DOMINIKA JASIŃSKA-STASIACZEK, MD
Endometriosis & Adenomyosis
Endometriosis is a common condition where a tissue similar to the lining of uterus grows in other places such as ovaries, peritoneum, pelvic organs like rectum, bowel, ureter or bladder and even other organs for example diaphragm, lungs, brain, stomach, heart.
The exact number is difficult to estimate due to a delay in diagnosis of 7-10 years. The patients suffers from severe pelvic pain which is often linked with menstrual periods. The disease has a major impact on the fertility of affected women. It is known that men can also suffer from this disease, however it is a very rare situation
It affects more than 10-12% (190 million) of reproductive age women and about 50% of infertile women globally.
Adenomyosis occurs when the tissue that normally lines the uterus (endometrial tissue) grows into the muscular wall of the uterus. It can cause no symptoms, but usually patients suffer from heavy menstrual bleeding, pain during menstruation (dysmenorrhea), chronic pelvic pain and pain during intercourse (dyspareunia). It is also well known that adenomyosis can affect fertility and may contribute to difficulties in the implantation of the embryo, causing miscarriages. Patients with endometriosis and/or adenomyosis have also worse pregnancy outcomes such as higher risk of preeclampsia, preterm birth or intrauterine growth restriction (IUGR). It is estimated that about 80% of patients suspected of endometriosis also have adenomyosis and conversely, 80% of patients with adenomyosis will develop endometriosis
There are studies which shows that also uterine fibroids/myomas coexist with endometriosis/adenomyosis in 70-80% cases.
The cause of these diseases remains unknown. they may have genetic origin, because they appear 6-8 times more often in mothers, daughters and sisters. However, the factors that activate these genes and the development of the diseases (epigenetics) are still undiscovered.
The theory of retrograde menstruation as the cause of developing endometriosis has been rejected. Currently, the theory about HOX genes methylation is interesting. Methylation is a phenomenon that commonly occurs during tissue regeneration, as a result of their hypoxia or during inflammation. HOX genes are responsible, among others, for the female reproductive organ development, including the endometrium. Studies have shown that changes in the methylation pattern of these genes contribute to the formation of endometriosis cells. This would explain the development of endometriosis in distant tissues such as the eye or brain, as well as endometriosis in men. However, it does not explain what factors cause these “wrong” methylation patterns. There is needed more research about this.
Dealing with more and more patients suffering from endometriosis and/or adenomyosis drove me to increase knowledge in this field. I perform pelvic floor ultrasound in endometriosis/adenomyosis diagnostics. I also do advanced laparoscopy surgeries in deep endometriosis and adenomyosis and continuously train myself in this area. I work in a hospital where together with our radiologists we created a professional MRI endometriosis diagnostic centre