Endometriosis = a disease in which tissue that
normally grows inside the uterus grows outside the uterus
https://www.zeit.de/zett/2022-09/medical-gaslighting-patienten-symptome-diagnose#medical-gaslighting-2-2-tab
Vergleich: Siehe: Krankheiten + Women’s Problems
Was ist Medical Gaslighting?
Notizen machen: welche Fragen sollen im Termin geklärt werden? Was soll
als Nächstes passieren? Das Wichtigste zuerst ansprechen.
Symptomtagebuch führen: genau aufschreiben, welche Symptome wann und in
welcher Intensität auftreten.
Nicht allein sein: wenn möglich, zu Gesprächen eine Vertrauensperson
mitbringen, die unterstützt und sachlich bleibt.
Ergebnisoffen bleiben: nicht jeder Bauchschmerz ist Endometriose, die meisten Diagnosen sind wohlüberlegt. Wenn die Situation es zulässt, abwarten und im
Zweifel wiederkommen.
Zweitmeinung einholen: bei einem blöden Gefühl die Praxis wechseln. Vor
bestimmten Operationen gibt es sogar einen Rechtsanspruch auf eine
Zweitmeinung.
Beschwerde einlegen: zum Beispiel bei den Patient:innenfürsprecher:innen im Krankenhaus oder bei der zuständigen Landesärztekammer.
Was hilft?
Notizen machen: welche Fragen sollen im Termin geklärt werden? Was soll
als Nächstes passieren? Das Wichtigste zuerst ansprechen.
Symptomtagebuch führen: genau aufschreiben, welche Symptome wann und in
welcher Intensität auftreten.
Nicht allein sein: wenn möglich, zu Gesprächen eine Vertrauensperson
mitbringen, die unterstützt und sachlich bleibt.
Ergebnisoffen bleiben: nicht jeder Bauchschmerz ist Endometriose, die meisten Diagnosen sind wohlüberlegt. Wenn die Situation es zulässt, abwarten und im
Zweifel wiederkommen.
Zweitmeinung einholen: bei einem blöden Gefühl die Praxis wechseln. Vor
bestimmten Operationen gibt es sogar einen Rechtsanspruch auf eine
Zweitmeinung.
Beschwerde einlegen: zum Beispiel bei den Patient:innenfürsprecher:innen
im Krankenhaus oder bei der zuständigen Landesärztekammer.
[Charlotte von Lenthe]
16. Mai 2018, 20:10 h. Aktualisiert am 16. Mai 2018, 20:17 h. 300 Kommentare
Endometriose: Viele Frauen sprechen nicht über Schmerzen, um nicht wehleidig zu erscheinen.
Fast zehn Jahre dauerte es, bis meine Schwester eine klare Diagnose bekam. Jeden Monat litt sie unter extremen Schmerzen während der Menstruation, meist lag sie über eine Woche lang im Bett – hoch dosierte Schmerztabletten und Wärmflasche halfen nur ansatzweise. Niemand kam auf die Idee, dass die Schmerzen andere Ursachen als ihre Periode haben könnten. Frauenärztinnen und -ärzte schickten sie immer wieder nach Hause ("Das sind ganz normale Regelschmerzen."). Nichts half. Bis sie selbst recherchierte, auf eine Bauchspiegelung bestand – und Recht bekam: Ein schwerer Fall von Endometriose.
"Endo-was?", bekommt sie meistens als Antwort, wenn sie von ihrer Erkrankung erzählt – die Wenigsten können etwas mit dem Begriff anfangen. Dabei ist Endometriose eine der häufigsten Frauenerkrankungen überhaupt und noch dazu eine der Hauptursachen für weibliche Unfruchtbarkeit. Sie beeinträchtigt das Leben der Betroffenen in allen Bereichen – bei der Schauspielerin Lena Dunham waren die Schmerzen so stark, dass sie sich mit 31 Jahren die Gebärmutter entfernen ließ. Die Krankheit ist nicht nur unterschätzt, sondern weitgehend unbekannt: Ein rätselhaftes, verstecktes "Frauenleiden".
Depressionen und Angststörungen
Schätzungsweise 10-20% (die Dunkelziffer ist hoch) aller Frauen zwischen 15 und 50 Jahren leiden an Endometriose, in Deutschland kommen jährlich etwa 40.000 Neuerkrankungen hinzu. Endometriose ist eine chronische Krankheit, bei der Zellen, die denen in der Gebärmutter -dem Endometrium- sehr ähnlich sind, an anderen Stellen des Körpers auftreten, etwa am Bauchfell, an den Eierstöcken, in der Blase oder im Darm. Einige dieser Herde reagieren auf hormonelle Veränderungen während des Zyklus, führen zu Entzündungen und können besonders während der Menstruation starke Schmerzen verursachen (im Unterbauch, im Rücken, in den Beinen oder Leisten, in Leber oder Lunge). Außerdem zählen chronische Erschöpfung, unregelmäßige und starke Menstruationsblutungen, Schmerzen beim Geschlechtsverkehr, Migräne, Ohnmacht und Unfruchtbarkeit zu den Symptomen – um nur einige zu nennen. In der Folge kommt es natürlich zu massiven Einschränkungen in allen Lebensbereichen: im Beruf, in der Partnerschaft oder bei der Familienplanung. Nicht selten leiden die Betroffenen unter Depressionen oder Angststörungen.
Die großen Unterschiede des Krankheitsverlaufs machen Diagnose und Behandlung kompliziert – bei meiner Schwester treten die Endometrioseherde z.B. ausschließlich in der Gebärmuttermuskulatur auf (Adenomyose). Aus den jeweiligen Befunden lassen sich wiederum kaum Rückschlüsse über die Art und Intensität der Beschwerden ziehen. Schon ein winziger Knoten kann quälende Schmerzen verursachen. Bisher gibt es keine Möglichkeit der Heilung. Je nach Ausprägung der Krankheit wird daher meist versucht, die Beschwerden mit unterschiedlichen Therapieformen in den Griff zu bekommen. Damit ihre Gebärmutter, die durch die Endometriose bereits stark vergrößert ist, nicht weiter anwächst und um die Schmerzen zu lindern, nimmt meine Schwester die Pille durchgehend. So wird versucht, ihre Periode hormonell komplett zu unterdrücken.
Frauen gelten schnell als wehleidig
Andere Möglichkeiten sind die operative Entfernung der Endometrioseherde, das künstliches Herbeiführen der Wechseljahre oder die Entfernung der Gebärmutter +/o. der Eierstöcke. Keine dieser Therapieformen, die sowieso lediglich der Symptombekämpfung dienen, kann mit hundertprozentiger Sicherheit das Auftreten erneuter Beschwerden verhindern – von den beträchtlichen Nebenwirkungen, die alle Optionen in der Regel mit sich bringen, einmal ganz abgesehen. Weitere Therapieformen hält die Schulmedizin nicht bereit, denn Tatsache ist: Obwohl so viele Frauen darunter leiden, wurde das Rätsel Endometriose bisher schlicht nicht hinreichend erforscht.
Sylvia Mechsner, die Endometriose-Spezialistin der Charité in Berlin, ist überzeugt, dass Männer so eine schmerzhafte Krankheit nicht aushalten würden und in diesem Bereich schon viel mehr passiert wäre -etwa durch mehr Gelder oder mehr Lobby-, wenn auch Männer von der Krankheit betroffen wären. Frauen gelten schnell als wehleidig, ja hysterisch. Die Bloggerin Martina Liel, die seit über 26 Jahren mit Endometriose lebt, berichtet von Reaktionen verschiedener Frauenärzte -auch von Ärztinnen-, die von "Stellen Sie sich nicht so an, andere haben die Schmerzen auch überlebt" über "Suchen Sie sich einen stressfreien Job" bis zu "Bekommen Sie doch einfach ein Kind, dann
wird das erst mal besser" reichen.
Die ebenfalls betroffene Autorin Abby Norman erzählt in ihrem kürzlich in den USA erschienenen Memoir Ask me about my uterus: A quest to make doctors believe in women’s pain, wie sie Ärzten gegenüber wiederholt über starke Schmerzen beim Sex klagte. Erst als ihr Partner sie zur Untersuchung begleitete und seine Frustration zum Ausdruck brachte, wurde sie ernst genommen: "Die Tatsache, dass ich eine Enttäuschung für einen Mann war, schien den Unterschied zu machen."
Der Fall meiner Schwester ist kein Einzelfall. Im Durchschnitt dauert es tatsächlich zehn Jahre (!), bis die Krankheit erkannt wird. Die Booker-Preisträgerin Hilary Mantel erzählt in ihrer Autobiografie Von Geist und Geistern, wie schmerzhaft der Weg hin zu einer klaren Diagnose oft ist. Sie wurde jahrelang mit Psychopharmaka behandelt – und in die Psychiatrie eingewiesen. Auch hier führte erst die eigene Recherche zu Klarheit. Solche Geschichten sind leider eher die Regel als Ausnahme. Häufig haben die Patientinnen Fehldiagnosen, Ärztemarathons, dilettantische Behandlungen und jahrelange Ungewissheit hinter sich, und erst der unerfüllte Kinderwunsch veranlasst Frauenärztinnen und -ärzte, Endometriose überhaupt als mögliche Erkrankung in Betracht zu ziehen.
Eine eindeutige Diagnose ist aufwendig. Manche Knoten sind so klein, dass selbst Spezialisten sie übersehen. Für einen gesicherten Befund ist eine Bauchspiegelung notwendig. Oft fehlen die Zeit und das Geld für eine umfassende, individuelle Untersuchung. Klagt man über starke Schmerzen bei der Regelblutung, haben Frauenärztinnen und -ärzte meist zwei schnelle Lösungen auf Lager: Pille oder Ibuprofen. Hinzu kommt Unwissenheit. Nicht nur die Forschung hinkt hinterher, auch im Medizinstudium nimmt Endometriose bis heute keinen nennenswerten Platz ein. Und egal wie schwerwiegend die Erkrankung in vielen Fällen ist: Da sie gutartig -und nicht tödlich- verläuft, hält sich das Interesse vonseiten der Forschung in Grenzen, Forschungsgelder stehen nicht zur Verfügung.
"Du siehst aber gar nicht krank aus"
Es hat sich bestätigt, dass Ärztinnen und Ärzte auf Schmerzen je nach Geschlecht des Patienten unterschiedlich reagieren. Eine Studie aus dem Jahr 2008 zeigte, dass Frauen bei akuten Schmerzen in der Notaufnahme weniger schnell behandelt werden als Männer mit den gleichen Symptomen. Zudem bekommen sie -wie eine andere Studie herausfand- häufiger Beruhigungsmittel anstelle von Schmerzmitteln verschrieben. Schmerzen von Frauen werden sehr viel wahrscheinlicher als "psychisch bedingt" und
"nicht echt" abgetan als die von Männern. Und das, obwohl Frauen tatsächlich von Schmerzen berichten, die nicht nur häufiger auftreten und länger andauern als bei Männern, sondern auch intensiver sind.
Die Schmerzen bei Endometriose sind äußerlich nicht sichtbar ("Wie, es geht dir schlecht? Du siehst gar nicht krank aus!"), lassen sich schwer messen und noch weniger lässt sich das Ausmaß der Auswirkungen auf weibliche Biografien erfassen. Darüber hinaus ist der weibliche Zyklus noch immer ein großes Tabuthema. In der Schule gibt es nichts Peinlicheres, als ein Tampon, der aus der Tasche fällt – ganz zu schweigen von einem Blutfleck auf der Hose. In der Arbeit schützt man lieber Magen-Darm-Grippe vor als von Menstruationsbeschwerden zu sprechen. Und selbst in den aufgeklärtesten Männergruppen kommt es bestenfalls zu pflichtschuldigem Interesse gepaart mit ängstlicher Zurückhaltung, wenn Frauen erwähnen, dass sie ihre Tage haben. Für junge Frauen ist es also nicht leicht zu erkennen, was normal ist, und was nicht. In den allermeisten Fällen werden Periodenschmerzen als ganz normal abgetan – mit ein bisschen Sport, gesunder Ernährung und einer Wärmflasche ist das schon in den Griff zu kriegen.
Endometriose braucht Aufmerksamkeit – durch frühe Aufklärung, nicht nur von Frauen, sondern vor allem auch von Männern; die Krankheit braucht mehr Mittel in der Forschung; und sie braucht die Thematisierung in Medien und Literatur, wie es in Ansätzen bereits passiert. Tatsächlich steckt hinter der Verharmlosung und gesellschaftlichen Tabuisierung weiblicher Schmerzen aber ein tiefliegendes Problem: Viele junge Frauen sind sich der Gefahr, selbstmitleidig oder melodramatisch zu wirken, durchaus bewusst und vermeiden daher tunlichst, in die Opferrolle zu fallen. Sie sind "postverwundet", wie die Essayistin Leslie Jamison sie in ihrem Band Die Empathie-Tests nennt:
Um überholte Vorstellungen von Weiblichkeit nicht zu stützen, begegnen sie ihrem Schmerz mit Sarkasmus, Verhaltenheit oder Gleichgültigkeit – und finden keine geeignete Form, ihrem Schmerz Ausdruck zu verleihen.
[Luc de Schepper]
Endometriosis and Homeopathy
What to expect from homeopathy. How does Homeopathy differ in looking at
a condition such as endometriosis? As you will see, to the contrary of what you
might expect, Homeopathy is a true science, looking at each case of
endometriosis quite differently than allopathy or
modern medical science. I hope to answer more of some questions that might have
intrigued the sufferer of endometriosis and which at present time are left
unanswered by modern medicine. Questions such as: "How did I come to this
condition? Is there any way to prevent this condition? Is this condition just a
different expression of the same root of an imbalance deep in our system, and
this imbalance randomly expresses itself in different pathological expressions
or diseases, one of them endometriosis? What about our offspring? What can we
expect them to suffer from in case we suffer from endometriosis?
Can this all be answered by Homeopathy? Yes! Much more, it can be
treated, cured and prevented.
Before I will answer one by one the above questions which are crucial to
your goal of achieving health, I will outline in short the principles on which
Homeopathy is based, comparing it with our approach to disease in allopathy so you will see a distinct different approach to
illness in general, and endometriosis in particular. Before I start explaining
you what homeopathy can do for you the endometriosis patient, consider the
advantages of homeopathy when compared to Allopathic (modern) medicine.
Homeopathic treatment is individualized-it considers the whole patient
through symptoms (causality, mental, emotional and physical), rather than the
disease as a name. Too often, we physicians think that our work is finished
when we put a label on the patient. "Yes, you have endometriosis."
Homeopathy does not need a name for a disease. It looks at the person as a
whole and tries to find the contributing factors of disease. What does allopathy say about the causes of endometriosis? They have
not been established-- in other words we don't know! We see that it can run in
families (more in first-degree relatives like mother, sister, and daughter) and
that the risk increases after age 30, or when having an abnormal uterus
(exceptional). But does this knowledge leads to a therapy in which you can say,
the endometriosis sufferer, "I know what to do now so I can say for sure,
none of my offspring will suffer from this.? Not at all! So we just hope and
pray that it will not effect our children. Are the measures (surgery, drugs
with its multiple side effects) a guarantee for a "cure" for you the
sufferer? We already know the answer to this: it is a resounded NO.
All remedies recommended in homeopathy have extensive human experiment.
Contrary to what opponents of homeopathy would have you believe, all remedies
are tested in the only scientific way, i.e. on normal, healthy individuals.
This really should be taken over by modern medicine. I just saw on Larry King
Reagan's doctor speaking about Alzheimer and he asked volunteers for studies
with new untested drugs. Doctors should be the first ones to do this on
themselves like homeopathic physicians have been doing this for two centuries
now.
The homeopathic method of prescribing on a totality of symptoms is
designed to be curative, not just palliative and suppressive as when takes a
sleeping pill for insomnia. Little in allopathic medicine is directed at
reparation.
This is just the contrary of what is often said by your doctor. Drugs
used in endometriosis are geared towards suppressing the activity of the
ovaries and therefore slow down the growth of the endometrial tissue. But
suppressing is exactly what it means--suppressing, not curing with all dire
consequences as a result.
Homeopathy has its time-tested usefulness. Remedies used two hundred
years ago are still used with the same efficacy as then for the same diseases.
Allopathic medical fads run their course and disappear rapidly, whereas
homeopathy is practiced all over the world. In fact it is the second most
widespread form of medicine practiced in the whole world.
There is no drugging effect, and there are no side effects from
homeopathic remedies. Unwanted effects are homeopathic aggravations, recognized
by the well-trained homeopath and easily managed. I am sure when you take Danazol (acne, weight gain, lower voice, beard growth,
vaginal dryness, bleeding between periods, mood swings, liver malfunction,
etc.) or the birth control pill (increased appetite, vein thrombosis, bleeding,
nausea) or the gonadotropin releasing hormone
agonists (GnRH agonists) with side effects such as
hot flashes, loss of calcium from the bones, dryness of the vagina and mood
swings. Drug treatment according to our own medical findings does not cure your
endometriosis, when you stop them, the disease usually returns. So in other
words, if you don't opt for surgery with a total hysterectomy. Serious side
effects can result from those drugs! Surgery is advised to women with moderate
to severe endometriosis, again this does not lead to a cure according to allopathy. Why? Because it addresses the end result of the
illness--the weeds, but not at all the root, the why you got this in the first
place. And then there is the risk of adhesions with every removal of
endometrial tissue. Only removal of both ovaries prevents recurrence of
endometriosis but is this solution for these young women? Obviously not!
Practical plan for the Endometriosis Patient with Homeopathy and Answers
to Previous Questions
Time-Line for Order of Treatment and Diagnosis: the big difference with allopathy!: This will answer the question, How did I come
to this?
For a physician, every investigation into an illness starts with a good
inquiry. Getting the facts together, the symptoms with their modalities and the
different factors in the patient's lifestyle contributing to the disease are
essential if we want to be successful in restoring the patient's health. Yet,
most of the time, the physician often neglects the most important question:
"What happened in your life when you became sick or just before you became
sick?" I see enough doctors' reports from my patients. They are explicit
enough in the description of symptoms and the enumeration of the different
illnesses, but they rarely link the onset of the disease to a meaningful event
in the patient's life. Yet, it is most often the clue to the solution. For you
Endometriosis patient, this will be your first task. Communicate to your
physician the exact circumstances and the first symptoms observed. Some
examples that I have seen in practice will clarify this. I might see ten
endometriosis patients with almost identical symptoms. They will be treated
identical in allopathic medicine with the few drugs, which address some of the
symptoms. Yet, these ten patients have ten different beginnings or aetiologies.
They were "never well since"
a heartbreak, an operation because of sensitivity to anesthesia,
a delivery, an intestinal infection with a loss of liquids, taking the birth
control pill, an acute fear situation like one almost died in a car accident,
recurrent intake of antibiotics, a sunstroke, death of a family member, etc. I
can make this list ten pages long and this is exactly what your doctor needs to
do. The regular medical doctor will treat these different beginnings in the
same way, simply because they have the same endings! How can we be so shortsighted? But these beginnings (triggers) have
decreased your resistance and will lead to illness, endometriosis in your case.
And a homeopathic physician can tell who among the population is at risk to get
endometriosis even when exposed to the same trigger! Because the question can
be posed, "Why if a "grief" can lead to endometriosis, why is
not everyone getting it when suffering a grief?
A diseased state is to be viewed as a decrease in vital energy (Qi in Chinese medicine). Once this energy has reached a
certain low level, the patient is susceptible to viruses, bacteria, yeast and
parasites, which are consequences, not causes! When are we going to learn in
Western medicine to put the horse before the cart, not behind it? It is this
attitude that makes us lose the battle against cancer, AIDS and other serious
chronic disease. So the first question I ask you the endometriosis patient is,
"What happened in your life on the moment that you became aware of the
first symptoms of endometriosis (and we mean the months preceding your
symptoms)??? This is the first important factor to discover. It is the trigger
that has put the lit on the fire, it is not the only factor because no matter
what the trigger is, the terrain has to be just right to start something like
endometriosis. This terrain is what we refer to in Homeopathy as the Miasms, which correspond basically, to your genetic
background. It corresponds to what you received from your parents and what you
will transfer to your offspring. More about this a little later.
When a homeopathic physician looks at the ten above mentioned
Endometriosis patients, he will possible come up with ten different remedies,
in spite of these patients having almost the same symptom picture. Does it not
make more sense to treat the root of the problem, and not merely the little
sick branches. Yet most doctors, alternative or classical, do not more than
branch cutting, simply because they do not know how to restore the sick root.
Allopathic medicine with its strong opinion about germs does not have the tools
to repair the beginnings of Endometriosis. So they keep on using the few
medications that cover some of the symptoms of Endometriosis or resort to
surgery. Yet all these measures fail to address the beginnings of Endometriosis
or why you got endometriosis in the first place!. Only "total" health
modalities like acupuncture, chiropractic but especially homeopathy is capable
of turning Endometriosis patient's lives around.
Genetic Background (Miasms) or the Fertile
Ground for Illness
The second factor that plays a role in getting endometriosis is what we
already alluded to: the genetic background. Homeopathy is able to determine
what people and who of your children is able to get endometriosis. How?
By looking at both parents' family history and see what Miasm is predisposed. (A miasm is
a defect, a groove, a predisposition to certain illness, a weakness, we
inherited from our ancestors. Obviously we all have defects but in case of
endometriosis, we are talking about the sycotic.: miasm.
Endometriosis is however only one expression of this Sycotic
miasm. What are some of the other expressions?
Symptoms can either be on the mental, emotional or physical plane.
Patient's can either show symptoms only on the physical plane, others more sick
on the emotional plane and the most sick have symptoms on the mental plane.
I invite all of you to think about of how many of these symptoms you
have or you see in your children/parents.
Mental for people with endometriosis: Forgetfulness for things just
done, just said, Thoughts vanishing while speaking, bad memory for recent
things, not old things. Imagine of you have to study this way: the only good
energy is at night, starting around 20 - 23 h. But during the day, teenager's exhibit
dreaming, inattention, restlessness, can't sit still, in other words many of
our kids and maybe some among you have suffered from what they call now in
general terms ADD and ADHD. But it belongs to the same root as endometriosis.
Emotional symptoms: Thrill seekers, passionate people, love sex and
talking about it, they prefer a short but exciting life above and long and
boring one. Life has to be full of fun and thrills, unfortunately this can lead
to criminality as the border is easily transgressed all in the name of fun, in
search of the next new thrill. But definitely a great deal of our sycotic children are ADD or ADHD. children.
A sycotic person is one of extremes, never
finding the middle ground.
Physical symptoms: warts, cysts, asthma, tumors,
polyps, and any "hyper" activity of any gland, besides all the
"-itis" diseases.
So what about treatment? Do you understand now why in allopathic
medicine we have to say that surgery neither drugs is capable to eradicate
endometriosis? And if we eradicate (rather suppress) its other expressions and
the ones I have mention to you will appear. So in other words, if I suppress
physical expressions, either the emotional or mental that I have mention will
appear if you are not strong; if you are strong the endometriosis will come
back. Why? Because we don't treat the root, the trigger and the miasmatic background. We have those remedies in Homeopathy
tailored to each individual, this has nothing to do with a protocol. We are all
different, we came to what we are in a different way, it is the sum of whatever
happened in your life, and the only thing you have in common now is the
endometriosis. And even that is not always expressed in the same way. Now you
understand that the remedy you get from a homeopath, after answering so many
more questions than to your regular physician, is the sum of your genetic make
up and what happened in your life, so in other words it covers the beginnings
of the disease, it focuses on them, on the root, because only such eradication
can lead to a normal state. I hope that every endometriosis patient would learn
about the magic of homeopathy in the eradication of their suffering.
Endometriosis (from Greek ἔνδον - endon,
"within", and μήτρα - mētra,
"womb") is a gynecological medical
condition in which cells from the lining of the uterus (endometrium)
appear and flourish outside the uterine cavity (ovaries). The uterine cavity is
lined by endometrial cells, which are under the influence of female hormones.
These endometrial-like cells in areas outside the uterus (endometriosis) are
influenced by hormonal changes and respond in a way that is similar to the
cells found inside the uterus. Symptoms often < with the menstrual cycle.
Typically seen during the reproductive years; it has been estimated that
endometriosis occurs in roughly 5–10% of women. Symptoms may depend on the site
of active endometriosis. Its main but not universal symptom is pelvic pain in
various manifestations. Endometriosis is a common finding in women with
infertility.
A major symptom of endometriosis is recurring pelvic pain. The pain can
be mild to severe cramping that occurs on both sides of the pelvis, in the
lower back and rectal area, and even down the legs.
The amount of pain a woman feels correlates poorly with the extent or
stage (1 - 4) of endometriosis, with some women having little or no pain
despite having extensive endometriosis or endometriosis with scarring, while,
on the other hand, other women may have severe pain even though they have only
a few small areas of endometriosis.
Symptoms may include:
Dysmenorrhea.
– painful, sometimes disabling cramps during menses; pain may get worse over time
(progressive pain), also lower back pains linked to the pelvis
chronic pelvic pain –
typically accompanied by lower back pain or abdominal pain
dyspareunia
– painful sex
dysuria
– urinary urgency, frequency, and sometimes painful voiding
Throbbing, gnawing, and dragging pain to the legs are reported more
commonly by women with endometriosis. Compared with women with superficial
endometriosis, those with deep disease appear to be more likely to report
shooting rectal pain and a sense of their insides being pulled down. Individual
pain areas and pain intensity appears to be unrelated to the surgical
diagnosis, and the area of pain unrelated to area of endometriosis.
Many women with infertility may have endometriosis. As endometriosis can
lead to anatomical distortions and adhesions (the fibrous bands that form
between tissues and organs following recovery from an injury), the causality
may be easy to understand; however, the link between infertility and
endometriosis remains enigmatic when the extent of endometriosis is limited. It
has been suggested that endometriotic lesions release
factors which are detrimental to gametes or embryos, or, alternatively,
endometriosis may more likely develop in women who fail to conceive for other
reasons and thus be a secondary phenomenon; for this reason it is preferable to
speak of endometriosis-associated infertility in such cases. In some cases it
can take a woman with endometriosis 7–10 years to conceive her first child, to
most couples this can be stressful and daunting.
Other symptoms may be present, including:
Constipation
chronic fatigue
In addition to pain during menstruation, the pain of endometriosis can
occur at other times of the month. There can be pain with ovulation, pain
associated with adhesions, pain caused by inflammation in the pelvic cavity,
pain during bowel movements and urination, during general bodily movement like
exercise, pain from standing or walking, and pain with intercourse. But the
most desperate pain is usually with menses and many women dread having their
periods. Pain can also start a week before menses, during and even a week after
menses, or it can be constant. There is no known cure for endometriosis. There
are some additional conditions that are seen in increased frequency among
people with endometriosis, but where there is uncertainty whether these are
factors that predispose to endometriosis or vice versa.
Endometriosis bears no relationship to endometrial cancer. Current
research has demonstrated an association between endometriosis and certain
types of cancers, notably ovarian cancer, non-Hodgkin's lymphoma and brain
cancer. Endometriosis often also coexists with leiomyoma
or adenomyosis, as well as autoimmune disorders. A
1988 survey conducted in the US found significantly more hypothyroidism,
fibromyalgia, chronic fatigue syndrome, autoimmune diseases, allergies and
asthma in women with endometriosis compared to the general population.
Complications of endometriosis include:
Internal scarring
Adhesions
Pelvic cysts
Chocolate cyst of ovaries
Ruptured cyst
Bowel obstruction
Environmental
There is a growing suspicion that environmental factors may cause
endometriosis, specifically some plastics and cooking with certain types of
plastic containers with microwave ovens. Dioxin exposure has been found a very
likely cause of endometriosis in one well known study by The Endometriosis
association that found that 79% of monkeys developed Endometriosis after
receiving doses of dioxin.
Other sources suggest that pesticides and hormones in our food cause a
hormone imbalance.
Tobacco smoking: The risk of
endometriosis has been reported to be reduced in smokers. Smoking causes
decreased estrogens with increased breakthrough bleeding and shortened luteal phases. Smokers have an earlier than normal (by
about 1.5–3 years) menopause which suggests that there is some toxic effect of
smoking on the follicles directly. Chemically, nicotine has been shown to
concentrate in cervical mucous and metabolites have been found in follicular
fluid and been associated with delayed follicular growth and maturation.
Finally, there is some effect on tubal motility because smoking is associated
with an increased incidence of ectopic pregnancy as well as an increased spontaneous
abortion rate.
Aging brings with it many effects that may reduce fertility. Depletion
over time of ovarian follicles affects menstrual regularity. Endometriosis has
more time to produce scarring of the ovary and tubes so they cannot move freely
or it can even replace ovarian follicular tissue if ovarian endometriosis
persists and grows. Leiomyomata (fibroids) can slowly
grow and start causing endometrial bleeding that disrupts implantation sites or
distorts the endometrial cavity which affects carrying a pregnancy in the very
early stages. Abdominal adhesions from other intraabdominal
surgery, or ruptured ovarian cysts can also affect tubal motility needed to
sweep the ovary and gather an ovulated follicle (egg).
Pathophysiology
While the exact cause of endometriosis remains unknown, many theories
have been presented to better understand and explain its development. These
concepts do not necessarily exclude each other. The pathophysiology
of endometriosis is likely to be multifactorial and
to involve an interplay between several factors.
Broadly, the aspects of the pathophysiology
can basically be classified as underlying predisposing factors, metabolic
changes, formation of ectopic endometrium, and
generation of pain and other effects. It is not certain, however, to what
degree predisposing factors lead to metabolic changes and so on, or if
metabolic changes or formation of ectopic endometrium
is the primary cause. Also, there are several theories within each category,
but the uncertainty over what is a cause versus what is an effect when
considered in relation to other aspects is as true for any individual entry in
the pathophysiology of endometriosis.
Also, pathogenic mechanisms appear to differ in the formation of
distinct types of endometriotic lesion, such as
peritoneal, ovarian and rectovaginal lesions.
Metabolic changes
Endometriosis is a condition that is estrogen-dependent
and thus seen primarily during the reproductive years. In experimental models, estrogen is necessary to induce or maintain endometriosis.
Medical therapy is often aimed at lowering estrogen
levels to control the disease. Additionally, the current research into aromatase, an estrogen-synthesizing
enzyme, has provided evidence as to why and how the disease persists after
menopause and hysterectomy.
Retrograde menstruation
The theory of retrograde menstruation is the most widely accepted theory
for the formation of ectopic endometrium in
endometriosis. It suggests that during a woman's menstrual flow, some of the
endometrial debris exits the uterus through the fallopian tubes and attaches
itself to the peritoneal surface (the lining of the abdominal cavity) where it
can proceed to invade the tissue as endometriosis.
While most women may have some retrograde menstrual flow, typically
their immune system is able to clear the debris and prevent implantation and
growth of cells from this occurrence. However, in some patients, endometrial
tissue transplanted by retrograde menstruation may be able to implant and
establish itself as endometriosis. Factors that might cause the tissue to grow
in some women but not in others need to be studied, and some of the possible
causes below may provide some explanation, e.g., hereditary factors, toxins, or
a compromised immune system. It can be argued that the uninterrupted occurrence
of regular menstruation month after month for decades is a modern phenomenon,
as in the past women had more frequent menstrual rest due to pregnancy and
lactation.
Retrograde menstruation alone is not able to explain all instances of
endometriosis, and it needs additional factors such as genetic or immune
differences to account for the fact that many women with retrograde
menstruation do not have endometriosis. Research is focusing on the possibility
that the immune system may not be able to cope with the cyclic onslaught of
retrograde menstrual fluid. In this context there is interest in studying the
relationship of endometriosis to autoimmune disease, allergic reactions, and
the impact of toxins. It is still unclear what, if any, causal relationship
exists between toxins, autoimmune disease, and endometriosis.
In addition, at least one study found that endometriotic
lesions are biochemically very different from artificially transplanted ectopic
tissue. The latter finding, however, can in turn be explained by that the cells
that establish endometrial lesions are not of the main cell type in ordinary endometrium, but rather of a side population cell type, as
supported by exhibitition of a side population
phenotype upon staining with Hoechst dye and by flow cytometric
analysis.
The way endometriosis causes pain is the subject of much research.
Because many women with endometriosis feel pain during or around their periods
and may spill further menstrual flow into the pelvis with each menstruation,
some researchers are trying to reduce menstrual events in patients with
endometriosis.
Endometriosis lesions react to hormonal stimulation and may
"bleed" at the time of menstruation. The blood accumulates locally,
causes swelling, and triggers inflammatory responses with the activation of
cytokines. It is thought that this process may cause pain.
Pain can also occur from adhesions (internal scar tissue) binding
internal organs to each other, causing organ dislocation. Fallopian tubes,
ovaries, the uterus, the bowels, and the bladder can be bound together in ways
that are painful on a daily basis, not just during menstrual periods.
Also, endometriotic lesions can develop their
own nerve supply, thereby creating a direct and two-way interaction between
lesions and the central nervous system, potentially producing a variety of
individual differences in pain that can, in some women, become independent of
the disease itself.
Most endometriosis is found on these structures in the pelvic cavity:
Ovaries (the most common site)
Fallopian tubes
The back of the uterus and the
posterior cul-de-sac
The front of the uterus and
the anterior cul-de-sac
Uterine ligaments such as the
broad or round ligament of the uterus
Pelvic and back wall
Intestines, most commonly the rectosigmoid. (Bowel endometriosis affects approximately
10% of women with endometriosis, and can cause severe pain with bowel
movements)
Urinary bladder and ureters
Endometriosis may spread to the cervix and vagina or to sites of a
surgical abdominal incision.
The only way to diagnose endometriosis is by laparoscopy or other types
of surgery with lesion biopsy. The diagnosis is based on the characteristic
appearance of the disease, and should be corroborated by a biopsy.
Surgery for diagnoses also allows for surgical treatment of
endometriosis at the same time.
Doctors can often feel the endometrial growths during a pelvic exam, and
these symptoms may be signs of endometriosis, diagnosis cannot be confirmed
without performing a laparoscopic procedure.
Often the symptoms of ovarian cancer are identical to those of
endometriosis. If a misdiagnosis of endometriosis occurs due to failure to
confirm diagnosis through laparoscopy, early diagnosis of ovarian cancer, which
is crucial for successful treatment, may have been missed.
Stage I (Minimal)
Findings restricted to only
superficial lesions and possibly a few filmy adhesions
Stage II (Mild)
In addition, some deep lesions
are present in the cul-de-sac
Stage III (Moderate)
As above, plus presence of endometriomas on the ovary and more adhesions.
Stage IV (Severe)
As above, plus large endometriomas, extensive adhesions.
Prevention
Use of combined oral contraceptives is associated with a reduced risk of
endometriosis, apparently giving a relative risk of endometriosis of 0.63
during active use, yet with limited quality of evidence according to a
systematic review.
Hormonal medication
Progesterone or Progestins: Progesterone counteracts oestrogen and inhibits
the growth of the endometrium. Such therapy can
reduce or eliminate menstruation in a controlled and reversible fashion. Progestins are chemical variants of natural progesterone.
Avoiding products with xenoestrogens, which have a similar effect to naturally
produced oestrogen and can increase growth of the endometrium.
Hormone contraception therapy:
Oral contraceptives reduce the menstrual pain associated with endometriosis.
They may function by reducing or eliminating menstrual flow and providing estrogen support. Typically, it is a long-term approach.
Recently Seasonale was FDA approved to reduce periods
to 4 per year.
Surgery
Procedures are classified as
Conservative therapy: when reproductive organs are retained, consists of
the excision (called cystectomy) of the endometrium, adhesions, resection of endometriomas,
and restoration of normal pelvic anatomy as much as is possible. There are
combinations as well, notably one consisting of cystectomy
followed by ablative surgery (removal of endometrium)
using a CO2 laser to vaporize the remaining 10–20% of the endometrioma
wall close to the hilus. Laparoscopy, besides being
used for diagnosis, can also be an option for surgery. It's considered a
"minimally invasive" surgery because the surgeon makes very small
openings (incisions) at (or around) the belly button and lower portion of the
belly. A thin telescope-like instrument (the laparoscope) is placed into one
incision, which allows the doctor to look for endometriosis using a small
camera attached to the laparoscope. Small instruments are inserted through the
incisions to remove the tissue and adhesions. Because the incisions are very
small, there will only be small scars on the skin after the procedure. The
patient usually can go home the day of the surgery and should be able to return
to their usual activities.
Semi-conservative therapy: when ovarian function is allowed to continue,
preserves a healthy appearing ovary, but also increases the risk of recurrence.
Comparison of medicinal and surgical interventions
Efficacy studies show that both medicinal and surgical interventions
produce roughly equivalent pain-relief benefits. Recurrence of pain was found
to be 44 and 53% with medicinal and surgical interventions, respectively.
However, each approach has its own advantages and disadvantages.
Disadvantages of medicinal interventions
Adverse effects are common
Not likely to improve
fertility
Some can only be used for
limited periods of time
Advantages of surgery
Significant efficacy for pain
control.
Has increased efficacy over
medicinal intervention for infertility treatment
Combined with biopsy, it is
the only way to achieve a definitive diagnosis
Can often be carried out as a
minimally invasive (laparoscopic) procedure to reduce morbidity and minimize
the risk of post-operative adhesions.
One theory above suggests that endometriosis is an auto-immune. condition and if the immune system is compromised with a food
intolerance, then removing that food from the diet can, in some people, have an
effect.
Various dietary recommendations are made in popular media. For example,
common intolerances in people with endometriosis are claimed to be wheat, sugar,
meat and dairy. Avoiding foods high in hormones and inflammatory fats also
appears to be important in endometriosis pain management. Eating foods high in
indole-3-carbinol, such as cruciferous vegetables appears to be helpful in
balancing hormones and managing pain.
However, these popular claims are typically not supported by scientific
studies. According to one scientific study, diets high in fat and low in fruit
and β-carotene
were associated with a lower risk of endometriosis, contradicting the typical
idea of a healthy diet. Consumption of omega 3 fatty acids, particularly EPA,
as a food supplement has been suggested as a therapy for endometriosis. Use of
soy has been reported to both alleviate pain and to aggravate symptoms, making
its use questionable.
Physical therapy for pain
management in endometriosis has been investigated in a pilot study suggesting
possible benefit. Physical exertion such as lifting, prolonged standing or
running does < pelvic pain.
Use of heating pads on the
lower back area, may provide some temporary relief. Laboratory studies indicate
that heparin may alleviate endometriosis-associated fibrosis.
Vaginal childbirth decreases recurrence of endometriosis. In contrast,
endometriosis recurrence rates have been shown to be higher in women who have
not given birth vaginally, such as in Cesarean
section.
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