Menstrual pain that makes it difficult to get pregnant is called Endometriosis

Endometriosis is a benign, estrogen-dependent inflammatory disease characterized by the presence of ectopic endometrial implants. The most common predilection for endometriosis is the ovaries, followed by the anterior/posterior cul-de-sac, broad and uterosacral ligaments, uterus, fallopian tubes, sigmoid colon and appendix. Endometriosis is a chronic inflammatory disease in women of reproductive age and can cause pain and infertility.

 

The pathogenesis of endometriosis can be explained by several theories such as retrograde menstruation, immune changes, coelomic metaplasia, metastatic spread, stem cells, and the role of genetics.

 

In the theory of retrograde menstruation proposed by Sampson in the 1920s, it was proposed that endometrial tissue is transported retrograde through patent fallopian tubes into the peritoneal cavity. Endometrial cells then attach to peritoneal mesothelial cells, form a blood supply, proliferate and produce endometrial implants.

 

In the 1960s, Ferguson proposed the theory of coelomic metaplasia according to which the peritoneum contains undifferentiated cells that can differentiate into endometrial cells.

 

Meanwhile, in the theory of pathogenesis of immune changes, it is stated that women with endometriosis have changes in the immune system that prevent them from clearing reflux cells/endometrial fragments that appear in retrograde menstruation. This may explain why some women with retrograde menstruation develop endometriosis while others do not. Cell-mediated immunity is thought to be deficient in patients with endometriosis, as a result of which leukocytes cannot recognize that endometrial tissue is not in its normal location. There are also studies showing decreased cytotoxicity in endometrial cells secondary to impaired NK cell activity. Once endometriosis has formed, the body's immune system also potentiates the development and increases the severity of endometriosis. In women with endometriosis, there is an increased number of leukocytes and macrophages in and around the endometrial implant and in the peritoneal fluid. These cells secrete cytokines and growth factors (IL-1,6 and 8, TNF, RANTES, VEGF) into the peritoneal environment, which in turn recruits capillaries and surrounding leukocytes leading to proliferation of endometrial implants with increased vascular supply.

 

Endometriosis causes fertility problems through mechanical disturbances such as adhesions, impaired release or retrieval of oocytes, impaired sperm motility, irregular myometrial contraction disorders, impaired fertilization and embryo transport, and inflammatory disorders.

 

The gold standard for diagnosing endometriosis is laparoscopy. On ultrasound, the picture of the endometriosis cyst shows a ground glass appearance. To determine the degree of endometriosis, the endometriosis infertility index developed in 2010 can be used which has an association with pregnancy rates (Figure 1).

 

Figure 1. Endometriosis Fertility Index

 

Drugs used as therapy for pain in endometriosis include the hormonal drug dienogest, combined oral contraceptives, progestins, danazol and gonadotropin-releasing hormone agonists or antagonists (GnRH analogues).

 

Surgical excision of endometriomas in women with subfertility is a controversial topic, given the risk of damage to the ovarian reserve. In terms of clinical effects, systematic review studies did not show the benefits of endometrioma surgery, either aspiration or cystectomy, on IVF results. 7 However, surgery may be considered if the endometrioma is large so that it interferes with the ovum pick-up procedure in IVF.

 

If Hermina's friends have symptoms as described, don't wait later, please immediately consult a Obstetrics and Gynecology Specialist at Hermina Podomoro Hospital.