Endometriosis: symptoms and treatment

Likelihood of endometriosis increases with age

What is certain, however, is that the probability of developing endometriosis increases with the number of menstrual days actually experienced. Because mucosal cells can shift with each individual bleeding, the likelihood of endometriosis is usually higher in older women than in younger ones. Even very long bleeding within the individual cycles can promote the development of endometriosis. In addition, endometriosis can spread further with each cycle, as bleeding in the abdomen in turn causes cells to shift and new foci to form.

Symptoms and complaints of endometriosis

Endometriosis generally particularly affects the abdomen and pelvis, such as the ovaries, uterine muscles as well as peritoneum, bladder and intestines. In rarer cases, the mucosal cells also settle in more distant organs, such as the lungs.

Depending on the location and size of the endometriosis foci, and also due to their quantity, four degrees of severity are distinguished. However, it should be noted that the severity does not necessarily say anything about the extent of the complaints. Not every endometriosis results in physical discomfort and, conversely, even a few endometriosis foci can cause severe pain. Since the disease proceeds differently in every woman, the symptoms also differ greatly from each other.

• Severe abdominal or back pain often occurs immediately before, during and immediately after the period.
• Heavy or irregular menstrual bleeding as well as intermittent bleeding or spotting can also be the result of endometriosis.
• If, on the other hand, the intestine or bladder are affected by endometriosis lesions, cyclical bladder or bowel cramps can occur.

Endometriosis as a cause of chronic conditions

However, a disease not only causes cyclical pain, but can also cause chronic conditions caused by the bleeding of endometriosis foci in the abdomen. Since the blood cannot drain out of the uterus, as in menstruation, it is partially absorbed and broken down by the surrounding tissue. In the process, however, this tissue becomes irritated and inflamed. The inflamed areas may cause adhesions and scars during healing. As the process repeats itself monthly, these impairments worsen and lead to cycle-independent pain, such as an unpleasant, permanent pulling in the abdomen.

Another problem with bleeding in the abdomen is that not all the leaking blood can be absorbed by the tissue. From the remaining blood, cysts are formed, which are also called “chocolate cysts” due to the color and consistency of the old blood. Depending on the location of these cysts, they can hinder the functioning of other organs. Many sufferers also complain of an impairment of general well-being due to listlessness, mood swings, bloating or persistent fatigue.

Effect of endometriosis on fertility

In the case of an unfulfilled desire to have children, endometriosis is the cause in about 25 to 30 percent. The disturbance of fertility can be caused in various ways.

• Fallopian tubes: Cysts that press on the fallopian tubes can cause constriction, preventing the egg from being transported to the uterus. The same effect also has adhesions and scars that stick to the fallopian tubes.
• ovaries: Cysts that have settled directly in the ovaries can interfere with egg maturation.
• Inflammation: Due to tissue irritation in the abdomen, the body increasingly releases inflammatory substances that can hinder egg maturation, ovulation or fertilization.
• Immune system: The foreign mucosal cells in the abdomen cause a defensive reaction that can also affect the implantation of the embryo in the uterus.
• Sexual intercourse: Depending on the location and size of cysts or endometriosis foci, severe pain can occur during sexual intercourse, so that this is hardly possible.

Other causes of infertility can also be, for example,ectopic pregnancy,OAT syndromeorhyperprolactinemia. You can read more about it in our posts.

Diagnosis of endometriosis

In Germany alone, around 30,000 women are newly diagnosed with endometriosis every year. Unfortunately, however, the disease is often discovered very late and rather by chance, as it has so many different manifestations. On average, six years pass between the appearance of the first symptoms, which is not synonymous with the onset of the disease, and the diagnosis.

Therefore, it is all the more important that any affected women carefully observe any pain that may occur and take their complaints seriously in order to enable the earliest possible diagnosis. Especially in the case of unwanted childlessness, for which there is no other explanation, endometriosis should be specifically examined, even if there are no physical complaints.

For the diagnosis, the affected person first conducts a detailed conversation with the gynecologist. The doctor may already be able to conclude from the described complaints on an existing problem. This is followed by a gynaecological examination in which larger endometriosis foci can be palpated or, depending on the location, seen within the uterine canal.

Through an ultrasound scan or another imaging technique, such as computed tomography or magnetic resonance imaging, endometriosis cysts in the ovaries can be detected. As a rule, they differ from other cysts by their special shape and uniform structure.

However, a truly reliable diagnosis, which must be the basis of successful treatment, is only possible through laparoscopy and a tissue sample taken in this way, a so-called biopsy. The procedure is performed under the patient’s anesthesia. With the help of a few small incisions in the navel, a kind of camera, the laparoscope, is inserted into the abdomen through it. Through further incisions in the lower abdominal area, the surgeon can insert instruments into the abdomen to thoroughly examine the tissue and take a tissue sample. The sample is evaluated under the microscope to make or confirm a diagnosis.

Treatment of endometriosis

The type of treatment for endometriosis depends on the extent of the disease. If there are very few endometriosis foci, the patient is symptom-free or has no desire to have children, treatment can be dispensed with for the time being if necessary and under regular medical supervision. This is also more common in women of advanced age, as endometriosis usually regresses on its own after menopause.

However, it should be noted that endometriosis can spread further and further if not treated. The symptoms and complaints can worsen significantly, which is why effective and consistent treatment is recommended. It is important that the treatment method is tailored very precisely to the respective patient.

• Drug treatment: Depending on the severity of endometriosis, it may be sufficient to suppress the pain and symptoms with special medications, such as anti-inflammatories. However, endometriosis itself is not treated in this way, which is why regular observation by the doctor is highly recommended.
• Surgical removal: If endometriosis is detected during the diagnostic laparoscopy, the attending physician can intervene immediately. The individual foci can be carefully cut out without injuring the surrounding tissue. Another possibility is to destroy the mucosal islets by laser beams or electric current. Only in very rare cases and in the case of a very severe infestation, the surgeon must remove the entire uterus as a last resort to stop endometriosis.
• Hormone therapy: Another option for treatment is hormone treatment lasting several months, which partially or completely suppresses ovarian function. The production of the cycle-regulating sex hormones estrogen and progestin is stopped or minimized and the endometriosis foci dry out as a result. However, the inhibition of hormone production temporarily leads to menopausal symptoms such as hot flashes, mood swings, loss of libido or osteoporosis. These side effects can be mitigated by a so-called add-back therapy by supplying the body with a small dose of estrogen as compensation.

Which therapy is used in a specific case depends on the personal situation of the woman. A combination of different types of treatment is also possible. The chances of success for recovery are usually very good with a consistently carried out treatment, even spontaneous pregnancies are possible. In some cases, however, despite the removal of the endometriosis foci, artificial insemination is necessary in order to be able to fulfill the desire to have children. Unfortunately, a recurrence of endometriosis cannot be ruled out. A regular examination by the gynecologist is therefore highly recommended.

Find out more about other causes of childlessness in our “Infertility” section, how you can prepare for a visit to the doctor and how to deal with the diagnosis.