Causes of endometriosis

Endometriosis is a  hormone-dependent, inflammatory chronic disease. The etiology of endometriosis remains largely unexplained. In addition to genetic and immunological factors, environmental risk factors also play a role in the development of endometriosis, among which dioxin is most often mentioned. Women have a higher risk of developing the disease, if endometriosis is present in the family. 

Signs and symptoms of endometriosis

Some women experience many signs and symptoms of endometriosis, while some experience none. The most common signs/symptoms:

• severe pelvic pain during menstruation
• extremely painful cramps
• severe lower back pain
• painful urination and/or defecation
• heavy menstrual bleeding (even longer than 7 days) or intermittent bleeding
• pelvic pain during and up to 48 hours after intercourse (dyspareunia)

Other symptoms that women with endometriosis may experience:

• strong irritability before menstruation or a more severe form of pre-menstrual syndrome (PMS)
• bloating, a tense abdomen
• in bowel endometriosis alternating diarrhea and constipation, blood in the stool during menstruation
• in urinary tract endometriosis painful and/or frequent urination, even blood in the urine during menstruation
• fatigue, nausea

Diagnosing endometriosis

Women with endometriosis can wait years before they are finally diagnosed. A large part of this problem is the fact that the symptoms, signs, feelings of women are not treated seriously enough and are considered normal, usual, expected.
The second part of the problem in diagnosis is the diagnosis process itself – namely, if endometriosis does not cause endometriomas on the ovaries, which are visible with an ultrasound examination, the diagnosis can only be made with laparoscopy, which is an invasive procedure and is not part of routine examinations.

Classification of endometriosis

Depending on the amount of overgrown tissue and the location or prevalence, endometriosis is classified into 4 categories or levels (R-AFS classification):

Stage I: minimal endometriosis
Stage II.: mild endometriosis
Stage III.: moderate endometriosis
Stage IV.: severe endometriosis

There are three different forms of endometriosis, which can also occur simultaneously.

• Peritoneal endometriosis  appears in various forms (black, red and colorless lesions) on the peritoneum, serosa and surface of the ovary, in the pouch of Douglas (between the uterus and the intestine), in the ovarian cavity and in the sacrouterine ligaments. According to the R-AFS classification, it is defined as minimal and mild.
• Ovarian endometriosis – it appears in the ovary in the form of cysts, filled with thick brown liquid (also called chocolate cysts). According to the R-AFS classification, depending on the extent, it is defined as endometriosis II., III. or IV. stage.
• Deep infiltrative endometriosis occurs as nodules that grow deep below the peritoneum (more than 5 mm into the retroperitoneal space) – this form can affect all organs in the small pelvis, including the bowel, bladder and ureters. 

The level of endometriosis does not reflect the level of pain or the amount and intensity of the symptoms a woman experiences – so a woman with stage I can suffer severely and a woman with stage IV. does not even know that she has the disease.

Endometriosis and infertility

Although it is estimated that it affects 10-15% of women during the childbearing period, endometriosis is much more common in infertile patients, namely 20-50 %. Endometriosis affects a woman’s fertility in different ways:

• an inflammatory, unfavorable environment can have a negative effect on the quality of the oocyte (inflammatory processes and cysts on the ovaries, unfavorable hormonal environment),
• scarred tissue reduces or completely prevents the patency of the fallopian tubes, making it difficult or prevents the sperm from accessing the ovum
• if fertilization does occur, there is a high probability of an ectopic pregnancy
• scarred tissue can prevent the embryo from implanting in the uterus
• adhesions inside the pelvis can cause incorrect, non-physiological positioning of the reproductive organs and disable or weaken their function

Treatment of endometriosis

There is no known cure for endometriosis, but the disease can be controlled, and above all, the symptoms and/or negative impact on fertility and quality of life can be controlled, alleviated and reduced.

Pain relief

NSAIDs are recommended for pain relief in endometriosis, but they have limited efficacy. It is important for a woman to try different active ingredients and in this way find out which one suits her best.

It is recommended that a woman also resort to non-medicated pain relief, such as warm compresses, warm baths, drinking warm drinks. Physiotherapy, TENS and acupuncture can help.

Hormonal treatment

• combined contraceptive pills
• GnRH agonists (e.g. Suprefact)
• progestins, progestogens (e.g. Mirena insert, Visanne)
• aromatase inhibitors (e.g. Epsisolde)
• testosterone derivatives (e.g. Danazol, Gestrinon)

Surgical treatment

In the case of a severe form of endometriosis, surgical treatment is sometimes urgently needed, which removes foci, scars, growths, adhesions, sometimes also parts of the reproductive organs or even other organs in the pelvis and lower abdomen.

Laser vaporization, bipolar coagulation (electrical cauterization) and/or foci excision are most often performed during laparoscopic surgery .

Ovarian endometriomas are most often removed by enucleation (extraction), but often also by laparoscopic aspiration (suction) and fenestration and ablation (laser, electrical, thermal removal of tissue).

Natural aspects of endometriosis relief

Some experts believe that endometriosis is caused by a hormonal disorder. The theory assumes that women with endometriosis produce abnormal (insufficient or excessive) amounts of estrogen and/or progesterone. Others hypothesize that endometriosis may be caused by a malfunctioning liver. The liver may not break down active estrogen, which creates estrogen dominance in the body and causes progesterone deficiency. For this reason, as a natural approach, they suggest therapy that promotes normal liver function and therapy that strives to regulate hormonal imbalance. Adequate nutrition and nutritional supplements can also help with this.

Nutrition of women with endometriosis

An individual’s diet can alleviate the risk of developing endometriosis. For example, eating red meat and lots of saturated trans fats may increase risk, while eating lots of long-chain omega-3 fatty acids (found primarily in oily, cold-water fish) may lower it.

Other foods can also play an important role. Increased consumption of dairy products may reduce the risk of developing endometriosis. Dairy products also provide the body with vitamin D. Higher levels of vitamin D are associated with a reduced risk of endometriosis.

In addition, eating more fruits and vegetables may also provide some level of protection. Estrogen content can be reduced by lignans – phytoestrogen from flax or sesame seeds, probiotics, liver detoxification, cruciferous vegetables (broccoli, cauliflower, kale, Brussels sprouts), which contain the substance glucoraphanin.

It is recommended to avoid environmental chemicals: pesticides, fungicides, herbicides, heavy metals from soil, water and air, GMO food, dioxin and PCB from plastic packaging in which food is packed or from water in bottles.