Endometriosis: Causes and Treatment

Endometriosis is a condition in which the tissue that normally lines the inner cavity of the uterus (womb) grows, for various reasons, outside the uterus on the ovaries, fallopian tubes and other tissues and organs in the pelvis, causing clinical problems—above all pain and painful intercourse—that reduce the patient's quality of life. Although the exact mechanism of the disease is not fully known, it is thought to develop when menstrual blood flows backward through the tubes into the abdominal cavity, or through the transformation of cells in the peritoneum, the membrane lining the abdominal cavity.

When endometriosis settles on the ovaries and forms a cyst, it is known as an endometrioma (chocolate cyst).

What Are the Symptoms of Endometriosis?

• Pain, painful periods (dysmenorrhea): The main symptom of endometriosis is pelvic pain that often worsens during menstrual periods. The pain may become more severe over time, but its severity does not always match the extent of the disease. Very small endometriosis lesions can sometimes cause more severe pain than widespread ones.
• Painful intercourse
• Severe pain during bowel movements and/or urination
• Infertility
• Other symptoms: Fatigue, diarrhea, constipation, abdominal bloating and nausea are common complaints. These symptoms tend to flare up during menstruation.

Endometriosis can be confused diagnostically with other causes of chronic pelvic pain, such as pelvic inflammatory disease and ovarian cysts. With early diagnosis and a multidisciplinary approach, symptoms can be better controlled.

Risk Factors for Endometriosis

• Never having given birth
• Having a first period at an early age
• Reaching menopause at a later age
• Shorter intervals between periods
• Heavy periods lasting more than a week
• Exposure to high levels of estrogen
• Low body mass index
• Having one or more close relatives (mother, sister, aunt) with the disease
• Abnormalities of the reproductive system

Endometriosis usually develops a few years after menstruation begins. Symptoms may improve temporarily during pregnancy and often resolve completely after menopause.

Complications of Endometriosis

• Infertility: Infertility can occur in 30–50% of patients with endometriosis. Patients diagnosed with endometriosis who wish to become pregnant in the future are advised not to delay.

• Ovarian cancer risk: Although the risk is very low, these patients still require close follow-up.

Diagnosing Endometriosis

• Gynecological examination

• Ultrasound: Transvaginal ultrasound in particular is an important diagnostic tool.
• Magnetic resonance imaging (MRI): Useful for identifying endometriosis lesions, especially in patients for whom surgery is planned.
• Laparoscopy: Can be used both for diagnosis and for treatment.

Treatment of Endometriosis

Medical Treatment Options:

• Pain management: Painkillers are used to relieve the patient's pain. If pregnancy is not planned, hormonal treatment may be used alongside painkillers.
• Hormonal therapy: These treatments help slow the progression of the disease and prevent new lesions from forming. For this purpose, continuous use of oral contraceptives (birth control pills), progesterone therapy or gonadotropin-releasing hormone analogs may be considered.
• Infertility treatment: IVF methods may be used.

Surgical Treatment Options:

• Removal of the uterus together with the ovaries.

Some simple measures, such as warm baths and hot water bottles, can help ease the pain. Some patients benefit from acupuncture.

What to Keep in Mind When Going to Your Doctor's Appointment

• Write down your signs and symptoms.
• List the medications you take, including herbal products and vitamin supplements.
• Going with a relative will both support you and help you remember anything you forget.
• Write down the questions you plan to ask your doctor.