Online consultation on Endometriosis
Endometriosis is a disease manifested by the localization of tissue similar to the endometrium outside the uterus. The endometrium is the mucous layer of the uterus, which serves to attach the embryo and is also involved in the formation of the placenta. The endometrium is shed during each menstrual cycle.
The occurrence of endometriosis can basically be on any organ. The most common localization is in the pelvic area or on the ovaries. Endometriosis affects 10-15% of women of reproductive age.
This disease can cause dysmenorrhoea 🩸 (pain before menstruation), dysparenuiia (pain during sexual intercourse), dyschesia (pain during defecation) or pelipathi (non-cyclic pelvic pain caused first by cyclic inflammation that develops into adhesions with permanent pain).
The etiology of endometriosis is multifactorial, due to the increasing incidence of endometriosis, lifestyle and environmental factors are likely to be important. Women with shorter cycles and heavier periods are more often affected. Diagnosis can be carried out by biochemical examination, but more often an ultrasound examination is carried out 🩺. Treatment is always complex, it can be surgical or medicinal. 💊 Due to its frequent occurrence in the population, endometriosis is a very important disease that deserves the attention of experts👩🏼⚕️🧑🏻⚕️.
1) What are the predispositions for the development of endometriosis? The mother discovered it at the age of 40.
MD Radka Bažantová: Part of the cause of the disease is heredity, but in the majority
the case is the interplay of several factors. Risk factors can be: long-term exposure to endogenous estrogens (early menarche - first menstruation, and on the contrary late menopause, shortened menstrual cycle, obesity...), obstruction of menstrual blood flow (anomaly), there is also an immunological contribution. That's why I wouldn't stress about your mother's diagnosis (even stress is one of the risk factors). I would strive for a healthy lifestyle - plenty of exercise and a varied diet.
2) How is it possible to support pregnancy with an endometrial cyst and poor patency of the fallopian tube?
MD Radka Bažantová: A cyst as such does not have to prevent pregnancy. Sufficient supplementation with micronutrients is appropriate. Here, with a clear conscience, I would recommend the Verra Fertility and Pregnancy Complex, where everything is needed in one capsule. When it comes to the patency of the fallopian tube, it depends whether one or both are blocked. If there are adhesions on both fallopian tubes, the chance of spontaneous pregnancy is, unfortunately, very low.
3) Is it necessary to remove an endometrial cyst on the ovary if it prevents ovulation?
MD Radka Bažantová : In general, an endometrial cyst does not need to be removed. It is removed if it causes significant pain or if the long-term effort to get pregnant is unsuccessful.
4) I don't have tumor markers in my blood. How else can endometriosis be confirmed?
MD Radka Bažantová : An endometrial cyst can be recognized on an ultrasound examination. If it is suspected, it is advisable to go to a specialized workplace (e.g. Faculty Hospital of Královské Vinohrady). Of course, the clinic is also present: pelvic pain, pain during sexual intercourse, significantly painful menstruation, heavy bleeding.
5) What are the initial symptoms? Can the diagnosis be recognized on ultrasound?
MD Radka Bažantová: Symptoms can vary to varying degrees. Pelvic pains, significantly painful menstruation (new), pain during sexual intercourse, heavy bleeding during menstruation are common...if an endometrial cyst is present, it is possible to determine the diagnosis from ultrasound. A positive biochemical marker in the blood (ca 125) may also be present. If you have suspicions, it is advisable to visit a specialized workplace (e.g. Faculty Hospital of Královské Vinohrady).
6) Is it possible to have endometriosis, but no problems with the menstrual cycle or other difficulties?
MD Radka Bažantová : If there are no clinical symptoms and regular gynecological check-ups are fine, there is no need to stress about endometriosis ☺️.
7) Laparoscopic surgery awaits me with a solution according to the findings. I suspect an endometrial cyst. After that, my doctor will need a decision on what to do with the fallopian tubes in the event of an adverse finding. I don't suffer from any pain, like many women. After the operation, IVF (in vitro fertilization) will await us. Is it better to give the doctor permission to possibly remove the fallopian tubes?
MD Radka Bažantová: If an endometrial cyst is confirmed and at the same time the patency of the fallopian tubes is restricted, the fallopian tubes should be removed. Also from the point of view of future IVF, which in this situation should be fully covered by the insurance company. Chronic inflammation can occur in the fallopian tubes, which could then prevent successful IVF.
8) Is it possible for endometriosis to disappear after pregnancy?
MD Radka Bažantová: In most cases, endometriosis does not disappear during pregnancy. However, there are cases when the disease actually subsided.
9) What is your opinion on the "treatment" of endometriosis using hormonal contraception?
MD Radka Bažantová : Here it depends on the individual woman and her clinical findings. If it is a deep, infiltrating, endometriosis accompanied by severe pain that reduces the quality of life of a woman, and where surgery is planned, it is advisable, especially in the pre-operative period, to consider combined oral contraceptives.
10) Is it possible that it is endometriosis, even if the level of estrogen is at the lower limit? How much of a determinant is estrogen dominance? Does it always have to be diagnosed with endometriosis?
MD Radka Bažantová: Unfortunately, I will not be able to give you a clear answer here. Endometriosis is a very individual matter for every woman. Estrogen dominance is not a condition for diagnosis. In the laboratory, the ca125 marker can be positive. But it depends on the clinical symptoms, sonography findings. If there is any suspicion of this diagnosis, I would recommend that you visit a specialized clinic with an ultrasound check.
Many thanks to MUDr. Councilor Bažantová for the great answers and we look forward to seeing you again next time on our Instagram.