Definition, symptoms, diagnosis and treatment of endometriosis

Endometriosis is a disease that affects women of reproductive age usually are. It is characterized by the presence of endometrium outside the uterus. It is a progressive disease and can affect the reproductive system causing infertility.
First observed in 1869 by Rokitansky, endometriosis has every year, more cases. This increase in cases is due to the changing habits of today's women, who become pregnant later and have fewer children, causing higher estrogen exposure time and higher frequency of menses.
However, beyond the facts already mentioned, another factor influenced the increase in cases of endometriosis. This is the laparoscopy, which was popularized in recent years and contributed to the increase in diagnosis.
According to IPGO, Paulista Institute of Obstetrics and Gynecology, estimated that 10-14% of fertile women and 25 to 50% of infertile women have the disease. It is also estimated that the absolute number of women affected by the disease is 60 million worldwide.
The lesions caused by endometriosis are more commonly found in the ovaries and pelvic peritoneum, contain material bloody brown, black or purple.
Histologically, endometriosis is revealed by typical endometrial glands and stroma, erythrocytes, and hemosiderin deposition in macrophages, and fibrous connective tissue containing inflammatory cells.

CLASSIFICATION

Classification of endometriosis is based on three aspects: location of lesions, degree of involvement of organs affected and severity of the condition.
Endometriosis can be classified according to their infiltration and can be Type I, II or III.The first is the infiltration deep in the pouch of Douglas chronic form. The second is a peritoneal disease that has an upper intestinal contraction. And the third appears at the bottom of the pouch of Douglas and is called adenomyosis outside due to the development of endometriosis in the smooth muscle of the rectovaginal septum.
Much of the clinics using the American Fertility Society classification of endometriosis which splits into minimal, mild, moderate and severe, however, recent advances in research offer a new classification into three types: superficial or peritoneal, ovarian and deep infiltrating.

Superficial Endometriosis

The lesions are scattered on the inner surface of the abdomen sometimes even reaching the diaphragm. They are usually located on organs such as intestine, bladder and ureter. Common symptoms are: cramps, irregular menstruation and infertility.

Ovarian Endometriosis

Reaches the outside surface of the ovary, causing retraction to its interior. Due to the formation of cysts on the site, there are anatomical changes (s) of the ovaries. Formed cysts may be associated with endometriosis in other organs.

Deep endometriosis

It is considered the more aggressive because it can compromise a woman's fertility.Occurs when the implants reach a depth of more than half a centimeter involving organs such as bladder, ureters and bowel. The most likely origin of endometriosis is metaplasia, ie the transformation of embryonic tissue in a different one.

SYMPTOMS

Most women have no symptoms front of endometriosis. Those who have symptoms complain of pain, especially pelvic pain. The pain usually occurs in the days before menstruation. It is also common pain during intercourse and urination. Other symptoms that stand out are: diarrhea, menstrual irregularity, blood in urine and infertility.
Infertility occurs can occur due to mechanical factors related to inadequate tubal motility by fibrosis and also by ovarian impairment.

DIAGNOSIS

The hypothesis of the diagnosis can be raised based on the symptoms displayed by the patient (especially pelvic pain). It is also possible to identify nodules located in the pelvic ligaments or behind the uterus. Although these actions mentioned are not sufficient to establish the diagnosis, are very helpful at first. After the first evaluation of the health professional is necessary to perform imaging and / or direct inspection for the correct diagnosis.

Clinical examinations

They are part of the first part of the diagnosis, giving an idea of the presence of the disease. The most important findings in clinical examination are the presence of lumps, pain in the fundus of the vagina, retroverted uterus and the presence of cysts.


Laboratory Tests

Biochemical Markers

Biochemical markers may indicate the presence of endometriosis and indicate more precisely the patients who underwent laparoscopy should be. The most widely used marker is CA-125, Cancer Antigen 125, which should preferably be dosed in the first days of the menstrual cycle. The completion of the examination is performed by clinical laboratories common. It is easy to perform and must be entered at the first suspicion of disease. The downside of the examination is due to lack of precision in relating the disease, or other conditions can alter the outcome.

Pelvic Ultrasound

It is mainly used in the evaluation of the involvement of the ovaries, and possible diagnosis even in early stage.

Pelvic MRI

Method that has important application in ovarian endometriosis and deep. Mainly indicated when there is deep suspicion of the disease.

EBUS

Underused due to lack of availability and cost. We recommend the use of this test in suspected deep endometriosis.

Colonoscopy

Evaluates the effects of rectum and sigmoid. It is performed rectally to verify the commitment of the region.

Laparoscopy

It is considered the best diagnostic method, being more objective and conclusive to determine the extent of disease. Only test that ensures the certainty of diagnosis, in addition, has the advantage of being less invasive.
Laparoscopy is performed by blowing up carbon dioxide in the abdomen through a small incision (up to 1cm) at the umbilicus. An instrument is inserted into the abdominal cavity to view the abdomen and pelvis. During the procedure, tissue samples are removed for microscopic examination and confirm the presence or absence of endometriosis.

TREATMENT

The treatment of endometriosis aims to relieve or reduce pain, decrease the size of the implants, to reverse or limit the progression of the disease, preserve or restore fertility and prevent or delay disease recurrence. Treatment can be divided into surgical and medical, and psychological treatment, serving to support the first two.

Surgical Treatment

It has to be used when it comes to deep endometriosis. Performed by laparoscopy, surgical treatment is very complex and requires highly skilled professionals. Still, there are chances of occurring as the implications retosigmoidectomia (resection of part of the intestine).

Clinical Treatment

Medical therapy is the use of anti-inflammatory drugs and birth control pills before surgery, to ease the pain. It is also used after surgery, hormone treatment, aiming to halt menstruation, restricting the possible evolution of the disease. Medical therapy alone has not, therefore, curative value.

Psychological Treatment

Women with endometriosis have a high prevalence of depression. It is necessary that the depression is treated as a disease and not understood only as a result of stress stemming from recurrent endometriosis.
Psychology seeks to recover the quality of life of patients and understanding of mental pathology, as well as their function in daily life and also in helping the team in the therapeutic process.

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