Cristina is now 42 years old and, for more than 20 years, her existence has been an obstacle course, faced with patience and courage, but not always with the hope of being able to be supported in the management of the pathology that twenty-two years ago had appeared in her life. She is an elementary school teacher, specialized in supporting roles and her days have often been punctuated by work commitments, but above all by physical pain, caused by an illness:endometriosis.
The diagnosis did not come immediately. To accurately identify this kind of disorder, many investigations are necessary and Cristina’s journey to arrive at a first certain answer has inevitably been long and tortuous. “Only after 8 years of research – says the woman – did the doctors come to the conclusion that it was endometriosis. A term that was totally unknown to me, an evil I knew nothing about, unlike now that I know what I am dealing with “.
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At the beginning of the disease, the doctors to whom Cristina had turned, had groped in the dark. The severe pain, often disabling, conditioned the social life of the woman, especially at the working level. She had ended up isolating herself a bit from everything, tired of having to justify herself in every context and of being believed up to a certain point. “After a while they began to consider me an antisocial person, but I couldn’t tell in detail, they wouldn’t even understand. In fact, I organized work and study based on my menstrual cycles, calculating the times to be sure enough to be able to carry out the commitments made. In people’s eyes, I was trying to be okay, not to be seen in pain, numb with painkillers. But I was getting worse ”.
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The pains, every month, were getting stronger and not related only to the time of the cycle, with headaches, nausea, muscle aches and chronic fatigue. “I carried out my work with dedication and professionalism – explains Cristina – but sometimes my body couldn’t do it and then I took sick days. I was even ashamed to call work to tell them I wasn’t going, or to the doctor to ask for a certificate. I knew what they thought. For them I had nothing, if not a little stress that caused all my discomfort ”.
Then the turning point. Finally a doctor realizes that it may be endometriosis. We soon arrive at the laparoscopic operation which confirms the hypothesis. “It’s been 11 years since that surgery and I have a different life. The pains have significantly decreased, I follow the treatment and prevention protocol that they advised me and I manage to manage myself well. I do not give up. Now I know what I’m dealing with and awareness is already a step forward ”.
Per endometriosis means the presence of endometrium, that is, the normal tissue that lines the uterine cavity and which gives rise to menstrual flow, in an anomalous seat compared to the natural one. This tissue, in the presence of pathology, goes to place itself outside the uterine cavity, usually in the female pelvis, causing inflammation, pain and infertility.
A disorder that affects 150 million women in the world, 14 million in Europe and 3 million in Italy alone. Science has chosen the month of March to encourage awareness of the disease and the 19th, in particular, will be the World Day dedicated to endometriosis which begins to manifest itself after menarche, giving its first signs during adolescence.
The Dr. Almerindo Jacomuzzi, specialist in Gynecology and Obstetrics in Turin, explains that “the causes of the onset of endometriosis are not yet well known. There are three hypotheses: 1) A retrograde flow during the cycle whereby endometrial cells migrate through the salpinx into the peritoneum and are implanted here reacting to the hormonal stimuli of the ovary with monthly growth and bleeding. 2) The transformation of the peritoneal tissue in some areas into endometrial tissue. 3) An autoimmune action that is linked to genetic causes. The problem – continues the expert – begins with the onset of the menstrual cycle and ends with menopause. But in the meantime it can compromise the patient’s fertility. Not in all cases, however, only if the inflammatory processes affect organs involved in the process of fertilization. With patent salpingus and ovaries only partially affected, fertility will only be compromised partially”
To operate the 42-year-old Cristina, the protagonist of the story, was the doctor Pietro Giulio Signorile, today president of the Italian Endometriosis Foundation, surgeon, specialist in Obstetrics and Gynecology, which explains how important a certain and timely diagnosis is. “Early diagnosis is very important because endometriosis progresses over time. In Western countries there is an unacceptable diagnostic delay of about 8 years from the first symptoms. Symptoms are often confused and underestimated, the patient undergoes gynecological examinations, MRI scans, ultrasound, blood tests for the search for markers. At the moment, a new diagnostic tool is also being tested through saliva, in a fast and non-invasive way. In the samples of women suffering from endometriosis, altered values of the protein Za2G (Zinc-Alpha 2 Glycoprotein), the most specific marker for the disease, and of the Complement C3 and Albumin (HSA) are detected. These results encourage us to continue in research and development to ensure that the test can become accessible to all women with endometriosis or who even suspect it ”.
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“The main symptoms – he explains Stately – are the pelvic pains, even devastating, especially in the cycle and ovulation phase, moments in which the disease produces more secretion which determines a strong local inflammation. Then there is the chronic physical fatigue, determined by the continuous work of the immune system committed to stemming inflammation “.
To combat the disorder, one can act through a specific diet and the intake of hormones. “Once you have the diagnosis – he says Stately – you can work on the excess of hormones that causes the disease to grow, which generates inflammation and inflammation causes more hormones to be produced. It is a spiral. For this reason we have been developing a diet based on four pillars for over 10 years: reduction of estrogen intake (eg soy); increase in antiestrogenic foods (eg fiber); reduction of pro-inflammatory foods; increase in anti-inflammatory foods (eg Omega3). In this way, hormones, inflammation and pain are reduced. It acts on the symptoms and on the disease by reducing the percentage of growth “.
“Certainly nutrition is of great importance in the management of this disease – he confirms doctor Jacomuzzi – for the anti-inflammatory characteristics of some foods. It is necessary to prefer vegetables, cereals, legumes and substances rich in omega 3 such as oily fish. Little red meat and saturated fat “.
On the surgical front, on the other hand, we intervene through laparoscopy. “The only possible therapy, and sometimes even definitive, is the removal of the disease through laparoscopic surgery – he says Doctor Signorile -. The indications concern patients who experience severe pain and who have infertility due to the disease. The intervention on the one hand completes the diagnosis, on the other hand it serves to remove all foci. It can be decisive but must be performed in specialized centers. The average hospitalization is two days, the recovery is quite immediate “.
Per doctor Jacomuzzi “Surgery is recommended in the case of large ovarian masses or locations that cause risks for other organs (ureter-bladder -rectum-sigma). It is difficult with surgery – the doctor clarifies – to have a result of complete healing in future perspectives and the intervention sometimes brings with it big complications “.
“The beginning of the menstrual cycle, characterized by a strong production of hormones, is a delicate moment and you have to pay close attention to the symptoms, for example very severe menstrual pain, a sense of exhaustion, recurrent intestinal disorders, gastric disorders, chronic pelvic pain are alarm bells – warns Doctor Signorile – the invitation is to go to the doctor for a gynecological examination “.
The specialist who takes care of the patient will also give indications on the type of therapy to follow, especially to stem the severe pain. “They are recommended – he explains doctor Jacomuzzi – All anti-inflammatory drugs for the control of menstrual pain that mostly lasts throughout the cycle, not just the first day. Then hormonal drugs that reduce menstrual flow or stop it for a few months. The non-stop pill and drugs called analogs that interrupt the flow for months, but which often have side effects. “
A recent project of the Italian Endometriosis Foundation is working on providing assistance to women suffering from the disease. Above all through a Community, born in January 2018, and today with 30,000 members. The disease has a strong impact on working, family and social life. Often there are pains in sexual intercourse that prevent normal couple activity and there is the problem of infertility. In addition, there may be cases of ‘brain fog’, cerebral fog, with amnesia and attention disorders. The Community supports patients through interactions and advice.
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