Endometriosis is an inflammatory disease that affects about 10% of women of reproductive age. In endometriosis, tissue similar to the uterine lining (endometrium) grows abnormally outside the uterus. Endometriosis most commonly causes pain, the localization of which depends significantly on where the endometriosis lesions are located.
Endometriosis occurs in different forms. Endometriosis localized in the ovaries is often called endometrioma or chocolate cyst. Deep endometriosis can be located in the uterine ligaments, in the bladder or bowel wall, while superficial endometriosis occurs as small foci on the peritoneum in the pelvis. In addition, adenomyosis, in which endometriosis tissue grows inside the uterine wall (sometimes called uterine endometriosis), is often classified as a form of endometriosis.
10 % of women of reproductive age suffer from endometriosis, this corresponds to an estimated 190 million women worldwide.
According to the WHO, receiving a diagnosis of endometriosis takes an average of 4–12 years.
According to estimations more than 25% of women experiencing infertility have endometriosis.
The most common symptom of endometriosis is severe and long-lasting menstrual pain, which often begins already before the menstrual bleeding. Other symptoms may include pain in the lower abdomen under the following circumstances:
Although these symptoms can be caused by conditions other than endometriosis, other symptoms of endometriosis may include:
Some patients may suffer from chronic, vague lower abdominal pain. However, endometriosis can also be almost asymptomatic and discovered by chance, for example, during infertility tests.
In cases of deep endometriosis, several organs may be affected, such as the intestines, the urinary tract, etc. This can lead to various symptoms, such as pelvic pain, pain when urinating, etc. Surgery for endometriosis can be complex in these cases and, therefore, the risk of complications is higher. If the endometriosis is very severe, it can affect nearby organs and cause serious renal and intestinal problems.
Endometriosis can be treated in various ways. The appropriate treatment for each woman depends on her symptoms and whether she wants to get pregnant in the future.
The medications used to treat it are:
During pregnancy, endometriosis patients usually feel well, but after childbirth it is a good idea to have a plan for restarting hormone treatment. Hormone treatment should be started no later than after breastfeeding ends, so that symptoms remain under control.
The diagnosis of endometriosis is suspected by the patient’s symptoms (chronic pelvic pain, pain with menstruation, urinary or bowel symptoms, difficulty getting pregnant) or by a physical examination.
In some cases, it may be useful to perform an appropriate imaging (ultrasound, MRI). The only way to know for sure if you have endometriosis is to perform surgery, remove endometrial tissue and have it analysed by a pathologist.
Endometriosis can make it difficult to get pregnant, but not all endometriosis patients suffer from infertility. It is estimated to be the cause of infertility in 25 % of our patients.
It is important to note that drug treatments for endometriosis effectively prevent pregnancy, so the treatment plan should be made individually not only to reach a pregnancy, but also to consider the treatment after pregnancy.
In mild forms of the disease, it is possible to wait whether pregnancy begins spontaneously after discontinuing hormone therapy. The symptoms of endometriosis may worsen rapidly after stopping medication, in this case it is worth discussing the situation and pregnancy prognosis with an infertility doctor. In more severe cases, IVF may be necessary soon after demanding surgery for endometriosis. Treatment plans and implementation should be carefully planned and implemented in collaboration with the treating physician /surgeon.
The mechanisms by which endometriosis causes infertility are controversial and depend partly on the degree of disease involvement.
There is no specific test to detect endometriosis, but it can be suspected through symptoms and a physical examination. In some cases, an imaging test (ultrasound or MRI) may be helpful. The only way to know for sure if you have endometriosis is to remove endometrial tissue through surgery and analyze it.
Endometriosis is a chronic benign disease that depends on hormones (estrogens). It is associated with a slight increase in the risk of certain types of ovarian cancer. This risk is significantly reduced with contraceptive treatment. No reliable diagnostic tests are available.
Surgery should be considered when chronic pelvic pain does not improve with medical treatment, when there are large endometriomas, and when endometriotic implants compromise the proper functioning of other organs such as the intestines or bladder. In some cases, surgery is performed to improve reproductive prognosis.
The aftereffects of surgery largely depend on which pelvic structures are affected and on the stage of the disease. Chronic pain may persist, genitourinary and intestinal injuries secondary to surgery may occur, or abdominal adhesions may develop (certain tissues or organs stick to each other).
Unfortunately, endometriosis cannot be prevented. However, treatment with contraceptives or hormones that discontinue the menstrual bleedings can slow its progression and alleviate the symptoms of the disease. In addition, it is known that women with endometriosis who become pregnant experience a significant improvement in their clinical condition.
The most significant development in recent years is that surgical indications have become increasingly limited. This helps preserve ovarian function and fertility in patients affected by the disease, since surgery greatly impacts ovarian reserve.
There is still a long way to go to fully understand this disease and thereby improve its treatment and prognosis.
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