Endometriosis is quite common among women; about 10 % of them are affected by this disease in reproductive age. This is a condition when inner uterus tissues called endometrium starts growing outside the womb that could cause pelvic pain and discomfort, though, in many cases the disease could manifest no obvious symptoms. It is very important to have regular checkups with a gynecologist because when not treated endometriosis could lead to serious issues as chronicle severe pain and infertility. German medical centers offer a range of services that differ significantly depending on lesion degree.
The nature of endometriosis is still unclear, though, there several popular theories why it happens.
- Retrograde Menstruation. One of the named possible causes is retrograde menstruation, which is a condition when menstrual blood including particles of uterus lining (enfometrium) does not embed outside completely during menstruation but stay in reproductive organs (ovaries, fallopian tubes) and start growing into endometrial patches. It also can flow into abdominal via fallopian tubes and implant there. The only fault of this theory, it could not explain endometriosis in those women who had hysterectomy.
- Genetic Factors. Another explanation is family history. If woman have any of female relatives as mother or sister diagnosed with such a condition the risk of endometriosis is higher. It is also noticed that probability of disease also depends on ethnicity. While in African-Caribbean women the risk is lower, in Asian patients it opposite higher than in white women.
- Cells of Endometrium in Blood and Lymph. It is not proved but some researches consider that cells of endometrium could permeate into blood and lymph and travel trough the body. It is maybe not very convincing but with this theory is possible to explain why rarely endometrial implants are found in such remote parts as brain or eye.
- Induction Theory. Another theory suggests that peritoneal cells could convert into endometrial tissues due to hormonal or immune factors.
- Scar Implantation. It is considered that during such kinds of surgery as hysterectomy endometrial cells could transplant to the incision.
- Immune System Disorders. It is believed that immune system problems could be a proper ground for development of endometriosis. Many women with the condition have low immunity.
- Environmental Causes. Some scientists consider that among the possible reasons of endometriosis can be presence certain toxins in environment as dioxins affecting immune system. Currently, it is proved on animal but not certainly known about humans.
Other Risks Increasing Danger of Endometrial Disease
Among the other condition that could not be definitely proved as the cause of endometriosis but give evidence of accompanying factors you could name the following:
- Age 30-40
- Never giving birth
- Menstrual cycles shorter than 28 days
- Long menstruation period
- High level of estrogen in the body
- Low body mass index
- Early age of a first menstruation
- Later menopause
- Uterine abnormality and pelvic infection
What Causes Endometriosis Pain?
You could spend a lot of words explaining what is endometriosis – which is spreading of inner uterus lining outside the womb – but for those who have the disease, it could be named on one word – ‘pain’.
Severe pain accompanies you during your periods, when having sex; sometimes it could appear in the low back, bowel, bladder and rectum. But what is the nature of that pain which cause so much suffering to the woman.
The pain happens due to adhesions that appear in the spots of normal and implanted endometrial tissues. Growing, they cause tension giving pain which become especially severe during physical movement, e.g. while having sexual intercourse.
What Causes Bleeding?
One of the common symptoms of endometriosis at advanced stages is abnormal bleeding. ‘Abnormal’ means different from cyclical menstrual bleeding in frequency and longitude. Here is some possible reasons for appearing of abnormal bleeding:
- Ovarian cysts (so called chocolate cysts) when become too large create pressure to the ovary and produce abnormal bleeding which is, as rule, darker than normal menstrual blood.
- Adhesions in ovaries cause encasing of ovary into endometrial tissue that creates irritation on it. Then, ovary tried to escape creating cyst which could bleed.
- Sometimes the reason of bleeding can be not endometriosis itself but hormonal drugs used for it treatment. You always should be aware of possible side effects and report to your doctor.
What Causes Endometrial Cancer?
There is no any certain opinion what can cause endometrial cancer but some risks factors are know:
- Hormonal misbalance between two main female hormones estrogen and progesterone. It is important to understand that not level of hormone but its fluctuation could create risk condition.
- Never having a child. Women who have never been pregnant have higher risk of cancer.
- Longer childbearing period. As earlier you periods start and later finish more risk of cancer you have due to longer exposure of you endometrium to estrogen.
- Older age. The risk of malignant tumor increases in older age.
- Hormonal therapy for breast cancer. If you are taking tamoxifen, it can increase the risk.
- Obesity. Overweight can affect hormonal balance of the body.
Symptoms of Endometriosis
Permanent pain is a main sign. If you experience severe pain during menstruation, when having sex or even without any special reason, it is a reason to see your doctor. The other symptoms are low back pain, bowel movement pain, leg pain, and fatigue. In modern highly specialized medicine you could find different curing solutions starting from conservative treatment to homoeopathy but, before applying one, you need understanding what type and what stage is your lesion.
Endometriosis could be divided as following:
- Deep infiltrating
- Ovarian (chocolate cysts)
- Recto vaginal nodule
Before it was thought there is no difference in treatment methods for different kinds of lesions but recently another opinion started growing popular that various types of disease have different nature and, accordingly, could be treated in different ways.
Traditionally considered there are four stages of endometrial disease: minimal, mild, moderate, and severe. To determine specific treatment option for every individual case German gynecologist takes into consideration many factors as
- Medical history
- Genetic factors (whether you have close relative as mother or sister with same condition)
- Extend of lesion
- Woman’s desire to have a child
- Patient’s preferences on treatment method.
Sometimes with minimal or mild stage of endometriosis, ‘watchful waiting’ can be reasonable but in case of more advanced extend it is necessary to take immediate measures to prevent possible complications as infertility or endometrial cancer development. Conservative treatments for Endometriosis are pain relief medication and hormonal therapy.
Diagnostic surgical (laparoscopic) procedures and ultrasound are considered to be the most informative techniques, helping to study the internal organs and determine or rule out the endometriosis.
With vaginal ultrasound a specialist can study the morphological alternations of tissues and determine a stage of endometriosis process in a woman. What is important: Ultrasound study is best done in women on the 23-25-day of menstrual cycle.
The modern laparoscopy unit allows studying the abdomen and the pelvic organs of a woman in detail. Moreover, during the laparoscopy the tissue patterns from suspicious areas can be extracted for further pathological study. Modern diagnostic laparoscopy helps not only to study endometriosis lesions on pelvis or abdomen of a woman, but also to eliminate them.
The newest (3D) laparoscopy for endometriosis diagnostics and treatment in women is widely applied at German fertility clinics. It helps to achieve higher definition during visualizing the tissues and to study the internal organs in three dimensions. Three dimensional laparoscopy is also involved in treatment of endometriosis. It allows efficient extraction of the scarred tissue and helps to manage the proliferation of endometrium into the abdomen.
When you are diagnosed with endometriosis it is very important to make a test of endometrial tissue which helps to understand your situation better to prescribe appropriate treatment. For those purposes a doctor normally takes samplings of your endometrium for examination. Those sampling are called biopsy.
What is Biopsy?
It is a sample of uterus lining taken for study under a microscope in a laboratory. Detailed examination allows to determine a nature of your disease and, in case with endometriosis, to find a cause of abnormal bleeding and to check overgrowth of endometrium. Also it can be done to diagnose endometrial cancer. The test is especially precise in postmenopausal women.
The other reason to take biopsy is to check if hormone level of the body is in balance. In case of conceiving problems the sampling is checked for ability of uterine lining to support pregnancy.
How biopsy is performed?
Before coming for treatment do not use any vaginal cream for at least 2 days and do not have douche. If you want to take any of nonsteroidal anti-inflammatory drugs before procedure to reduce discomfort please say it to your doctor.
The procedure can be done in physician office or in gynecological hospital. It is performed on examination table in normal position as for checkup. For fixing uterus steady cervix may be slightly grasped with special instrument. After examining your female organs and cleaning of your vagina and cervix a sample is taken.
There are few devises to take the sampling:
- Small pipelle that allows to take a piece of tissue fast but could hurt a little
- Electronic suction device. The procedure is not painful but can cause discomfort.
- Special liquid which is sprayed and, then, washed out. Sometimes special brush can be used to remove some lining before washing.
You physician could use any of above devices. The whole procedure takes about 10 minutes, after that the sampling is placed in liquid substance and send to laboratory. It takes 5-7 days for complete examination.
It is better not to have intercourse for a few days after biopsy taking as mild cramping is possible.
You should not undertake any excessive physical efforts and to carry something heavy.
The Risks of Endometrial Biopsy
The risks of biopsy are minimal but there are some possible side effects is good to mention:
- Minimal bleeding
- Uterine wall puncture (rarely)
If you are pregnant, you should inform your doctor as the procedure can cause miscarriage.
Also you should say if you are allergic to any of medication or is taking some drugs as, for example, blood thinners.
You should immediately consult with the doctor of you have any of below symptoms after procedure.
- Too much bleeding after two days
- Smelly discharge from your vagina
- Abdominal pain
In most cases, you do not have all of those complications and feel you comfortable in two days after the treatment.
Normal result is considered when endometrium cells are normal without any pathology. The abnormal result if in your sampling found any of below deviations:
- Fibroids cells
- Hormone imbalance
- Uterine polyps
Precancerous and cancerous cells.
Dilation and curettage (D&C)
D&C is another test done with the same purpose but in a slightly different performance. Dilation and curettage is normally done in a hospital. For this procedure a sharp instrument named a curette is used. D&C is done to find a cause of heavy bleeding. It is a painful treatment and it is done under general or local anesthesia. If you are going to have a first one you should not eat and drink 8 hours before procedure.
For taking a sampling the doctor put a curved bladed tool into vagina to spread the vaginal walls and to see inside the vagina and cervix. Then the cervix is dilated and the by curette (spoon-like instrument the top lining of the uterus is gently scraped off and taken for biopsy.
After you will awake you could go home the same day but it is recommended to be careful next few days and do not overstrain, do exercising and other energetic activities. You may feel tied after dilation but it is because of general anesthesia. You also can have sore throat as a result of placing endotracheal tube while sleepy but all discomfort will be gone in a few days. It is better to refrain from having sex for a next week after treatment. The reason why D&C is used for defining the causes of heavy bleeding is that it possible to take more material. And another treatment called hysteroscopy may be performed during dilation and curettage when the doctor studies uterus lining.
Among the painkillers applied for endometrial pain are nonsteroidal anti-inflammatory drugs (NSAIDS) and opioids. The type of medicine is individual and such kind of medications as ibuprofen and other NSAIDS could be helpful for some women but non-effective for others. Exercising, massage or yoga could be useful in reducing pain as they produce endorphin.
Hormonal Treatment for Endometriosis
Hormonal medicine might be effective in many cases. Sometimes hormonal contraceptives can reduce or even eliminate symptoms of disease as they act to decrease growth of endometrial tissue. Woman could be prescribed to take gonadotropin-releasing hormone (GnRH) agonists and antagonists which inhibit female sexual characteristics and could create artificial menopause. Those medications normally prescribed for women who do not expect to have children.
Endometriosis is a condition when uterine lining (endometrium) starts growing outside the uterus and causes pain and discomfort. Endometrial patches can be find in ovaries and fallopian tubes, in abdominal area, bladder and, rarely, in other tissues as eye or brain. According common classification there are four degrees of the disease: minimal, mild, moderate and severe. Different kinds of treatment could be recommended depending on the stage and surgery among them is considered as one of the most effective.
The causes of endometrial disease are still unclear and it is hardly known the means to completely eliminate them. Both hormonal therapy and surgery are effective only in alleviating of such symptoms as pain and bleeding but they could not prevent endometrial tissues from residual growing. The both treatments have pro and contra but surgical invasion is proved as most effective method at mild and moderate stages when woman wants to conceive a child.
It is not completely clear how endometriosis related to infertility but it is noticed that in women had surgical treatment of endometrial lesions the birth rate is increased. Recent studies in Canada gave a result that cumulative probability of pregnancy in group which was undergone to surgery was 30% versus 17% in group without treatment, and birth rate is 4.7% versus 2.4 %.
Surgical procedure is also proved as effective in reducing pain. Some sources claims as it is contradictory but there are many reports from patient who had been experiencing pain for years but had recovery after surgery of endometriosis. The affect of operation is based on removal of adhesions between endometrial lesions and normal organs tissues that create tension.
Laparoscopic Minimally Invasive Surgery
Presently, laparoscopy is the most widely used techniques for endometrial disease. It used both for diagnostic and for relieving. The problem with endometriosis, it hardly could be found in another way.
Laparoscopy is normally performed under general anesthesia but also can be done with local or spinal anesthesia. The surgeon makes small incision for introducing laparoscope, abdomen is inflated with carbon dioxide to create operative space and, then, by means of laparoscopic camera travelling inside surgeon investigate the area. The surgical tools are inserted via another incision an everything what is found could be removed immediately.
Nowadays, there are several methods for removal of endometrial tissues: excision with surgical tools, destroying them with laser and using electric current. By means of laparoscopy it is possible to clear endometrial lesions from ovaries keeping female fertility. In case when total or sub-total hysterectomy (uterus removal) is needed it is also can be performed by minimally invasive method.
Only in the most complex cases radical open surgery is used. As a rule, decision on total open hysterectomy is made only if it is absolutely necessary, e.g. in case of severe deep infiltrating endometriosis or endometrial cancer. In Germany the surgeons give preference to minimally invasive methods as they cause lesser damage to the patient’s body, have shorter recovery time and better cosmetic effect.
In endometrium growth such factor as hormonal level play significant role. The high level of estrogen stimulates female sexual function and could cause excessive growing endometrial tissues. To decrease estrogen not only chemical methods could be used but also some natural supplement based on medical herbs both oral and vaginal.
Recently researchers found that marijuana could help for relieving endometrial disease. But it should be noticed that smoking cannabis are strictly not recommended as inhaling smoke increases risks of endometriosis. In medical purposes vaginal vaporization are advised.
With GMG you could find the best medical care for endometriosis in Germany. Our qualified gynecologists will give you complete guidelines how to manage with our problem, fulfill accurate diagnostic and provide treatment in appropriate way. Please apply online.
Endometriosis quite often is associated with infertility, especially, when lesions spread in ovaries and fallopian tubes. It is necessary to start curing it as early as possible. German fertility centers have ample opportunity for relieving of endometriosis and saving female reproductive function. Sometimes, pregnancy itself could the best care for endometriosis. Please see a doctor timely and you will have a good chance living without disease and giving birth for healthy kids.
Another problem with endometrium growth that lesion on the advanced stages could be transformed into cancer. Endometrial carcinoma treatment, as a rule, involves surgery but, when inoperable, radiation therapy should be advised. With comprehensive approach of German specialists, the best method will be chosen and treatment will be performed at high professional level.
The answer is “yes” but... But you should start your treatment immediately and in proper way and it is better trying to get pregnant as early as possible, younger women have better chances to get pregnant despite of disease.
What does it mean “in proper way”? Well, one of the treatment methods used for endometrial disease is hormonal therapy with oral contraceptive or other types of hormones as progesterone and progestin. Those drugs are effective in reducing pain, reducing flow and decreasing size of the lesions but they also inhibit female sexual function and prevent conceiving. So if you intend to have a child, you should inform your gynecologist for choosing right treatment.
With minimal or mild stage it is probably reasonable just keep healthy style of life such as diet with many fruits, vegetables and cereals, exercising, supporting you body with necessary vitamins and try to get pregnant. If desired pregnancy does not happens for more than a half of year, it is better to make an appointment with a fertility specialist.
One is modern and effective method for removing endometrial tissues and adhesions is laser CO2 (LAS) excision and/or vaporization. It was proved based on researches in group of patients that birth rate after LAS has been increased.
On moderate stage surgery is the most effective treatment when the lesions are removed by laparoscopy or laser. Removing the effected tissues gives you relieve and increases your chances getting pregnant but, in this case, it is also better not to delay your reproductive plans as endometrial disease tends to come back.
Deep infiltrating endometriosis could significantly decrease your chances of pregnancy, especially, in cases when radical surgery is advised. German doctors normally suggest that means as a last resort. If you want to try keeping your female sexual function you are better to choose specialized center with qualified surgeons who could perform the surgery with high accuracy.
And remember, you should not lose hope. Yes, there is some evidence that endometriosis is associated with a birth preventing but it is not actually proved for 100%. The only fact is that among the women with diagnosed infertility is higher occurrence of endometriosis but it is unclear whether it could be a factor causing the failed conceiving.
Got Pregnant With Endometriosis
If you got pregnant with endometriosis, there is nothing to worry about. Opposite, pregnancy can improve your condition. In one third of cases, symptoms were worsened in early stage of pregnancy but, then, they were gone completely. As thought, that effects is might be associated with pregnancy hormones suppressing endometrium growth.
Despite of above mentioned medical care should not be stopped with pregnancy. In some cases, the disease has the risks as:
- Bleeding in a second half of pregnancy
- Need in caesarian section
- Earlier delivery of a baby (before 40 weeks)
Though, it is noticed that pregnancy can reduces symptoms of endometriosis but it is not obvious that disease is gone completely. Quite often it can relapse after woman stops breast feeding but in other cases it seems as disorder cured completely.
Controlled Ovarian Stimulation
Controlled Ovarian Stimulation (COS) is often uses in women with minimal or mild endometriosis for producing more eggs. CIS is used together with Intrauterine Insemination (IUI). Combining the both techniques improves birth success.
In Vitro Fertilization with Endometriosis
If after a number of attempts conception still does not happen, and laparoscopic treatment was not helpful, In Vitro Fertilization (IVF) can be a reasonable measure for improving fertility. IVR is a method of insemination when an egg and sperm are combined in laboratory and, then, placed to uterus. That kind of insemination eliminated possible hindrances for a spermatozoid when reaching the eggs. Additional hormonal therapy stimulates “superovulation” allowing the women’s body to produce many eggs in one time. This method is proved as increasing birth rate on women having endometrial disease but it is not cure the condition itself so pain and other symptoms can be back after pregnancy.
At any stage of your disease you need advice and professional care of qualified doctors. Please apply via GMG to any German fertility center or gynecological clinic for care endometriosis and you will have professional recommendation, all the modern diagnostic techniques, advanced treatment and possibilities for artificial insemination. You always have a chance to produce healthy children just do not give up your attempts.
Endometriosis mostly inflicts women of childbearing age, especially in their 30-s and 40-s and, then it is gone after menopause but sometimes symptoms stay and in postmenstrual period. In perimenopausal period the condition, opposite, could worsening and it is important to take timely care. Woman should be very mindful about those symptoms and have regular checkup with a doctor as quite often it could be starting endometrial cancer.
Just a few reports on endometrial disease in perimenopausal period are known, so there is no clear evidence if any special conditions can happen to support or reduce the disorder in that time. Some sources claim that with less progesterone womb lining could become thicker and result in endometrial disorder.
It is a fact that symptoms of endometrial disease depend on hormone estrogen level, which starts to decrease with menopause, but there is no direct cause and effect connection allowing concluding that endometriosis is hormonal disease and should stop with menopause. Another consideration that estrogen is produced not only by uterine activity and the other body tissue also produce the hormone, which could support disease symptoms.
Some women diagnosed with endometriosis in postmenstrual period but it does not mean they just have got the disease. It is common that many women had that condition for years before they were diagnosed. It could be absolutely asymptomatic and detected only with laparoscopy. That is why German doctors advise having regular examination and seeing your doctor not only in presence of obvious symptoms. And even if you experience pain it could be associated with so many causes that it is not possible to determine which of them effects you.
Sometimes symptoms of endometriosis can be provoked by hormone replacement therapy (HRT). Individual sensitivity of a woman also plays role in how her body reacts to estrogen including that received with medicine. In some cases women’s body could react in producing excessive endometrium.
Treatment in Postmenopausal Period
Of cause, you should consult with your clinician what treatment is preferable to you as it is very individual. But after menopause when woman does not care about bringing children any more surgery can be a wise decision. Again, it depends on disease degree which kind of surgical intervention to choose.
Presently, for gynecological issues laparoscopy is widely used as most progressive method causing less damage to the patients’ health. By means of minimally invasive hysterectomy you could remove your ovaries avoiding long recovery period, much bleeding and painful scars. Hysterectomy does not eliminate the causes of endometriosis but removing effected organs helps you get rid of pain.
In some most complicated cases, radical open surgery can be required with total removing of the uterus, cervix, ovaries, and fallopian tubes, especially when endometriosis accompanying with other problems, for example, cancer.
Endometrial Cancer Symptoms
Endometriosis is not a cancer. And many specialists definitely have agreed that it cannot develop into cancer. But at the same time, researches show that the risk of ovarian cancer as well as lymphoma is higher in those women who have uterine lining disorder. Probably, both of those diseases could be caused by the same conditions and follow together.
Another thing which is good to know, that in postmenstrual period both cancer and endometriosis could have similar symptoms. So if you have continuous pain in the pelvis, uterine bleeding or other discharges after menopause you should immediately see your doctor and have examination to exclude cancer or to catch it on earlier stage. Earlier you start treatment more chances for complete cure you have.
Other symptom of developing cancer can be chronic fatigue, hypothyroidism, worsening quality of life when you always feel limitation of your everyday activities because of pain and discomfort. All of those signs can be a good reason to apply for diagnostic.
According to the research of the World Endometriosis Research Foundation (WERF) on 2015 costs of endometriosis treatment was 11,497 USD (per women, per year), that is quite impressive figure. Based on current price situation in Europe clinics in Germany could suggest much more affordable price. It is not possible to do detailed comparison as treatment plan is individual in every case but below you could find average comparative costs for hysterectomy in US, UK and Germany.
|Open surgery, hospital||On request||11 783$ / 10 700€||On request|
|Laparoscopic hysterectomy, outpatient||3 800€||9 471$ / 8 600€||4 601£ / 5 100€|
*All the prices are based on a few estimations from different sites and could not be an offer. Please enquire to clinics for precise pricing
The air tickets prices from US to Germany starts as low as 490 EURO when buying in advance, and the prices for a flight from London to Germany starts from 48 EURO.