptoms: weight loss, vomiting, spitting up blood, loss of appetite
The cause of endometriosis is unknown and prevention is unfortunately not possible.
If the symptoms are known, imaging (pelvic UH, MRI or CT scan) is the first option, which can be supplemented by laboratory tests (CA-125, HE4, ROMA index).
The primary aim of treatment is to relieve pain and other symptoms and to restore fertility at childbearing age. The treatment is mainly surgical, with laparoscopic (keyhole) surgery to remove and eliminate the endometriotic nodules by penetrating the abdominal cavity. The surgery should aim to completely surgically remove the organs affected by the endometriosis causing the complaint, so it may be possible to partially remove the organ in question – ovaries, colon, bladder – but we can reconstruct it.
The other pillar of treatment is drug therapy, which aims to stop the endometrial lining from working. In this case, we use medication to remove the outer lining of the uterus, which will completely lose its function as a result of long-term treatment (minimum 6 months).
Successful treatment of endometriosis depends first and foremost on detecting the disease in time and using appropriate treatment. If treated in time, endometriosis can mean fertility preservation.
