Endometriosis is a chronic inflammatory condition with immunological and hormonal implications that not only affects the reproductive system but also has systemic effects. It is present in a significant percentage of women in our society, affecting their lives and well-being through different symptoms, primarily pain.
Endometriosis is frequently underdiagnosed because it is often not detectable through standard medical tests.
“What you don’t look for, you won’t find, and what you don’t find cannot be diagnosed or treated,” says Dr. Cortés in relation to this condition. Dr. Laura Cortés, gynaecologist and Head of the Integrative Gynaecology Unit at Clínica Planas, explains endometriosis: how to identify it, how it affects patients and the possible treatments. Read on!
What is endometriosis?
Endometriosis is a chronic inflammatory condition in which tissue from the uterus (the inner layer known as the endometrium) is also found in other locations, for example:
- Ovaries
- Fallopian tubes
- Peritoneum
- Bladder
- Intestines
The ectopic tissue responds to the hormones of the menstrual cycle, becoming inflamed and shedding in the same way as the endometrial tissue in the uterus. However, in this case, the bleeding cannot leave the body, causing inflammation, pain and adhesions.
It is usually a multifactorial condition but, broadly speaking, there is a genetic predisposition associated with:
- low-grade inflammation
- excess oestrogen.
Symptoms of endometriosis
In general, endometriosis is clearly associated with pain, the most common being pain related to menstruation.
Low-grade inflammation
Patients with endometriosis experience inflammation and often have excess oestrogen. In addition to menstrual pain, this can lead to inflammation at multiple levels, including:
- pain during bowel movements
- pain during urination or in the peritoneal area
- particularly when coinciding with menstruation.
Pain can occur wherever ectopic endometrial tissue is located.
Furthermore, as this is a chronic inflammatory condition involving immune and nervous system disorders, patients frequently experience other autoimmune conditions, such as:
- psoriasis
- coeliac disease
- lichen
- Hashimoto’s thyroiditis
- and many others.
Excess oestrogen
Patients often have excess oestrogen and/or impaired oestrogen metabolism. Hyperoestrogenism and poor liver detoxification are common, which can lead to a greater likelihood of:
- heavy periods
- acne
- fluid retention
- difficulty concentrating
- sacral pain
- headaches
- fibroids
- polyps
- varicose veins
- haemorrhoids
- migraines
- an increased risk of breast cancer.
In addition, there is often an excess of oestrogen that is not adequately balanced by progesterone. This means that patients frequently experience premenstrual syndrome, which can result in symptoms such as breast tenderness or bleeding in the days leading up to menstruation, as well as irritability and emotional instability.
Oxidative stress caused by persistent low-grade inflammation can lead to poor mitochondrial function. As mitochondria are responsible for generating energy, these patients may feel constantly tired.
All of these symptoms mean that, in many cases, patients with endometriosis may only experience 3 or 4 days each month completely free from the effects of the condition.
Who does endometriosis affect?
Endometriosis is not necessarily linked to maturity; it can occur in any woman of reproductive age. In fact, it is estimated to affect 10% of women in this age group, and many patients are believed to remain undiagnosed.
This is because endometriosis can be located in multiple areas and may not be visible on a standard ultrasound scan.
Endometriosis is not limited to superficial endometriosis located in the uterus and/or ovaries; it is often associated with deep endometriosis, very frequently involving the peritoneum, which may show little evidence on ultrasound despite causing significant symptoms. An ultrasound can confirm that a patient has endometriosis, but the absence of visible implants does not necessarily mean that she does not have the condition.
Diagnosing endometriosis
At the Gynaecology Unit at Clínica Planas, we approach the diagnosis of endometriosis from a perspective focused on the patient’s well-being, seeking to identify the causes of these symptoms through a detailed medical history, supported by any necessary tests and examinations. Ultimately, we do not simply treat images; we treat people, taking into account their life history, habits, and personal and family medical history.
We can perform a detailed ultrasound scan to thoroughly assess the pelvic cavity. We may also use MRI scans and laboratory markers, among other options, to confirm the diagnosis and attempt to identify the underlying cause of the problem.
It is very important to:
- assess the causes of hyperoestrogenism
- evaluate how oestrogens are detoxified by the liver
- and how they are eliminated through the urinary and intestinal systems.
Low-grade inflammation must be addressed by assessing the patient’s microbiota, particularly at intestinal, endometrial and oral levels. It is also important to improve oxidative stress and mitochondrial function in these patients.
Endometriosis treatment
The “polypill” approach is essential:
- assessing biological rhythms
- diet and stress
- rest
- physical activity.
An accumulation of unhealthy lifestyle habits, endocrine disruptors, environmental toxins, dietary factors and stress can contribute to hyperoestrogenism and the production of large amounts of free radicals, which can be highly detrimental to health by increasing oxidative stress and inflammation in the body. This can compromise liver health and mitochondrial function.
We need an anti-inflammatory diet, eliminating processed foods, establishing regular meal patterns and avoiding alcohol and tobacco.
It is important to encourage healthy lifestyle habits, regular physical activity, antioxidants and supplementation to combat oxidative stress, as well as managing stress through mindfulness, meditation, yoga, adaptogens and neural therapy.
It is also important to modulate the intestinal microbiota, which plays a fundamental role in the immune and nervous systems. Assessing dysbiosis and intestinal permeability is important, as is evaluating alterations in the vaginal, endometrial and oral microbiota. It is also advisable to investigate whether there are reactivated viruses, as well as markers of inflammation and autoimmunity.
Only in this way can we take a comprehensive and effective approach to endometriosis.
RECOMMENDED TREATMENTS
Gynaecology Consultation
Find out everything you need to know about our gynaecology consultations and the most advanced treatments available at Clínica Planas.
Menopause: Diagnosis and Treatment
Menopause is the stage when menstruation comes to an end. Discover the treatments available at Clínica Planas that are specifically designed to help alleviate symptoms during this process.
Labiaplasty
Acquired deformities of the female genitalia that may cause discomfort during everyday or sexual activities can be surgically corrected with excellent results.
