Arthrosis: Causes and Risk Factors
Menu
Endometriosis, a chronic health condition that primarily affects women in their reproductive years, is characterized by the abnormal presence of endometrial tissue outside the uterus. This ectopic endometrial tissue reacts to hormonal changes in the menstrual cycle in the same way as the uterine endometrium, leading to a variety of symptoms and complications.
The causes of Endometriosis remain unclear, but several theories have been proposed, including retrograde menstruation, hormonal imbalances, and genetic factors. Certain circumstances, such as nulliparity, early onset of menstruation, late menopause, irregular menstrual cycles, excessive alcohol consumption, a family history of endometriosis, presence of uterine anomalies, and high estrogen levels, are believed to increase the risk of developing endometriosis.
Endometriosis can manifest in different ways, making it a challenging condition to diagnose. In about 20-25% of cases, the condition is asymptomatic, meaning it does not produce any noticeable symptoms. In such instances, diagnosis often occurs incidentally during surgical procedures performed for other reasons, such as infertility treatment.
However, when symptoms do occur, they can range from mild to severe. Common symptoms include chronic pelvic pain, severe cramps in the abdominal area, recurrent vulvodynia (chronic pain affecting the vulva and surrounding tissues), dysmenorrhea (painful menstruation), dyspareunia (pain during sexual intercourse), and alterations in the menstrual cycle. Other symptoms may include rectal bleeding during menstruation, reduced fertility, fatigue, gastrointestinal disturbances, and a sense of fullness, particularly during menstruation.
Interestingly, the severity of symptoms is not always indicative of the severity of the disease. Some cases with small areas of ectopic endometrium can cause severe abdominal pain, while others with large amounts of ectopic tissue may present with milder symptoms.
Endometriosis can have profound effects on the menstrual cycle. The ectopic endometrium behaves like the endometrial tissue that lines the internal wall of the uterus, meaning it also sheds once a month in response to hormonal changes. However, unlike menstrual blood, which exits the body through the vagina, the blood from the ectopic endometrium has no exit route. This leads to inflammation in the surrounding areas and may result in the formation of endometriotic cysts.
Moreover, when endometriosis affects the inside of the pelvis, it can cause adhesions between various pelvic organs. These adhesions are bands of fibrous-scar tissue that abnormally connect parts of the same organ or different organs that are in close proximity. This phenomenon is a result of the irritative and inflammatory reactions promoted by blood loss at the level of the endometriotic lesions.
Endometriosis can lead to two major complications: sterility and malignant degeneration of the ectopic endometrium. Sterility, the most common complication, affects approximately 30-40% of patients with moderate to severe endometriosis. This typically occurs when the ectopic endometrium alters the anatomical relationships between the ovary and the fallopian tubes or damages the ovary, thereby creating a mechanical impediment to conception.
Malignant degeneration of the ectopic endometrium, although less common, is a serious complication. Research suggests that this risk is relatively low and tends to occur when endometriosis affects the ovaries.