Knife wounds in the belly every month
The long suffering of many women until they are diagnosed with endometriosis. What success therapies achieve, what supports the fight against the pain and how the wish to have a child can still be fulfilled.
“Unfortunately, it still takes an average of seven to ten years from the onset of symptoms to diagnosis,” explains Dr. Alina Staikov. Together with the Swiss Endometriosis Association, the gynaecologist has started an information project for which 28 women with this still unrecognised disease stood in front of the camera – each with her own story and emotions. The aim is to encourage other women. (“Love letters to my uterus” free download at www.gesundheit-heute.ch)
Dr Staikov, why is endometriosis still too little known?
One of the most common complaints of endometriosis is painful menstrual bleeding. Many affected women underestimate this. That is why they do not seek help immediately. However, the symptoms of endometriosis can be very different. If a woman complains of bladder or bowel problems but has no other symptoms, such as severe menstrual pain, this is not always considered a diagnosis. It is important that professionals pay more attention to this condition. Chronic and severe courses as well as impaired fertility could be avoided in this way. Endometriosis affects one in ten women of childbearing age.
What do women with endometriosis have to endure?
Endometriosis is a chronic disease of reproductive age, in which tissue similar to uterine mucosa is deposited in atypical places as endometriosis foci. The women suffer from severe menstrual pain, which they describe as knife wounds in the abdomen, and even fainting spells. They have chronic lower abdominal pain outside of their periods, pain during sexual intercourse, bladder and bowel problems. Sometimes such foci settle far outside the pelvis, such as in the lungs. The chronic pain is a great burden and considerably impairs daily life, even to the point of incapacity to work. These women are dependent on a great deal of understanding from their families and workplaces. A large proportion of women, up to 30 percent, suffer from infertility.
«These women are dependent on a great deal of understanding from their families and workplaces.»
How is endometriosis recognised and treated?
There is no simple test for endometriosis. The suspected diagnosis is confirmed with a laparoscopy. Endometriosis is a complex disease that also requires a complex therapy. Generally, surgery is necessary to remove the adhesions. In addition, hormone therapy and other supportive measures. However, neglected aftercare following surgery carries the risk of recurrence. Roughly speaking, a woman who does not receive therapy after the operation has a 50 percent risk of relapse after five years. An operation always depends on the age of the woman, her stage of life, the symptoms and findings. The same applies to hormone therapy. Does a woman want to have children or is she before the menopause?
What if there is a desire to have children?
Regarding endometriosis, it is particularly important that these women are actively approached at an early stage about their desire to have children. Because not only chronic inflammatory changes lead to organic causes, but also immunological mechanisms lead to a deterioration in egg quality. The area around the ovaries can be damaged and reduced in size, which naturally reduces the innate ovarian reserve. One form of endometriosis is adenomyosis, in which the lining of the uterus expands and pushes deep into the muscles. Up to 50 percent of all women who undergo fertility treatment suffer from endometriosis.
What else can a woman do to relieve the pain?
Nutritional counselling, alternative medicine such as TCM, physiotherapy and sports activities can support the fight against chronic pain. Psychological counselling helps to raise awareness and to work out mechanisms to break the vicious circle of pain and to strengthen all other therapies.
Should something also change in politics? Other countries are already further along.
Absolutely. In Germany, a 19-year-old woman is now calling for a national strategy for more education and research funding. After only a few days, more than 85,000 people have already signed the petition. France has also announced a national strategy. Switzerland also does research, but there is an urgent need for a national and, by extension, international strategy for awareness-raising, education, and research. I sincerely hope that we will soon achieve this awareness among the population and the professional communities. Even if the path of therapy takes a long time, timely, medical care can save a lot of quality of life – and save a lot of suffering.
Myomas: When nodes stand in the way of having a child
As with endometriosis, myomas – muscular nodules that form through the muscles of the uterus – are also observed to occur more frequently and to have a genetic predisposition. Hormonal influences and environmental factors also play a role. In the case of endometriosis, however, we are dealing with an organ-spreading course if no measures are taken and as long as the woman produces hormones. Myomas are a definable process. These nodes, which form inside and on the surface of the uterus towards the abdominal cavity or towards the uterine cavity, are not capable of damaging other organs. They remain in their capsule and can only grow. However, they do cause symptoms such as heavy and painful menstruation and blood intestines as a result. The fibroids are easily visible on ultrasound. The treatment depends on the size, type of fibroid, its location, growth tendency, desire to have a child and the woman’s stage of life. In the case of a large fibroid that may be interfering with fertility, surgery is indicated. It is also indicated for fibroids with a tendency to grow and symptoms such as heavy bleeding or pressure on the bladder with urinary urgency and incontinence, pressure on the bowel with digestive problems and constipation or pain during sexual intercourse. Depending on the size and stage of life, fibroids are removed by means of an abdominal or uterine endoscopy or by removing the uterus. If the fibroids are small, hormone therapy alleviates the symptoms and influences growth.
Danica Gröhlich is an editor for “GESUNDHEITHEUTE”, the Saturday evening health programme on SRF 1.
published: 23.02.2022, gesundheitheute
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