Gender medicine, what it is and what consequences endometriosis has

By Cristiano Antonino On May 2, 2023

Endometriosis is a chronic disease that affects women of childbearing age. When you are affected by endometrial disease, the cells of the endometrium (the innermost layer of the uterus) do not grow in their normal location, but come out of it – for still unknown reasons – and get stuck in different anatomical areas, partially occluding them or creating nodules and cysts that generate pain

Favored by the constant production, during the menstrual cycle, of hormones such as estrogen and progesterone, it seems that the region of the body most predisposed to accept the cells of the endometrium is all the pelvic region, so much so that affected women tend to complain of severe pain not only uterine, but also rectal and abdominal.

Endometriosis is unfortunately a disease that is still misunderstood and underestimated

It often appears at an early age, already with menarche, when it is recommended to undergo the first gynecological clinical checks.

If not treated in time, with therapies aimed at decreasing the production of estrogen and regulating inflammation, it can affect the ability to conceive.

What is endometriosis and how to identify it

Endometriosis is, in medical language, an ectopic disease that affects women of childbearing age.

In fact, we speak of ectopic endometrium or ectopic endometrial tissue when the cells of the endometrium, instead of settling in the uterine area, do so in other areas of the body such as the complex of female genitalia (above all tubes and vulva) and the organs of the pelvic (the rectum, the bladder, the intestines).

These areas can consequently become occluded and inflamed due to the progressive formation of painful nodules and cysts.

Cysts (or endometriomas) are usually red, bluish, and sometimes black in color because, in addition to collecting endometrial cells, they also harbor menstrual blood clots.

As foreign bodies, they generate inflammation and pain that can be mistaken for physiological menstrual pain.

With the latter, endometriosis pain has in common some characteristics such as that of occurring cyclically, in the menstrual or premenstrual phase, when the thickening of the mucosa is therefore complete thanks to the action of estrogen.

Endometriosis pains, if not properly treated, are destined to increase over time, since the endometrial mucosa follows precisely the same thickening trend as the uterine one and the cysts get bigger and bigger, progressively as the amount of cells and blood increases collected in them.

In very rare cases the disease, especially if it affects the vaginal area, can turn into a bleeding ulcer.

Today endometriosis is recognized as a chronic disabling disease; may benefit from certain pharmacological or surgical treatments aimed at reducing inflammation or surgical removal of the endometrioma.

Endometriosis: the symptoms

Identifying the symptoms of endometriosis is not easy: it can present a very variable clinical picture, from asymptomatic forms, up to cases in which it presents disabling characteristics.

Some alarm bells that could cause concern, and make you reflect on the fact that perhaps it is appropriate to undergo a medical check-up, are:

dysmenorrhea. Period pains are the first major symptom of endometriosis. In reality it is a rather common problem, and not necessarily directly connected to this type of pathology. The pain that appears in those suffering from endometriosis is usually very acute, up to compromising normal daily activities, and unresponsive to taking painkillers
dyspareunia. There are many women with endometriosis who complain of pelvic pain, sometimes even excruciating, during intimate relationships
pain during defecation and/or urination, especially during menstruation; blood loss in the urine or feces outside the menstrual phase can also occur
menorrhagia, particularly heavy bleeding during menstruation
asthenia and hyperthermia: chronic fatigue, with the body temperature level often rising above the average
infertility: the endometrium that protrudes from its normal site is often deposited in the areas where the engraftment of the embryos physiologically takes place. However, there are frequent cases in which it also attacks the fallopian tubes and ovarian reserves, preventing the ovules from developing as they should.

Endometriosis: what is it caused by?

The cause of endometriosis is, to date, unknown. However, there are several pathogenetic hypotheses.

A theory supported by many specialists predicts that endometriosis is the direct consequence of the reflux of menstrual blood.

Abnormalities in the internal conformation of the female genitals could cause blood reflux (also containing endometrial cells) to be generated during menstruation, which leaves the uterus and also affects the pelvis and abdomen, where these cells are deposited creating endometrial islets.

This hypothesis could be confirmed by the fact that endometriosis develops mainly in the tubes, ovaries and Douglas excavation, i.e. the part located between the uterus and the rectum.

Another hypothesis is that endometriosis is a purely genetic disorder, as there is a recurrence of many cases in the same families between first and second degree relatives.

The hormonal theory claims that during puberty some cells initially used for other functions are transformed into endometrial cells, due to the action of estrogen and progesterone.

Along the same lines, the metaplastic theory predicts that the cells of the peritoneum, for causes that are currently unknown, are transformed into endometrial cells.

Difficult to demonstrate, but still possible, would be the spread of endometrial cells by blood (blood) and lymphatic or surgically.

For example, the pelvic veins act as “carriers” on cells, placing them in other areas of the body where they are usually absent.

Finally, endometriosis could be due to alterations of the immune system, which is usually used to recognize them when they come out of the uterus, proceeding to eliminate them.

An abnormality in the lymphocytes could instead allow them to implant and multiply, giving rise to the disease.

Types of endometriosis

Endometrial-type disease can essentially present itself in 3 different ways depending on the symptoms felt, their intensity and the anatomical area affected by the presence of tissue adhesions.

Internal endometriosis. In this case the cells emerge from the innermost layer of the uterus, but remain confined to it, in other anatomical areas. In particular, the endometrium settles on the thickness of the myometrium, i.e. the muscular wall of the uterus. This double thickening generates uterine pain, especially in the menstrual and premenstrual phases when changes due to ovulation and the menstrual cycle already occur.
External pelvic endometriosis: in this case, the organs in the pelvic area are affected by the inflammation. The endometrium is deposited on the pelvic peritoneum and on the pelvic organs (ovaries, uterine ligaments, tubes, vulva, rectovaginal septum, bladder, urethra, sigmoid colon). It is the most common type of the three, and affects the majority of patients.
External endometriosis of a particular organ or tissue: we are faced with the particular case in which, to be affected by endometriosis, are anatomical districts outside the uterine and pelvic ones such as navel, appendix, lungs, scars following laparoscopic and cesarean operations, abdomen , small intestine and kidneys. However, these are much more rare cases than the previous ones.

Endometriosis: the diagnosis

As with any pathology in the medical field, establishing a diagnostic procedure that is unique for all cases of endometriosis is almost impossible. In fact, not only the symptoms, but also the ways in which it manifests itself, vary from patient to patient, depending on age and many other factors.

In order to obtain a diagnosis, it is essential to consult a gynecologist.

As a rule, a gynecological visit performed in the suspicion of endometriosis begins with a phase of collecting the symptoms and with the consequent evaluation of the patient’s clinical history.

It is only in a second instant that the doctor will proceed with an objective examination aimed at identifying the presence or absence of endometriomas.

The organs of the pelvic area are under close observation, paying particular attention to the areas where the patient feels pain.

The outpatient examination includes a phase of vaginal and, in some cases, also rectal exploration, to which a pelvic ultrasound can be added which allows the areas subject to pathology to be identified, even outside the genital area.

In selected cases, an ultrasound of the urinary tract may be prescribed.

For a more specific examination, the specialist may decide to perform an MRI in order to diagnose the anatomical area affected by the pathology also with the use of more detailed images.

How to treat endometriosis and when to intervene

Understanding when you are suffering from endometriosis and it is necessary to intervene is not always easy since, in a fair number of cases, the disease presents itself as totally asymptomatic.

What the specialists recommend is to educate yourself in the fact that experiencing severe and chronic menstrual pain is not a good sign and that, in the face of them, it is good to go to the clinic as soon as possible for a specialist visit.

Once endometriosis is diagnosed, different treatment options become available to patients, which must be consciously chosen according to the intensity with which the disease presents itself and the desire for a current or future pregnancy.

The approach to the treatment of endometriosis can be of two types: conservative (drugs) or surgical.

Drug therapy is usually the first step in curing the disorder

The gynecologist prescribes pain-relieving/anti-inflammatory drugs aimed at reducing inflammation, to which is added hormone therapy with anti-estrogenic action.

It reduces the level of estrogen, directly responsible for the appearance and spread of the disease.

Such therapy lowers the risk of endometriosis getting worse, but does not eradicate it.

Once treatment is stopped, symptoms may recur.

Surgery is the definitive step, which is chosen when hormonal drug therapy has not given the desired results.

It generally consists of the removal of the endometrium and its abnormal growths that cause pain.

It is a minimally invasive procedure, carried out in laparoscopy, which leaves very minimal marks and pays particular attention to maintaining the reproductive potential, without damaging the genital complex.

In more complicated cases, when endometriosis affects organs other than those of the reproductive system, a consultation and a multidisciplinary approach may be required.

In all cases, endometriosis is a disease that often relapses

Even after a surgical removal, the problem could recur.

What doctors recommend is maintaining a healthy lifestyle, which significantly and positively affects the course of the disease.

A correct supply of fiber and vitamins with nutrition, combined with abstention from smoking and alcohol, for example, has effects on reducing symptoms and inflammation.

Even constant physical activity helps to act beneficially.

Endometriosis: prevention and effects on daily life

The prevention of endometriosis passes from a few simple rules, aimed at diagnosing the disease in time and avoiding incurring more serious complications.

Endometrial disease is chronic and disabling and often appears with menarche, only to disappear definitively with menopause.

The physical pain felt, especially if very acute, acts as a sign of the presence of a more serious disorder.

For these reasons, for those who already experience menstrual pain during adolescence, it is advisable to undergo specialist visits in advance, in order to understand if the disorder does not actually derive from endometriosis.

The implications that the pathology in question has on the personal and daily life of women are numerous and do not only affect physical pain, ranging from the increase in ovarian-type tumors to infertility, up to the undermined mental well-being due to the inability to become mothers.

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