Second Opinion on Endometriosis

The inner side of the uterus is covered by a mucous tissue called endometrium. It thickens at certain times during the menstrual cycle, preparing to nestle a fertilized egg. However, sometimes these mucosal cells settle down outside the uterus and proliferate driven by the hormonal cycle, causing endometriosis. It is a common gynecological condition which, although benign, may lead to inflammation with pain and scarring. Some doctors may underestimate its risks, or lack the necessary expertise, so redundant endometrium growth is a frequent reason to seek a second opinion.

An overview: what is endometriosis?

Abnormal build-up of endometrium outside the womb may occur in the pelvic area, and also in various other parts of the entire abdominal cavity. It can affect intestines or even the lungs. Most of the time it manifests itself in relatively small foci - resembling a birthmark on the skin - but sometimes large ovarian cysts appear. They all develop and bleed along with the hormone-driven menstrual cycle, causing a local inflammatory reaction. As a result, patients suffer from pain caused by inflammation-irritated nerves. It becomes especially severe during menstruation. All the more, many affected women have difficulty getting pregnant.

Causes and risk factors

It is still not quite clear why in some women the mucous membrane from the uterus spreads inside the pelvis and abdomen. Thus, there is no way to prevent it. In some families endometriosis occurs more often than in others. If the mother suffered from the disease, the daughter has a six times higher risk of getting it during her reproductive years. Despite this familial predisposition, no single endometriosis gene has yet been found. Environmental factors as well as nutrition also seem to play a role.

During menopause new endometriosis cells cease to grow, since they are no longer influenced by female sex hormones.

Symptoms

Very often patients complain of severe pain during menses.

The following symptoms are also possible:

pain during sex;

bloating during menstruation;

pain in the back;

disturbed menstrual cycle;

fatigue;

increased susceptibility to infections, especially during menstruation;

blood in the urine and the bowel.

The pain location actually depends on where the mucosal tissue has spread. In the vast majority of cases, they settle down in the peritoneum and lead to severe pain during the period. If endometriosis lesions are found in the vaginal area, they can cause pain during sex.

Endometriosis-associated infertility

Endometrium proliferation can scar the fallopian tubes or destroy ovarian tissue, making it difficult or impossible to transport an egg to the uterus and get it fertilized it in the fallopian tube. Much more frequently, however, endometriosis seems to hinder the process of fertilization indirectly, by causing local inflammation. This is why many women with endometriosis have difficulties getting pregnant.

Diagnosis

A key issue in identifying the disease is case history taking, including a detailed description of symptoms and complaints.

In some cases, endometriosis lesions are detected by palpation; however an ultrasound examination is much more effective. If a deep endometriosis infiltration is suspected, physicians can use magnetic resonance imaging (MRI).

However, most often the disease cannot be detected with imaging because of its very tiny foci, so only a minimally invasive operation called laparoscopy can help. It allows not only to identify millimeter-size endometriosis foci and take tissue samples for pathology examination, but also to remove the scarring and lesions during the same procedure.

Treatment concepts

Before initiating therapy, a gynecology specialist will discuss which goals are to be met, for example, getting rid of pain or a pregnancy. It allows to work out a customized treatment plan adapted to individual symptoms and complaints.

Usually, a joint effort of a multidisciplinary team of physicians, specialists in pain therapy, psychosomatics and holistic medicine is needed to achieve the best results.

Basic therapy options comprise minimally invasive surgery (laparоscopy), drugs, psychosomatic support and complementary methods.

During laparoscopic procedures doctors confirm the diagnosis, determine the scope of the disease, and remove the endometriosis lesions, or destroy them with the help of radiofrequency, heat or laser, sparing the healthy adjacent tissues.

Drugs used in the treatment of endometriosis may include synthetic hormones (progestin) and GnRH analogs. If necessary, pain relievers and antispasmodics are added to the regimen. Herbal medications may also be considered.

Psychotherapy as well as relaxation techniques can help to restore peace of mind lost because of the severe psychological distress and life quality reduction often associated with the disorder.

Holistic therapy including homeopathy and acupuncture, as well as nutritional counseling, can have a positive influence the course of the disease.

Reasons to seek a second opinion on endometriosis

As with many other conditions requiring a comprehensive approach and special knowledge, issues involving abnormal endometrium proliferation are considered a particular subspecialty in gynecology. If your endometriosis treatment is ineffective, it’s probably time to consider getting advice from a physician with sufficient expertise, preferably the one working at a certified endometriosis center, where doctors are dealing with the condition much more often than in peer health facilities. 

The fact that redundant endometrium growth is not a malignant disease, does not mean that it should not be taken seriously. Continuous pain and discomfort, to let alone infertility, are reasons strong enough to take more effort in looking for a better solution and request a second opinion.