All About Endometriosis

March is Endometriosis Awareness Month. It's a relatively unknown, yet very serious disease where tissue can proliferate throughout your body, causing inflammation and adhesions. The complex condition of endometriosis and adenomyosis (= endometriosis interna) is still poorly understood or difficult to diagnose. Yet, endometriosis is estimated to affect one in nine people. Many patients often suffer in silence and have to wait years for a diagnosis. Meanwhile, the symptoms are excruciating and dominate your life. It's time to raise awareness about endometriosis.

What is endometriosis?

Endometriosis is a painful hormonal disorder in which tissue can proliferate throughout your body, causing inflammation and adhesions. This tissue (which resembles the lining of the uterus) is located outside the uterus and can grow anywhere: on the peritoneum in the pelvis and abdominal cavity, the diaphragm, your pleura, and sometimes even in the sinuses.

This causes inflammation, hard spots, adhesions, and cystic structures which cause severe pain.

Because the symptoms of endometriosis depend largely on how much tissue there is and where it is located, the disease is often not recognized quickly.

Some facts about endometriosis:

• It is estimated that 1 in 9 women has endometriosis.
• In general, it takes 7 to more than 20 years before a diagnosis is made.
• The complaints are diverse: think of terrible stomach cramps, pain during sex, and pain during bowel movements, excessive blood loss...
• Endometriosis is often not visible on ultrasound scans or in blood values.
• Although it is not certain exactly how the disease arises, we know that it is caused by a hormonal imbalance and manifests as an inflammatory disease.
• Anyone can get endometriosis. Teenagers and young adults can also develop endometriosis. Menopausal women can also experience problems with old tissue.

The diagnosis

Women often suffer from symptoms for years before a diagnosis is made. This is because the symptoms aren't always clear or consistent, or aren't visible on imaging. As a result, women are often sent from pillar to post. However, there are several ways to diagnose endometriosis.

Endometriosis can be recognised by symptoms in combination with an ultrasound, MRI and possibly a laparoscopy with tissue examination and manual vaginal and anal examination by an osteopath.

Endometriosis and adhesions cannot always be detected using images. Manual examination can sometimes identify endometriosis.

What kind of symptoms does endometriosis cause?

Symptoms can vary widely and depend on where you have endometriosis. Here are a few common symptoms:

• Very painful periods and/or ovulation
• Pain during sex (during entry and/or thrusting), depending on positions.
• Pain when pushing out a stool
• Anal cramps or pain
• Pain in the tailbone or coccyx
• Intestinal complaints
• Pain when urinating
• Fatigue
• Tailbone and pelvic complaints
• Lower back pain
• Diaphragm problems
• Fertility problems
• Nerve pain
• Heavy legs
• Despondency
• Difficult postnatal recovery

Symptoms are often confused with similar ones from other conditions, such as irritable bowel syndrome and fibromyalgia. These symptoms are often taboo and can also cause relationship problems: sex may be impossible due to the pain, and there's no clear cause.

How does endometriosis develop?

There is no certainty about this yet, but there are several hypotheses.

The cause was once thought to be retrograde menstruation. During menstruation, most menstrual blood flows out through the vagina, but with retrograde menstruation, some blood can also flow from the uterus into the abdominal cavity through the fallopian tubes.

Meanwhile, numerous hypotheses have emerged to explain the cause of endometriosis. Unfortunately, there's still no medical consensus on this.

According to the literature, the cause of endometriosis is probably a mix of different things: a hormonal imbalance, hereditary predisposition, immune disorders, stem cells, peritoneal cells, harmful substances, Müllerianosis and more.

It remains difficult to pinpoint a single cause, and often several factors play a role. More research is certainly needed to discover how endometriosis develops.

Is endometriosis hereditary?

Probably. And that's another reason it's not always noticeable. If women in your family always suffered from very heavy, painful periods, but accepted them as normal, you might also think it's normal and simply part of life.

Endometriosis and your fertility

Endometriosis is often immediately associated with fertility problems. However, not every patient with the condition has difficulty conceiving naturally.

The degree, severity, and location of endometriosis are factors that play a role. In addition, the hormonal imbalance caused by endometriosis also affects your fertility. The presence of cysts ( PCOS ) or endometriomas on the ovaries also affects the chances of pregnancy, as they can affect the quality of the follicle (the unmatured egg).

Endometriosis growths and adhesions can also obstruct the path between the ovaries and fallopian tubes.

Can you be cured of endometriosis?

Currently, there is no cure for this disease. The goal of treatment is therefore always to control symptoms and address any fertility problems (if you wish to have children).

There's no one-size-fits-all solution for endometriosis. But that doesn't mean you have to learn to live with it or that there 's no solution. The type of treatment you need depends on your symptoms.

There are three types of treatments that can provide relief from endometriosis. We discuss them below.

1. Medication

There are several medications that primarily affect the menstrual cycle or pain caused by endometriosis. These include hormone therapy, pain relief, and contraception. 

2. Osteopathy

Osteopathy is a therapeutic method that uses manual therapy to treat complaints by restoring natural bodily functions. An internationally recognized expert is the Flemish osteopath, DO - MSc Colette Peeters . Peeters has nearly 25 years of experience and expertise in examining and treating endometriosis patients.

Osteopathy is used to diagnose endometriosis, but also after surgery to restore mobility as much as possible. The body's internal structures should be loose and mobile. Vaginal or anal examinations can help you feel where there's a loss of movement and discover the source of the pain.

Studies show that osteopathic techniques have a positive effect on the quality of life of patients with endometriosis. Treatments can significantly reduce pain and fertility problems.

3. Surgery

The most effective way to treat endometriosis pain is surgical removal of the endometriomas and endometriotic lesions. This is sometimes necessary when there is severe damage and the lesions have grown over. Surgery will not cure endometriosis, but it can reduce pain.

Finally

If you're experiencing vague symptoms and there seems to be no solution, we strongly advise you not to give up. Even if you've already been diagnosed, very painful periods are n't normal, and you don't have to live with them. Chat with us , and we'd be happy to discuss how we can help. 

Want to learn more about endometriosis in the meantime? We recommend these podcasts and websites:

• Podcast No Little Man about Endometriosis
• Podcast Taboebs about endometriosis
• Behind Endo (Stories) is a community with a website and members platform where fellow endometriosis sufferers can find a lot of information and help during their search
• Colette Peeters' website