Endometriosis: what is it and how can we have a diagnosis?

Endometriosis is a chronic disease, related to female hormonal activity and manifested by the presence of endometrial tissue outside the uterine cavity. This ectopic tissue has the same cyclical activity as uterine endometrial tissue, so that throughout the menstrual cycle it can produce painful symptoms due to the bleeding inside endometriotic implants. Thus, endometriosis symptoms can range from absent or very mild discomfort to disabling pain for women who have it.

Painful manifestations appear mainly during the menstrual period or during sexual intercourse, and can interfere with many aspects of daily life.

The causes that origin endometriosis are not established. Retrograde menstruation theory says that which menstrual blood would pass into the peritoneal cavity through the tubes. Another theory explains its appearance from the coelomic epithelium, explaining the presence of implants in more inaccessible places, such as the inguinal canal or the abdominal wall. Genetics has also been involved in the etiology of endometriosis. It is known that having an affected first-degree relative increases the risk of endometriosis between 5 and 8 times.

Its diagnosis is not always easy and many women have to suffer years until they are correctly diagnosed. Fortunately, today some techniques allow an earlier diagnosis such as magnetic resonance imaging and tumor marker tests or transvaginal ultrasound with or without 3D imaging. However, a certitude diagnosis can only be obtained after endometriotic implant biopsy, which is obtained through abdominal surgery, either by laparotomy or laparoscopy.

Some studies have tried to find a relationship between endometriosis and various biomarkers obtained from plasma samples collected during menstruation. Annexin V, VEGF, CA 125 and sICAM-1 or glycodelin are some of the biomarkers that allowed the diagnosis of patients with endometriosis undiagnosed by ultrasound, with a sensitivity close to 90%.

The correct diagnosis of endometriosis allows, on the one hand, the treatment of the patient so that the symptoms that she presents are reduced to a minimum and, on the other hand, the planning of her reproductive future, since endometriosis can significantly impair fertility of women who suffer from it.

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