Endometriosis is so far one of the health problems that is a very scary scourge for a woman. Endometriosis is a fertility disorder that can reduce a woman's chances of conceiving. Even so, that does not mean that endometriosis cannot be controlled, with proper treatment the effects of endometriosis can be minimized so that the chances of getting pregnant can increase.
What is endometriosis?
Endometriosis is an inflammatory disease in which endometrial tissue or the inner wall of the uterus is found where it shouldn't be, it can be in the ovaries, uterine muscles, lining of the pelvic wall and other organs. This disease is characterized by pain during menstruation or pain during intercourse. Other symptoms that can occur are profuse menstruation, chronic pelvic pain, buttock pain, blood in the stool or urine during menstruation and pain radiating from the lower abdomen to the top or back.
Endometriosis can be divided into stages I-II and stages III-IV where in stages I-II, endometriosis is found only in the form of endometriosis patches on the abdominal wall or pelvis while in stages III-IV endometriosis is found in the form of endometriosis cysts in the ovaries or adenomyosis in the muscles womb. Stage I-II endometriosis cannot be seen by transrectal or transvaginal ultrasound or even MRI. Diagnosis of endometriosis stages I-II can only be done through a laparoscopic procedure where a camera is inserted through a 1 cm hole in the abdomen to be able to see patches of endometriosis on the abdominal wall or pelvis. So for patients with symptoms of severe menstrual pain but no abnormalities are found through an ultrasound examination, it is not certain that there is no endometriosis.
Endometriosis pathologically the cells are still benign even though the nature of endometriosis is like cancer where the disease spreads and infiltrates inside to make access to the abdominal and pelvic walls and other organs. Endometriosis that grows in the ovaries becomes endometriosis cysts or chocolate cysts. Endometriosis that grows in the uterine muscle becomes Adenomyosis. Adenomyosis is often suspected of myoma or fibroid. Clinically both are lumps or tumors that grow in the uterine muscle. But the appearance of ultrasound and its properties are much different. Myomas are clearly demarcated apart from the surrounding uterine muscle so that surgical removal of myomas can be ensured to be clean while Adenomyosis has unclear boundaries because adenomyosis cells infiltrate into normal uterine muscle cells so that removal of adenomyosis can never be completely clean and results in a high recurrence rate very. Therefore the definitive operation for adenomyosis is to remove it along with the uterus to make sure it will not recur.
Why does endometriosis make it difficult for women to get pregnant?
There are several things that cause this, including:
- Endometriosis reduces the quality of the eggs.
One theory of endometriosis is the accumulation of free radicals and peritoneal fluids that are toxic to the embryo and egg. Free radicals that are triggered by exposure to environmental pollutants greatly affect the quality of egg cells so that it has an impact on difficulty of fertilization or poor quality of pregnancy (blighted ovum or pregnancy that does not develop). - Endometriosis causes changes in the normal anatomy of the reproductive organs.
The basis of endometriosis is inflammation or inflammation. From this inflammatory process, inflammatory mediators will be produced which will cause adhesions to the reproductive organs. It can be in the form of blockage of the fallopian tubes, sticking of the ovaries to the back wall of the uterus and intestines, causing obstructions to the egg cells meeting with sperm for fertilization in the fallopian tubes. - Endometriosis reduces egg cell reserves (Ovarian Reserve).
Not only the quality, but the quantity of egg cells also decreases with endometriosis, especially with the appearance of endometriosis cysts in the ovaries because the growing cysts cause more pressure on healthy eggs. The indication for surgery is if the size of the cyst is above 4 cm. Surgical removal of cysts can be carried out using minimally invasive or laparoscopic principles, namely by making a small hole (0.5-1 cm) in the stomach, treating it for only 1 day and being able to return to normal activities the next day. Do not wait for the cyst to be removed until it is very large, because if the cyst is already very large, only a small amount of healthy ovarian tissue can be left, which means that there are only a few healthy egg cells left for sperm to fertilize, which will make it difficult for pregnancy to occur. Endometriosis cysts without therapy will not go away on their own but will enlarge as the disease progresses. - Endometriosis is a disease throughout the reproductive age.
This disease will continue to develop as long as the patient is still menstruating and still in reproductive age, not yet menopausal. This disease will stop temporarily if the patient stops menstruating (pregnancy or menopause). Regardless of the therapy, whether surgery or drugs, endometriosis will always recur. Therefore, pregnancy must be sought, not waiting, competing with the recurrence of the disease. It must be realized that the high recurrence rate for all endometriosis is related to its infiltration and spread, so that no therapy can cleanly eradicate these endometriosis cells, especially if exposure to environmental pollutants (chemicals, plastic contamination, cigarette smoke and vehicles, preservatives) and dyes, junk food and processed meats including hormone-injected meats) are not avoided.
What is the recommended therapy for endometriosis?
Endometriosis therapy is divided into 2 groups, namely operative therapy and drugs. Any therapy taken cannot prevent recurrence of the disease, only delays or prolongs the time of recurrence. The type of therapy taken depends on the patient's fertility desire (whether or not you want to get pregnant), the patient's age, and the severity of the disease.
For patients who still want to get pregnant, conservative therapy by maintaining a healthy uterus and ovaries is an option. The procedure for removing cysts and other endometriosis lesions using a laparoscope is the best procedure because the endometriosis lesions can be visualized more clearly with this procedure so that the removal of endometriosis lesions can be done more cleanly compared to ordinary surgical procedures. For patients who do not want to get pregnant again, radical therapy is an option to prevent high recurrence rates. Depending on the location of the endometriosis lesion, surgical removal of the uterus (in cases of adenomyosis) or removal of the ovaries (in cases of recurrent endometriosis cysts) can be performed.
Drug therapy is only temporary and very limited because it has several side effects. Drug therapy creates an "artificial pregnancy" condition by administering hormonal drugs such as birth control pills and the hormone progesterone. Or create an "artificial menopause" condition by administering hormone-suppressing drugs that are limited to a maximum of only 6 months. As soon as the drug is stopped and menstruation returns to normal, the journey of endometriosis will also resume.
Conclusion: Endometriosis is an inflammatory disease that reduces the quality and quantity of egg cells and changes the normal anatomy of the reproductive organs, making pregnancy difficult.
Endometriosis is always developing and recurring regardless of any therapy given. Therefore, for patients who want to get pregnant, a pregnancy must be attempted with a pregnancy program, not waiting because they are competing with the recurrence of the disease. The combination of operative therapy with laparoscopy and hormone-suppressing drugs is the best choice of therapy at this time followed immediately with the pregnancy program.
After knowing all about endometriosis and its relation to difficulties getting pregnant in women, it's a good idea to start paying attention to the condition of your reproductive health and that of your loved ones. Don't forget to immediately check with your obstetrician (obstetrics and gynecology specialist) when you find problems related to your reproductive health conditions or those you love.
This article was written by dr. Caroline Tirtajasa, Sp.OG(K) (Obstetric and Gynecology Specialist at EMC Pulomas Hospital).