Endometriosis
Endometriosis refers to a medical condition in which small segments of the inner membrane of the uterus (endometrium) appear outside the uterine cavity. Endometrial growths are most commonly found in the area of the lesser pelvis, i.e. behind the uterus and near the pelvic wall, but also on the superior surface of the urinary bladder, as small endometrial lesions on the lining of the abdominal cavity (peritoneum), on the Fallopian tubes and in the ovaries (E. genitalis externa), although they can generally occur in every area of the body and, in very rare cases, also outside the pelvic and abdominal cavity (E. extragenitalis). Endometriosis may also develop in Caesarean section scars, when tiny particles of the mucous membrane are transported into the abdominal wall during surgery.
weiter zur Entstehung...
Although there is a distinction between two basic theories on the development of endometriosis, both can be considered correct and are probably connected. The first theory hypothesises transference of groups of cells, i.e. tiny pieces of tissue, from the uterine cavity to other areas of the body. This may occur during the menstrual cycle as a result of retrograde bleeding, when a part of the menstrual blood flowing from the uterus to the vulva escapes through the Fallopian tubes into the abdominal cavity. The transference theory is supported by the observation of endometrial growths in the abdominal wall following Caesarean sections, see above;
Second, affected women appear to have a presumably congenital immune deficiency, which enables endometrial cells to settle and remain in other parts of the body. This process also causes the formation of new blood vessels in relation to the endometrial growths. Just like the mucous membrane of the uterine cavity, endometrial growths are also subject to the menstrual period.
During the first half of this cycle, the mucous membrane is stimulated and built up to release blood during menstruation. The flow of menses causes painful symptoms on the peritoneum and can lead to growths and scarring shrinkage of tissue. More commonly, cysts are found in the ovaries containing a dark and thick collection of fluid resulting from the coagulation of the continuously repeated small bleedings. Due to their appearance, such growths are also referred to as “chocolate cysts”. The effects of such changes can cause pain, reduced fertility and organic complications such as the rare occurrence of an obstruction of urinary flow and hydronephrosis of the kidney, when scarring and shrinkage of the peritoneum of the pelvic wall causes a compression of sections of the urinary tract.
weiter zur Prophylaxe...
zurück zur Definition...
Second, affected women appear to have a presumably congenital immune deficiency, which enables endometrial cells to settle and remain in other parts of the body. This process also causes the formation of new blood vessels in relation to the endometrial growths. Just like the mucous membrane of the uterine cavity, endometrial growths are also subject to the menstrual period.
During the first half of this cycle, the mucous membrane is stimulated and built up to release blood during menstruation. The flow of menses causes painful symptoms on the peritoneum and can lead to growths and scarring shrinkage of tissue. More commonly, cysts are found in the ovaries containing a dark and thick collection of fluid resulting from the coagulation of the continuously repeated small bleedings. Due to their appearance, such growths are also referred to as “chocolate cysts”. The effects of such changes can cause pain, reduced fertility and organic complications such as the rare occurrence of an obstruction of urinary flow and hydronephrosis of the kidney, when scarring and shrinkage of the peritoneum of the pelvic wall causes a compression of sections of the urinary tract.
weiter zur Prophylaxe...
zurück zur Definition...
Since the origin of endometriosis is not yet fully understood, there are no specifically cause-oriented treatment or prevention measures. As the spreading and the development of symptoms is related to the period and particularly to menstrual bleeding, the only prevention is to suppress menstruation through birth-control medication (oral contraceptives, “the pill“), apart from pregnancy and the breastfeeding period, which also have a positive effect due to the absence of menstrual bleeding during this time.
weiter zu Symptome...
zurück zur Entstehung...
weiter zu Symptome...
zurück zur Entstehung...
Endometriosis is often diagnosed by chance during surgical inspections of the abdominal cavity. The condition can remain completely silent or cause only few symptoms. Typically, endometriosis already becomes apparent one to two days before menstruation by causing pain that is gradually increasing over the course of years. Since endometriosis affects fertility by causing adhesions in the Fallopian tubes, it is often diagnosed during fertility treatment. However, the fertility may have already been limited before, as a consequence of an improper transport mechanism of the menstrual flow (see above retrograde bleeding).
weiter zur Diagnostik...
zurück zur Prophylaxe...
zurück zur Prophylaxe...
If typical signs and symptoms are present, the diagnosis can usually be made as a working hypothesis when the patient’s statements and the gynaecological examination indicate the characteristic pain spots. Prescribing “the pill” as a test, if possible for a long period of time without bleeding interruptions (termed long cycles), may support but not confirm the diagnosis by immediately alleviating the symptoms. The only way to confirm endometriosis suspicions is through invasive diagnostic procedures, such as laparoscopy. Transvaginal ultrasound may also be helpful in the diagnosis. Endometrial segments that are grown into the muscle wall of the uterus are sometimes difficult to detect and can cause a very painful internal endometriosis (endometriosis genitalis interna, or adenomyosis).
weiter zur Therapie...
zurück zu Symptome...
zurück zu Symptome...
The treatment depends on the individual therapeutic goals: For example, hormonal contraception (the pill and hormone-releasing systems such as the vaginal ring or intra-uterine spiral) is usually sufficient to prevent pain and structural changes. Pure, oestrogen-free progestogens are also available in this case.
However, if the patient wishes to become pregnant or if there are organic complications, surgical treatment will be necessary as a first step. The endometrial growths and the immediate surrounding tissue need to be completely removed, which is followed by anti-hormone therapy (artificial menopause) to prevent the endometriosis from returning. Depending on the severity on the condition, the operation can be performed using minimally invasive techniques as part of a laparoscopy. If more complex open-abdomen surgery is required, it may be necessary for the gynaecologist to cooperate with a responsible surgeon or urologist.
zurück zur Definition
zurück zur Diagnostik...
However, if the patient wishes to become pregnant or if there are organic complications, surgical treatment will be necessary as a first step. The endometrial growths and the immediate surrounding tissue need to be completely removed, which is followed by anti-hormone therapy (artificial menopause) to prevent the endometriosis from returning. Depending on the severity on the condition, the operation can be performed using minimally invasive techniques as part of a laparoscopy. If more complex open-abdomen surgery is required, it may be necessary for the gynaecologist to cooperate with a responsible surgeon or urologist.
zurück zur Definition
zurück zur Diagnostik...
Department(s)
Links for further information