A endometriosis It is a disease that affects about 15% of Brazilian women, according to the Ministry of Health. This Wednesday (7), the International Day of the fight against endometriosis In order to make the population aware of the condition, which can cause disabling symptoms and lead to infertility.
The disease is characterized by the growth of endometrial tissue fragments – which covers the inner area of the uterus – out of the organ. The exact cause for the is still unknown, but among risk factors are early menstruation, pregnancy after 30 years and structural anomalies in the womb.
One of the main symptoms of endometriosis is the strong that in many cases can be disabling.
“It can start days before menstruation and persist until bleeding ceases. In addition, it is common for patients with endometriosis not to respond well to the usual colic drugs,” explains Maíra Campos, endocrine gynecologist and hoping replacement specialist, to CNN.
According to Campos, menstrual cramps are no longer considered “normal” when impacting quality of life, affecting daily activities, work, study and sex life.
In addition to menstrual colic, other symptoms of endometriosis may include:
- Pain during sexual intercourse (called dysgunia);
- Pain to evacuate or urinate, especially in the menstrual period;
- Very intense menstrual bleeding;
- Infertility or difficulty to get pregnant;
- Chronic fatigue;
- Abdominal swelling;
- Cyclic intestinal changes.
“It is essential to observe the repetition of these symptoms throughout the cycles, as they help in clinical reasoning,” says Campos.
In addition, in cases of deep endometriosis – when endometrial tissue reaches other organs beyond the uterus, such as intestine, bladder, ureters and even diaphragm – symptoms can go beyond those mentioned above, including stool bleeding, urinate pain and blood in the urine, intense pain and lower back pain.
“In rarer cases, there may be cyclic chest pain, related to endometriosis foci in the diaphragm or in pleura,” he warns.
To confirm the diagnosis of endometriosis, it is possible to perform image exams such as transvaginal ultrasound with intestinal and pelvic preparation to identify lesions.
“Although the definitive diagnosis can only be made by biopsy (usually during videolaparoscopy), image exams today can very accurately indicate endometriosis outbreaks, allowing many patients to be treated without the need for diagnostic surgery,” explains Campos.
How does endometriosis affect fertility?
One of the characteristic symptoms of endometriosis is a, being one of the main causes for the condition. According to the Ministry of Health, about 40% of women with the disease face difficulty getting pregnant.
“The condition can compromise fertility in various forms. In addition to anatomical adhesions and distortions, endometriosis foci release inflammatory substances, affecting egg quality and endometrium receptivity. Ovarian reserve reduction can also occur, especially in the presence of endometriotic cysts (endometriomas),” explains Alessandra Evangelist, specialist, specialist in assisted reproduction of the Vida Clinic, unit of Fertgroup.
According to Evangelist, if not treated correctly, the impacts of endometriosis on fertility can become irreversible. “However, with proper treatment, many women can preserve or recover their fertility. Therefore, early diagnosis and the adoption of preservation strategies are essential,” says the expert.
And how is the treatment done?
Treatment may vary according to the severity of symptoms, the location of the woman’s injuries and the will to get pregnant.
“Clinical options include hormonal contraceptives (combined or only progesterone), intrauterine devices [] With levonorgestrel, and medicines that block estrogen production, such as GnRH analogs, ”says Campos.
In more severe cases, or where there is resistance to clinical treatment, surgery is indicated. “The procedure removes endometriosis foci, restoring pelvic anatomy and increasing the chances of gestation,” says Evangelist. Therefore, surgical treatment is also recommended for patients who have the desire to get pregnant.
In addition, egg freezing is a recommended technique for women who have moderate or advanced stage endometriosis. The procedure allows eggs to be collected and stored while the patient still has a good ovarian reserve, ensuring greater chances of success in future pregnancy attempts.
According to evangelist, the ideal is that preservation be performed before endometriosis causes more severe damage to ovaries or significantly reduces the quality of eggs. “This can be done at any stage of reproductive life, but it is particularly effective up to the age of 35, when the reserve and the quality of the eggs are better,” he says.
In addition, the Brazilian Society of Endometriosis and Minimally Invasive Gynecology (SBE) warns that patients with endometriosis who want to perform gynecological surgery should also consider freezing eggs before the procedure.
