What is Endometriosis?
Endometriosis is a chronic gynecological condition in which cells similar to those that line the inside of the uterus (endometrium) grow outside of it. These lesions are most commonly found in the ovaries, fallopian tubes, and tissues surrounding the uterus, though they may also occur in other organs of the body.
A distinctive feature of the condition is that the extrauterine lesions behave like normal endometrium—they bleed every month during menstruation, causing inflammation, scarring, and chronic pain. However, since this blood has no outlet, it accumulates in the surrounding tissues, creating adhesions and cysts.
Endometriosis is one of the most common gynecological conditions and is estimated to affect 1 in 10 women of reproductive age worldwide. Despite its prevalence, diagnosis is delayed by an average of 7 to 10 years after the onset of the first symptoms.
Causes & Risk Factors
The exact causes of endometriosis have not been fully elucidated. The prevailing theory is that of retrograde menstruation, in which menstrual blood containing endometrial cells flows backward through the fallopian tubes into the pelvic cavity instead of being expelled normally. However, since this phenomenon is observed in many women who do not develop endometriosis, it is believed that the pathophysiology of the disease is multifactorial.
Other factors associated with the onset of the condition include prolonged exposure to estrogen, congenital uterine abnormalities that obstruct normal menstrual flow, as well as genetic factors.
Symptoms
The symptoms of endometriosis vary significantly from woman to woman.
Important: About 25% of women with endometriosis have no symptoms at all. This is why regular gynecological checkups are essential even when you feel well.
Pelvic Pain
This is the main symptom of endometriosis. It often occurs during menstruation and can begin up to a week before your period. The pain is caused by bleeding from endometriosis lesions during the menstrual cycle, which leads to inflammation and scarring of the surrounding tissues. In some cases, the pain extends to the lower back and lower extremities.
Dyspareunia
Pain during sexual intercourse is an equally common symptom of endometriosis and is often one of the first reasons a woman visits a gynecologist.
Menstrual Disorders
Endometriosis can cause heavy or irregular periods, spotting outside the menstrual cycle, and severe ovulation pain.
Gastrointestinal Symptoms
Some women experience diarrhea, constipation, or nausea, especially during menstruation. These symptoms are often mistakenly attributed to other conditions, resulting in a delayed diagnosis.
Chronic Fatigue
The chronic inflammation associated with endometriosis can cause severe fatigue that does not subside with rest and significantly affects quality of life.
Weight Gain
Some women with endometriosis experience weight gain, which is primarily linked to the hormonal dysfunction and chronic inflammation characteristic of the condition, as well as to reduced physical activity due to pain.
It is worth noting that the severity of pain is not necessarily correlated with the extent or stage of the disease. A woman with extensive endometriosis may have mild symptoms, and vice versa.
Diagnosis
Diagnosing endometriosis is one of the greatest challenges in gynecology. Its symptoms overlap with those of other conditions, and confirming the diagnosis requires specialized testing. This is why diagnosis is delayed by an average of 7 to 10 years after the first symptoms appear.
The diagnostic approach begins with taking a detailed medical history and performing a clinical examination, which can raise strong suspicion of the condition.
To confirm the diagnosis, the gynecologist performs specialized tests:
Transvaginal Ultrasound
A transvaginal ultrasound is the first diagnostic step—it can identify findings that indicate the presence of endometriosis, such as endometriotic cysts on the ovaries (endometriomas), signs of adenomyosis, or hydrosalpinx. However, ultrasound cannot detect small foci of endometriosis.
Magnetic Resonance Imaging (MRI)
Magnetic resonance imaging provides more detailed imaging and can detect even small lesions that are not visible on ultrasound. It is used as a supplementary test when there is a strong clinical suspicion of endometriosis.
Laparoscopy
Laparoscopy is the only way to definitively diagnose endometriosis. It is a minimally invasive surgical procedure during which the gynecologist inserts a small camera into the abdominal cavity and directly examines the tissues. During the procedure, a biopsy may be taken for histological confirmation, and endometriosis lesions can be treated surgically at the same time.
Treatment
There is no definitive cure for endometriosis, but there are effective treatment options aimed at relieving pain, slowing the progression of the disease, and preserving fertility.
The treatment plan is personalized and depends on the woman’s age, the extent of the condition, the severity of her symptoms, and her reproductive goals.
Pharmacological Management
Pharmacological treatment primarily aims to reduce pain and halt the progression of the condition. The gynecologist may choose between hormonal preparations such as hormonal contraceptives or progesterone medications, which suppress menstrual activity and reduce inflammation. Anti-inflammatory medications are also used to manage pain.
Medication is effective for pain relief, but it does not address the infertility associated with endometriosis.
Surgical Treatment
Laparoscopic surgery is the most effective option for both pain relief and improving fertility. During the procedure, the gynecologist locates and removes the endometriosis lesions, adhesions, and cysts. Complete excision of the lesions is associated with significantly lower recurrence rates compared to other surgical techniques. In the surgical treatment of endometriotic cysts, excellent surgical technique is of the utmost importance in order to minimize tissue damage and, consequently, reduce ovarian reserve.
It is important to know that endometriosis has high recurrence rates—estimated to exceed 20% within two years and reach up to 50% within five years. For this reason, post-surgical follow-up is essential.
Endometriosis and Fertility
The relationship between endometriosis and fertility is one of the most common concerns among women with the condition. It is estimated that about one-third of women who have difficulty conceiving have endometriosis; however, this does not mean that endometriosis inevitably leads to infertility.
How does endometriosis affect fertility?
The mechanisms through which endometriosis can affect fertility include anatomical distortions and adhesions that alter the pelvic anatomy, inflammatory activity that creates an unfavorable environment for gametes and embryos, as well as endometriotic cysts on the ovaries that may reduce ovarian reserve.
Natural Conception
Many women with endometriosis conceive naturally, especially when the condition is in its early stages. Surgical removal of endometriotic lesions and adhesions can significantly improve the chances of natural conception.
In Vitro Fertilization
In cases of extensive endometriosis or when natural conception is not achieved, in vitro fertilization is an effective option. Endometriosis can affect the response to ovarian stimulation; however, with an appropriate personalized protocol, the results are encouraging. Each case is evaluated individually by a specialized gynecologist.
Fertility Preservation
For women who do not wish to conceive immediately but are concerned about their future fertility, egg or embryo cryopreservation is an option worth discussing with their gynecologist before any surgical procedure.
Endometriosis does not mean you cannot have children.
With the right diagnosis, appropriate treatment, and specialized care, many women with endometriosis are able to fulfill their dream of becoming mothers.
Endometriosis During Menopause
Endometriosis is highly estrogen-dependent, which is why symptoms usually subside with the onset of menopause. However, in some cases, the disease may remain active—particularly in women with extensive disease that has not been adequately treated or in those receiving hormone replacement therapy, which can stimulate residual endometriosis lesions.
For this reason, women with a history of endometriosis who are considering hormone replacement therapy should discuss this with a specialist gynecologist. Regular check-ups remain essential even after menopause, as a link has been established between long-term endometriosis and an increased risk of certain forms of ovarian cancer.
Frequently Asked Questions (FAQ)
Lower back pain is a common symptom of endometriosis that is often overlooked or attributed to other causes. It occurs when endometriotic lesions are located in the ligaments that support the uterus or in the peritoneal cavity near the spine. The inflammation caused by these lesions during the menstrual cycle can radiate to the lower back and lower extremities.
Yes, in rare cases, endometrial cells can be transferred to the cesarean section incision during the procedure and grow there. This is a rare form of endometriosis that presents as a painful mass at the cesarean scar and usually manifests as cyclic pain associated with the menstrual cycle.
Endometriosis is a benign condition and, in the vast majority of cases, does not progress to cancer. However, in rare cases, a link has been documented with certain forms of ovarian cancer, primarily in women with long-standing and untreated disease. This is an additional reason why regular follow-up by a specialist gynecologist is essential.
The delay in diagnosis is due to a combination of factors. The symptoms of endometriosis, such as severe pain during menstruation, are often considered “normal” by the women themselves as well as by physicians. Furthermore, a definitive diagnosis requires laparoscopy, which is not recommended as the first diagnostic step. Raising awareness among both women and doctors is crucial for the early recognition of the condition.
Recovery after laparoscopic surgery for endometriosis depends on the extent of the procedure. Generally, most women return to their daily activities within 1 to 2 weeks, while full recovery may take up to 4 to 6 weeks depending on the complexity of the procedure. Your gynecologist will provide you with personalized recovery instructions.
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