Endometriosis is one of those mysterious cases in gynaecology classified by the presence of normal uterine lining growing outside the uterus, specialist obstetrician-gynaecologist Dr David Emvula has said.
During a recent engagement session with Namibia Medical Care, Emvula stated that endometriosis causes internal organs such as the intestines and uterus to be attached, adding that endometriosis has a variable range of manifestations – from accidentally-found asymptomatic lesions to a severe condition, which does not depend on the size of the lesion.
“It is a mysterious condition. We do not understand pathogenesis or how it starts, but we believe it has to do with the menstruation that goes through the fallopian tubes, which open into the inside of the peritoneum. Subsequently, these then start growing outside of the uterus,” he stated.
He added that why some women develop this condition and not everyone is still a mystery. But there are theories of some form of genetic linkages found in mothers, daughters or siblings.
“It may be linked to genetics, but when it comes to lifestyle, it is not established if there is any lifestyle associated with the condition. All we know is that some menstruation goes into the abdomen, but more studies are going on,” he stated.
Emvula highlighted that symptoms include chronic pelvic pain that is present in most women. “This is the pain situated in the lower part of the abdomen, and this is usually present throughout, and gets worse during the menstruation period,” he said.
Women experience infertility or failure to conceive, and another common symptom is pain during sex.
“When a woman is having sexual intercourse, they tend to have pain, to a point where they require their partner to stop. Some have a form of bleeding after intercourse; they vary, and some women are asymptomatic and may not have any symptoms,” stated Emvula.
Although clinicians do not understand the condition, he said some of the misconceptions are centred on social behaviour, and the use of contraceptives or medication.
“Another misconception is infertility. It doesn’t mean that if a woman has endometriosis, they cannot conceive or not reproduce. With treatment, they will be able to either conceive naturally, or require assisted reproductive technology,” he added.
The Windhoek IFV Clinic states that in cases where there is obvious disruption of the normal anatomy, endometriosis is a known cause of fertility problems. Between 30-40% of patients with endometriosis are infertile. This is two to three times the rate of infertility in the general population.
“In patients with endometriosis, the monthly fecundity (chance of getting pregnant) decreases by 12-36%. However, the long-term cumulative pregnancy rates are normal in patients with minimal endometriosis and normal anatomy. Studies provide contradicting information, but the bulk of research currently indicates that pregnancy rates are not improved by treating minimal endometriosis,” states the clinic on its website.
It further explains that endometriosis is commonly found in the cul-de-sac (behind the uterus), the rectovaginal septum (the tissue between the rectum and vagina), on the surface of the rectum, the fallopian tubes and ovaries, the uterosacral ligaments, the bladder, and the pelvic side wall.
Generally, endometriosis in the rectovaginal septum is more likely to deeply invade the underlying structures.
“Some researchers suggest that the woman’s body may form antibodies against the misplaced endometrial tissue. The same antibodies may attack the uterine lining and cause a high spontaneous abortion rate: up to three times the normal rate.
Fortunately, removing the endometriosis with medication or with surgery will reduce this risk to normal.”
The clinic says the normal tissue surrounding the endometriosis implant becomes puckered and ischemic (suffering from lack of oxygen), causing pain similar to that from a heart attack.
Attacked over a prolonged period, the fallopian tubes may become inflamed and swell shut.
Blocked by adhesions, the tubes can no longer provide safe passage for egg, sperm and embryo.
Ectopic pregnancies become a real danger: up to 16 times more likely than the normal population.