Endometriosis
Endometriosis is a chronic inflammatory condition where tissue similar to the uterine lining grows outside the uterus — causing pain, adhesions and often difficulty conceiving.
Symptoms of endometriosis — when to be concerned
Symptoms vary depending on the location and extent of the implants. Many women live for years with pain dismissed as "normal" when in fact it needs evaluation.
- Dysmenorrhea: Severe period pain that does not respond to common painkillers — the most common symptom.
- Chronic pelvic pain: Discomfort or pain in the pelvis that persists beyond the days of menstruation.
- Dyspareunia: Pain during sexual intercourse, especially with deep penetration.
- Constipation or abdominal pain during the menstrual period, when implants are present on the rectum.
- Frequent urination or pain during urination, when endometriosis affects the bladder.
- Infertility: In women struggling to conceive, endometriosis is found in 20–50% of cases.
- Fatigue, bloating and gastrointestinal disturbances around the menstrual period.
Causes and risk factors
The exact causes are not fully understood. The most widely accepted theory is retrograde menstruation, but genetic predisposition and immune factors also play a role.
- Family history: Significantly increases the risk — endometriosis runs in families.
- Short cycle (<27 days) or prolonged period (>7 days).
- No prior childbirth or first pregnancy at an older age.
- Low BMI — associated with certain forms of endometriosis.
- Reproductive tract abnormalities that obstruct normal menstrual flow.
Treatment of endometriosis — options depending on symptoms
There is no definitive cure. The goal is symptom control, improvement of quality of life and preservation of fertility. The strategy is individualized based on age, stage, symptoms and desire for children.
- Hormonal therapy: Oral contraceptives, progestins or GnRH agonists reduce implant growth and pain.
- Mirena IUS: Progesterone-releasing intrauterine device — effective for dysmenorrhea and chronic pelvic pain.
- Analgesics / NSAIDs: Supplementary management of period pain.
How endometriosis is diagnosed
Diagnosis is often delayed 7–10 years from the first symptoms. Early evaluation by a specialized gynecologist reduces this delay and prevents complications.
- Clinical examination: Bimanual palpation to identify tenderness, nodularity or palpable implants.
- Transvaginal ultrasound: Detects endometriomas ("chocolate cysts") and deep implants — first-line imaging.
- Pelvic MRI: Necessary for mapping deep infiltrating endometriosis (rectum, ureter, bladder) before surgery.
- Laparoscopy with biopsy: The gold standard for definitive histological confirmation — both diagnostic and therapeutic.
Tests for assessment of extent and fertility
Beyond imaging, the impact of endometriosis on fertility and adjacent organs is assessed.
- CA-125: May be elevated in severe endometriosis — useful for monitoring, not diagnosis.
- AMH (Anti-Müllerian Hormone): Assessment of ovarian reserve, especially in the presence of endometriomas.
- Hysterosalpingography or laparoscopic tubal patency testing: In women with difficulty conceiving.
- Cystoscopy / sigmoidoscopy: When bladder or rectal involvement is suspected.
Stages of endometriosis
Endometriosis is classified into 4 stages (I–IV) based on the extent, depth and location of implants and adhesions. The stage does not always correlate with pain intensity — women with stage I may have severe pain, while stage IV may sometimes produce minimal symptoms.
- Stage I (minimal): Isolated superficial implants, no adhesions.
- Stage II (mild): More and deeper implants, few adhesions.
- Stage III (moderate): Multiple deep implants, ovarian endometriomas, characteristic adhesions.
- Stage IV (severe): Extensive deep implants, large endometriomas, dense adhesions — often affecting the rectum, ureters and bladder.
Surgical treatment of endometriosis
Surgery is indicated when hormonal therapy is insufficient, when endometriomas or deep infiltrating disease are present, or when endometriosis affects fertility.
- Laparoscopic excision of implants: Removal of all visible lesions — better outcomes for pain and fertility compared to ablation alone.
- Robotic excision of deep endometriosis: For complex implants (rectovaginal septum, ureters, bladder) — high precision, lower risk of damage to adjacent organs.
- Laparoscopic cystectomy of endometriomas: Removal of "chocolate cysts" with ovarian preservation — in women of reproductive age.
- Surgery + IVF: Combined approach in cases of severe endometriosis with infertility.
Prevention of recurrence and long-term follow-up
Endometriosis tends to recur. Long-term hormonal therapy after surgery reduces the risk of recurrence, while regular follow-up allows early detection.
- Maintenance hormonal therapy after surgery to reduce recurrence.
- Ultrasound every 6–12 months to monitor for endometriomas.
- Annual evaluation of symptoms and quality of life.
- Women who wish to conceive: Early fertility assessment — do not delay.
Symptoms
Symptoms vary depending on the location and extent of the implants. Many women live for years with pain dismissed as "normal" when in fact it needs evaluation.
- Dysmenorrhea: Severe period pain that does not respond to common painkillers — the most common symptom.
- Chronic pelvic pain: Discomfort or pain in the pelvis that persists beyond the days of menstruation.
- Dyspareunia: Pain during sexual intercourse, especially with deep penetration.
- Constipation or abdominal pain during the menstrual period, when implants are present on the rectum.
- Frequent urination or pain during urination, when endometriosis affects the bladder.
- Infertility: In women struggling to conceive, endometriosis is found in 20–50% of cases.
- Fatigue, bloating and gastrointestinal disturbances around the menstrual period.
The exact causes are not fully understood. The most widely accepted theory is retrograde menstruation, but genetic predisposition and immune factors also play a role.
- Family history: Significantly increases the risk — endometriosis runs in families.
- Short cycle (<27 days) or prolonged period (>7 days).
- No prior childbirth or first pregnancy at an older age.
- Low BMI — associated with certain forms of endometriosis.
- Reproductive tract abnormalities that obstruct normal menstrual flow.
There is no definitive cure. The goal is symptom control, improvement of quality of life and preservation of fertility. The strategy is individualized based on age, stage, symptoms and desire for children.
- Hormonal therapy: Oral contraceptives, progestins or GnRH agonists reduce implant growth and pain.
- Mirena IUS: Progesterone-releasing intrauterine device — effective for dysmenorrhea and chronic pelvic pain.
- Analgesics / NSAIDs: Supplementary management of period pain.
This information is for educational purposes and does not replace medical advice. For diagnosis and personalized treatment, book an appointment.
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