Endometriosi ed alimentazione, esiste un legame? L’intervista all’esperto

Le donne affette da endometriosi sono molte, eppure la maggior parte di esse non sa nemmeno di esserlo: non riescono ad avere bambini e il più delle volte si accorgono della malattia solo durante la disperata corsa alla maternità. Secondo recenti dati Onu, la patologia colpisce 3 milioni di signore solo in Italia e oltre 150 milioni nel mondo. Ma come si diagnostica e soprattutto come si cura l’endometriosi? L’alimentazione può essere d’aiuto? Ne parliamo con l’esperto, il dottor Ettore Alemani, medico chirurgo specialista in Ostetricia e Ginecologia, dirigente medico  dell’Azienda Ospedaliera di Legnano.

Che cos’è l’endometriosi?

L’endometriosi è una patologia ginecologica benigna che accompagna l’età fertile della donna. E’ legata alla presenza del tessuto che riveste l’utero, l’endometrio, al di fuori del corpo uterino. Il risultato è il verificarsi di una “pseudo-mestruazione” in sedi diverse, per esempio a livello ovarico, con la formazione di cisti endometriosiche, o a livello peritoneale, con la presenza di noduli endometriosici diffusi. La diagnosi è essenzialmente istopatologica, cioè deriva dall’analisi del tessuto prelevato in corso d’intervento chirurgico. Occorre, inoltre, precisare che la malattia può evidenziarsi anche in distretti diversi, quali la vescica, il grosso intestino, i genitali esterni ed è stata riscontrata anche a livello polmonare.

Cosa causa la presenza dell’endometrio al di fuori dell’utero?

Con l’impianto endometriosico si vengono ad alterare le funzioni fisiologiche dell’organo colpito con ripercussioni cliniche importanti, cui si associa una reazione infiammatoria dei tessuti interessati. Restringendo il campo alle localizzazioni più frequenti (pelvi e genitali femminili interni), la malattia si esprime in modo molto variabile: si possono formare cisti ovariche (endometriomi), dette anche cisti a cioccolato, che durante il normale ciclo mestruale possono sanguinare nel loro interno, diventando sempre più grandi. Ma è possibile anche che si manifestino localizzazioni tubariche e/o del peritoneo pelvico con conseguente alterazione della funzione tubarica.  Non vi sono dubbi che le distorsioni anatomiche e le aderenze causate dall’endometriosi riducano in modo significativo il potenziale riproduttivo delle donne affette.

Quali sono i principali sintomi?

Il sintomo più frequente è la dismenorrea (80%), ovvero il dolore durante la mestruazione, seguono poi le algie pelviche (30%) e la dispareunia profonda (35%),  quest’ultimo è il termine con cui si indica il dolore durante i rapporti sessuali. Purtroppo però l’endometriosi è una malattia subdola, perché un aspetto particolare del comportamento clinico consiste nella totale asintomaticità che a volte accompagna anche gli stadi più avanzati.

Quali sono gli esami per accertare la malattia?

La visita ginecologica è sicuramente il primo approccio verso un sospetto di lesione endometriosica.  Poi si possono eseguire degli esami strumentali non invasivi, di grande aiuto, come l’ecografia trans addominale e trans vaginale, con cui è possibile individuare lesioni di pochi centimetri sia a carico dei genitali interni sia sul fondo vaginale. Molto importanti sono anche la risonanza magnetica e la laparoscopia, tecnica mini invasiva per la visione diretta della pelvi che, da una funzione puramente diagnostica, può brillantemente diventare terapeutica in quanto in grado di rimuovere le lesioni endometriosiche.

Come si cura?

Come abbiamo detto, la terapia chirurgica laparoscopica è sicuramente valida nella rimozione di lesioni ovariche, con concomitante riduzione delle formazioni aderenziali e distruzione di lesioni peritoneali. Ma non dimentichiamoci della terapia medica che è importante quanto l’atto chirurgico. I vari farmaci, attualmente proposti, hanno la funzione di ridurre l’incidenza della recidiva della malattia. I più utilizzati sono gli estroprogestinici in continuo (la pillola anticoncezionale), i soli progestinici assunti in vari dosaggi durante il mese e i farmaci iniettivi capaci di annullare l’attività ovarica inibendo in tal modo la produzione di estrogeni.

Esiste una relazione tra alimentazione ed endometriosi?

È stata dimostrata l’esistenza di una relazione tra igiene alimentare e insorgenza di malattie degenerative, mancano però ulteriori studi scientifici in grado di determinare l’esatta correlazione tra patologia in atto e modello alimentare.  Sicuramente un’equilibrata alimentazione e un giusto e regolare controllo della funzione intestinale favoriscono una vita sana e una minor incidenza di patologie croniche e degenerative.

Per quanto riguarda l’endometriosi, uno studio pubblicato su Human Reproduction dagli studiosi della Harvard Medical School di Boston ha messo in evidenza come il più elevato consumo di acidi grassi insaturi (Omega 3) riduca il rischio di endometriosi del 22%, mentre al contrario un eccessivo consumo di acidi grassi saturi “grassi cattivi” può aumentarlo del 48%. Il meccanismo per cui gli omega 3 siano favorevoli è da mettere in relazione con il metabolismo delle prostaglandine. Un’altra ricerca coordinata dall’Istituto Mario Negri ha, invece, dimostrato come le verdure a foglie verdi siano importanti nella riduzione di rischio.

Perché è meglio ridurre caffeina, alcol, cioccolato, grassi saturi, bevande ad alto contenuto di zucchero e carboidrati raffinati?

Le sostanze eccitanti di uso comune, come il caffè e le sigarette, andrebbero rispettivamente ridotte e abolite. L’abuso di caffeina e nicotina portano a un aumento dello stress psicofisico con ripercussioni importanti su tutti gli apparati. Bisogna moderare, inoltre, il consumo di alcol, cioccolato, grassi animali, carboidrati raffinati, latte anche se, nel lavoro dell’Istituto Mario Negri, non si è dimostrata una correlazione significativa per il rischio di endometriosi.  Favorevole è invece l’assunzione di fibre con la dieta, poiché oltre a regolare la funzione intestinale, contribuiscono alla riduzione del livello degli estrogeni circolanti, con minore impatto sui tessuti dipendenti. Pertanto è opportuno mettere alla base dell’alimentazione il consumo di cereali integrali, legumi, frutta e verdura, pesce, mentre è bene limitare le proteine di origine animale.

Quanto, invece, sono importanti le vitamine e che ruolo hanno nei casi di endometriosi?

Molto si legge sull’interazione del corretto apporto alimentare di vitamine e l’insorgenza di endometriosi, ma per poter definire quali gruppi siano realmente utili nella cura della malattia, occorrono altri studi prospettici, molto lunghi e complessi. Sicuramente bisogna favorire una dieta con abbondante frutta fresca e secca con guscio, come le noci, e le granaglie (i semi di lino e di girasole).

 

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1.083 commenti su “Endometriosi ed alimentazione, esiste un legame? L’intervista all’esperto”

  1. non sto ‘ prendendo piu’ la pillola perche mi dava dolore forte alla testa e da un po’ di tempo ho di nuovo dolore e gonfiore dalla parte sinistra. ho sempre la pnacia gonfia in basso.lanno scorso a giugno ho avuto in operazione di laparascopia che mi hanno tolto cisti , fibromi.aderenze dovute al cesareo avuto nel 2005 con la nascita delle mie figlie nate premature di soli 620 gr.tutto sono sicura che e’ dovuto a questa malattia anchre la nascita delle mie picciline che adesso hanno 6 anni e sono bellissime.presto faro’ una latra ecografia

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  2. cosa devo fare con questo dolore continuo e gonfiore? prendo il buscofen continuamente.puo’ darsi mi sia tornata e peggiorata?

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    • Ciao Francesca! Non possiamo far altro che consigliarti di sentire cosa dice il medico alla prossima ecografia. Il dolore e il gonfiore purtroppo sono sintomi piuttosto comuni in chi è affetta da endometriosi e solo con i necessari accertamenti potrai sapere se la situazione che hai affrontato lo scorso anno (cisti e aderenze) si è ripresentata e se è necessario intervenire. Per quanto ne sappiamo la terapia farmacologica dell’endometriosi ha fatto passi avanti quindi il medico potrebbe prescriverti qualcosa che non ti dia effetti collaterali come il mal di testa. Complimenti per le piccole e in bocca al lupo per tutto!

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