Endometriosis: the undetected gynaecological condition
When endometrial cells grow outside the womb, it can lead to excruciating pain and infertility. In Switzerland, 1 in 10 women is affected by this benign, but painful, chronic condition.
Lower abdominal cramps, back pain, lack of concentration, fatigue, diarrhoea: every month women with endometriosis suffer these agonising symptoms. Since they can be mistaken for regular period pain, it often take several years for a diagnosis.
What is endometriosis?
In endometriosis, the womb lining, also known as the endometrium, does not stay where it belongs – in the womb. It migrates around the body and grows anywhere, usually in the abdomen. It often attaches to the ovaries, peritoneum, bladder or between the vagina and intestines. These cells do not forget their original purpose, and subsequently grow and bleed during the cycle. Unlike in menstruation, however, the blood and mucus cannot discharge through the vagina, but remain in the body. For many women, this results in cysts, infections and adhesions, which can cause severe pain.
Signs and symptoms
How the condition manifests varies from woman to woman. The extent of spread in the body is not related to the symptoms; smaller sites can cause severe pain, while women with extensive sites may not be aware of their condition.
Those affected by severe symptoms may scarcely be able to cope with their work or everyday life during the acute phase. Their life is very restricted and depends on their cycle. People often only find out about the illness when seeking medical advice due to an inability to conceive children. This is because the symptoms are frequently mistaken for normal period symptoms. In general, anything that goes beyond a slight twinge and discomfort, and which prevents you from fully participating in your daily life, should be examined by a doctor.
Possible symptoms of endometriosis:
- Severe lower abdominal pain before and during menstruation
- Heavy or prolonged periods
- Lower abdominal pain which is independent of menstruation and can be very severe
- Pain during or after sex
- Pain or bleeding on urinating or defecating
- Inability to conceive children
- Lack of energy and drive
- Back pain
Our health advisors can provide you with useful information.
Causes and risk factors
The cause of endometriosis is still not fully understood by scientists. A common explanation is that during your period, some menstrual blood flows back along the Fallopian tubes into the abdomen.
The cells grow uncontrollably, attack organs, try to attach to the circulatory system and may spread locally or throughout the body. Endometriosis is a master of metamorphosis and difficult to recognise, which is why it is sometimes called a “medical chameleon”.
The illness is now assumed to be hereditary. Statistically, women with the following characteristics are most often affected:
- Early first period
- Short cycle and longer bleeding
- Surgery on the womb
- Late first pregnancy
Diagnosis
Medical history plays an important role in identifying the illness. Questions are asked about a family history of endometriosis, current symptoms, bowel movements, urination and sexuality.
Sometimes, sites of endometriosis between the intestine and vagina are palpable during gynaecological examinations. Larger sites and cysts outside the womb can be found with an ultrasound examination. However, small sites or endometrial cells that have grown in the womb muscles cannot be detected by ultrasound.
Therefore, a laparoscopy is the only way to definitively detect endometriosis.
Are you unsure whether you have endometriosis? Keeping a pain diary can help with the diagnosis. Note down the following points: when and in what situations does pain occur? Is there a connection to your cycle?
Therapy and treatment
As endometriosis is a chronic inflammatory disorder, it can unfortunately only be cured in isolated cases. There is good news for older sufferers: normally, the symptoms disappear by themselves during menopause – i.e. after your last period. Specialists recommend a combination of different treatment methods.
A laparoscopy is not only used for diagnosis, but is also the best method for removing sites of endometriosis in the lower abdomen. The abdomen is examined for them during the operation. The site of endometriosis is then either targeted by vaporisation with a high-frequency current, heat or laser, or surgically removed.
A diagnostic laparoscopy lasts approximately 30 minutes. A treatment laparoscopy, in which adhesions or extensive endometriosis are removed, can take up to two hours. However, even after surgery, new sites can form. Furthermore, surgery can lead to adhesions and cysts.
Depending on the severity of the pain, anti-inflammatory painkillers such as ibuprofen or naproxen or stronger prescription painkillers may help. It is essential that you seek advice from your doctor when taking painkillers.
Many women with endometriosis suffer from pelvic floor muscle tension. Breathing and relaxation exercises can effectively relax the pelvic floor. Targeted pelvic floor training also helps bladder weakness.
Endometriosis can be mitigated if the cycle is stopped. It sounds simple: if you don’t bleed, you don’t feel pain. Progesterone is often used for this. It suppresses your cycle and periods. Progesterone is natural, as the female body also produces it. The treatment simultaneously affects the normal womb lining. This results in stopping menstruation.
Another type of hormone therapy is taking GnRH (gonadotropin-releasing hormone) analogues. This synthetic hormone artificially induces menopause – but brings with it all the typical symptoms: hot flushes, headaches, fatigue and osteoporosis. GnRH should only be taken for a short time under strict medical supervision and its use should be thoroughly assessed.
Hormone therapy is not recommended if you are trying to conceive. It has a contraceptive effect. However, hormone therapy is recommended by specialists in the event of a future desire to conceive.
Specialists recommend various complementary treatments in addition to conventional medicine:
TCM: Both acupuncture and Chinese herbal medicine can help to ease pain.
Traditional homeopathy: Natural hormone therapy with oestrogen or progesterone can relieve pain.
Herbal medicine: Typical medicinal herbs for women with anti-inflammatory and hormone-regulating properties can support other treatments. These include, for example, raspberry leaf and lady’s mantle, which regulate the hormone balance and strengthen the womb.
Stress reduction: Japanese researchers have found that alleviating stress can reduce the progression of endometriosis.
Struggling to get pregnant? An inability to conceive can be caused by severe endometriosis.
Mucosal spread, adhesions and scarring in the Fallopian tubes or ovaries prevent sperm from freely reaching the eggs. Inflammation can prevent fertilised eggs from implanting in the womb lining. The quality of the eggs also decreases. Infertility is particularly common when the peritoneum is inflamed by endometriosis.
The likelihood of pregnancy increases with an operation to remove the site of endometriosis.
Nutritional tips for endometriosis
- Healthy fats, such as olive oil and omega-3 fatty acids, improve the metabolism. These are found in linseed oil and fatty cold-water fish, for example.
- Selenium, zinc and vitamins E and C have an anti-inflammatory effect. Good foods include nuts, lentils and currants.
- Cutting out products with cow’s milk a week before your period can relieve the pain.
- Fibre in wholegrain products, fruit and vegetables lowers oestrogen levels. It has the same effect if you cut out alcohol or lose a lot of excess weight. Oestrogen is a significant factor in the development of endometriosis.
- Sugar and refined flour products have an effect on hormones and inflammation levels via insulin. You should therefore reduce their consumption.
Nadia Cifarelli (BSc Psychology, certified holistic health advisor) works for the Helsana health consultation service. She assists customers with questions about nutrition, psychology and the female reproductive organs. Nadia Cifarelli advised the editorial team on this article.
