What is suppressed ovulation

Endometriosis means "uterine lining disease". There is no slang term. Almost every tenth woman is affected by endometriosis, a benign growth of the lining of the uterus. It can be assumed that around 20% of all women of reproductive age suffer from it, often without knowing about the disease, even though endometriosis is usually associated with considerable pain and cuts in life and family planning.

Uterine mucous membrane on the wrong track
Endometriosis is a disease in the course of which tissue, which is similar in structure and function to the lining of the uterus, settles outside the uterus. Although the tissue is not absolutely identical, it is subject to the hormonal fluctuations of the female cycle. As a result, the migrating tissue reacts to the hormones of the ovary and nests of endometriosis form, which can cause cysts and adhesions. For example, small red or whitish nodules but also large black-brown cysts develop. The different manifestations of the tissue deposits make diagnosis difficult. Although the disease almost never becomes life-threatening, it is a chronic disease with a progressive character. The cysts and adhesions are benign and the risk of a malignant course is very low (less than 1%).

Complaints and symptoms
The main characteristic of endometriosis is severe pain that recurs every month. The symptoms that apply to around 50% of all women affected include:

  • Pain of varying degrees before and during menstruation in the abdomen and back
  • very heavy and / or irregular menstruation
  • Pain during or after intercourse
  • Radiation of pain in the legs
  • Pain during ovulation
  • Pain in bowel movements
  • Cramps and pain when urinating or when defecating

It is important that almost half of the women affected do not feel anything from their disease. Endometriosis is usually detected by chance during a gynecological examination or through a laparoscopy.

Manifestations of endometriosis
Depending on the occurrence of endometriosis, a distinction is made between different groups and forms.

Internal genital endometriosis:In this case, it is a matter of mucous membrane deposits on the internal genital organs (e.g. on the wall of the uterus). The term adenomyosis is also used in many cases. This is the most common form of the disease, which usually only occurs after the age of 35.

External genital endometriosis:Endometriosis settles outside of the genital organs, but within the small pelvis.

Extragenital endometriosis:This group includes endometriosis nests that appear in the vicinity of the small pelvis, but also in other areas of the body that are further away from the sexual organs (intestines, lungs, heart, urinary bladder).

The forms of endometriosis are so diverse that both diagnosis and appropriate treatment can be associated with many difficulties.

Endometriosis can cause infertility
The disease can, for example, show up during an examination due to the unfulfilled desire to have children, since endometriosis disrupts the functions of the fallopian tubes, ovaries and uterus. The inflammation that occurs in the course of endometriosis results in an increased release of macrophages (scavenger cells of the immune system). Ovulation is suppressed and the transport of the egg and its implantation in the uterus is prevented. As endometriosis nests grow into the wall of the fallopian tube, constrictions occur, which make the further transport of egg cells difficult or even completely impossible. Foci in the uterine muscles usually only appear from the age of 40. The uterus may be enlarged. Cysts are common in ovarian endometriosis. Often just a small focus on the ovary is the root of the problem. It bleeds with every menstruation. However, since the blood cannot drain away, it collects in the cyst. This can not only reach a considerable size, but the content thickens and discolored. There is severe pain just before and during the menstrual period.

Treatment of endometriosis
In general, treatment begins with a laparoscopy, during which it is often possible to destroy or remove part of the endometriosis foci (by coagulation). The findings indicate whether additional drug treatment is useful or whether further surgical steps need to be planned. Three substance groups are used in drug treatment:

  • Progestins
  • Danazol
  • GnRH analogs

Progestins simulate pregnancy and change the hormonal situation. Ovulation no longer takes place and the lining of the uterus recedes within six to eight weeks. Danazol acts on the pituitary gland, which acts as a control point for the production of hormones and stimulates the ovaries. The formation of estrogen is reduced and thus the stray uterine mucous membrane cells are put to a halt. GnRH stands for gonadotrophin releasing hormone. This completely blocks the pituitary gland and thus prevents the menstrual cycle. Danazol and GnRH analogs temporarily simulate menopause. The endometriosis tissue can no longer bleed and dries up over time. The treatment lasts up to six months and is mainly carried out with GnRH. The normal cycle then sets in within two to three months. Unfortunately, the endometriosis symptoms return in up to 66% of the women affected. In such cases, a second treatment is required.

Note: The risk of osteoporosis should be examined as part of a second treatment. Because the drugs (does not affect the progestins) reduce the mineral content of the skeletal system and increase the risk of bone loss. If only small foci of endometriosis are discovered, prescribing the pill is often sufficient. It reduces the body's own estrogen production and thus the decline in stray tissue (mini and micro pill).

Waiting for Menopause?
Drug therapy for endometriosis is rejected by many women and the symptoms are accepted. You are simply waiting for menopause and the end of the hormonal cycle. But women who get sick very early and suffer from menstrual pain are hardly helped. Depending on the stress caused by the symptoms, a therapy concept should be drawn up in a detailed discussion with the treating gynecologist. This is especially true for young girls and women who suffer from menstrual cramps before the age of 15 and up to the age of 20. If young girls complain of severe menstrual discomfort, they must be taken seriously and examined!

With this information, the professional association of gynecologists would like to draw attention to a widespread clinical picture for which there are no causal opportunities for a cure, but a clear alleviation of the symptoms.

Maria-E. Long-serious