According to World Health Organization data from 2021, endometriosis affects approximately 10% (or around 190 million in total) of women and girls of reproductive age worldwide.
This somewhat breaks the myth of endometriosis as a rather “exotic” female condition and raises the need for broader discussion, understanding and awareness of the nature of the condition.
Below you will find, in a short and structured form, the answers to the most important questions about endometriosis. Find out what it is, how it manifests and is diagnosed, how it is treated and how it affects women's quality of life and reproductive health.
What is endometriosis?
Endometriosis is a condition in which tissue similar to the endometrium (the tissue lining the inner wall of the uterus) begins to form and accumulate outside the uterus.
These atypical deposits – lesions and endometriotic foci – most often form on other organs inside the pelvis and abdominal cavity. The ovaries and fallopian tubes are often affected, and deep endometriosis can also affect the intestines, rectum, bladder and even the lungs.
Depending on its nature and extent, endometriosis can be observed in four different stages. These are minimal, mild, moderate and severe. The size, location and thickness of the lesions can vary, and in the most severe cases adhesions and accompanying cysts are observed.
Although it is considered a benign condition, endometriosis can be extremely painful. It can reduce quality of life and impair the level of reproductive health needed for easy conception.
What are the suspected causes of endometriosis in women?
The causes of the condition are still not fully understood, but there are various factors that specialists believe play a role in the development of endometriosis.
The spread of tissue and cells from inside the uterus to neighbouring organs may occur due to:
- Retrograde menstruation. In this condition, menstrual blood flows back through the fallopian tubes and into the pelvic cavity instead of out of the body. It contains endometrial cells that attach to the pelvic walls and the surfaces of the pelvic organs, where they continue to multiply.
- Transformation of peritoneal cells. The so-called “induction theory” suggests that hormones or immune factors promote the transformation of peritoneal cells – cells that line the inside of your abdomen – into endometrium-like cells.
- Transformation of embryonic cells. Hormones such as oestrogen can transform embryonic cells into endometrial cell deposits during puberty.
- Surgical incisions and scars. After operations such as a hysterectomy or caesarean section, endometrial cells can attach to the surgical incision and begin to form lesions and endometrial adhesions.
- Transport of endometrial cells. It is believed that blood vessels or the lymphatic system can also carry endometrial cells from the uterine lining to other parts of the body.
- Immune disorders. Acute, congenital or acquired problems with the immune system can also prevent the body from recognising and destroying endometrium-like tissue that has, for some reason, reached and is growing outside the uterus.
There are also additional risk factors in the development of endometriosis. These include early menstruation, late menopause, raised oestrogen levels in the body, deviations from a healthy weight and genetic predisposition.
Unfortunately, medicine cannot yet recommend a reliable protocol for preventing endometriosis. Still, the recommendations for a balanced diet and healthy physical activity are always a good start.
What are the typical symptoms of endometriosis?
The characteristic symptoms of endometriosis are so varied that diagnosis can take months or years. The reason is that some of the signs are mistakenly considered “normal”, while others point rather to different and better-known conditions.
That is why it is especially important to know and recognise the signs of endometriosis. The presence of more than one of them should be seen as a reason to consult a specialist in gynaecological and reproductive disorders.
The list of the most common symptoms at the different stages of endometriosis includes:
- Severe pain in the abdomen and back before and during menstruation
- Severe pain, cramps and discomfort during ovulation
- Chronic pelvic pain that worsens in sync with the menstrual cycle
- Urinary and bowel disturbances during the cycle, including pain, difficulty urinating, diarrhoea or constipation
- Digestive problems, bloating, gas and metabolic disturbances
- Deep pain during intercourse
- Hormonal imbalance and unexplained weight changes
- Reduced immunity and frequent genital and urinary tract infections
- Chronic fatigue, headaches and a tendency towards nervous disorders
- A prolonged low-grade fever with no apparent cause
- Formation of “chocolate” cysts in the ovaries
- Difficulty conceiving, complications in pregnancy and childbirth, etc.
As you can see, these symptoms can often be ignored or attributed to other conditions and diseases. This delays the treatment of endometriosis and can lead to various complications that permanently reduce your quality of life.
How is endometriosis diagnosed?
Diagnosing endometriosis is relatively easy when reliable equipment is available and an experienced specialist can interpret the results correctly. It is carried out in three main ways, namely:
- A standard gynaecological examination, in which endometriotic nodules are detected visually or by touch by the doctor;
- A transvaginal ultrasound examination, in which the characteristic “chocolate” or endometriotic cysts can easily be seen.
- Magnetic resonance imaging, which can track the formation of lesions and adhesions in all internal organs in the pelvis and abdominal cavity.
- Laparoscopy – an operation in which a camera (laparoscope) is inserted into the pelvis through a small incision near the navel, allowing the doctor to examine the pelvic organs for signs of endometriosis.
Of course, these methods are not mutually exclusive and can be used in various combinations at the discretion of the medical specialist.
How is endometriosis treated?
You have probably already wondered whether endometriosis is curable. The answer is more complex than “yes” or “no” and depends on many factors.
There is still no medicine that completely eliminates endometriosis in the sense that one is cured of a bacterium or virus. However, there are various types of non-invasive and invasive interventions that reduce symptoms and help women live with the condition without suffering from it.
These interventions are prescribed strictly individually by a specialist and may include:
- Medical treatment with oral contraceptives. They suppress menstrual bleeding and reduce episodes of severe and unbearable pain.
- Alternative hormonal therapies, suitable for women with contraindications to taking contraceptives. These may be gonadotropin-releasing hormone analogues or progestins.
- Surgical treatment through laparoscopic and open surgery, which can remove the cysts and adhesions in endometriotic foci when they are at an advanced stage.
Medical treatment and the invasive approach can give excellent results. To achieve this, it is important that they are tailored to the specifics of the case and carried out by a team with experience in the field.
Open surgical treatment often requires the involvement of a multidisciplinary team. The prescription of medication for endometriosis, in turn, may go through several phases until the optimal solution for the particular body is reached.
The holistic approach to the condition should not be neglected either. Through a balanced diet and lifestyle changes, many women manage to control both the symptoms and the spread of endometriosis.
Endometriosis and IVF?
It turns out that between 25% and 50% of women with diagnosed difficulty conceiving also have some degree of endometriosis. This makes the condition one of the “main suspects” when assessing reproductive health in women who have had unsuccessful attempts at pregnancy.
The good news is that endometriosis more often plays a role in conception itself than in carrying and delivering the baby. In other words – experience shows that IVF works just as successfully for women with this diagnosis as for those without endometriosis.
The main difference is that expectant mothers with endometriosis need closer monitoring and flexible dosing of medication. The aim is to suppress the symptoms of endometriosis as much as possible during pregnancy.
The Adella Clinic Sofia team works with modern equipment, proven specialists and up-to-date protocols. They help us both to address endometriosis itself and to avoid conflict between it and the dream of pregnancy and motherhood.
Do not hesitate to contact us to ask all your questions and receive an individual assessment of your condition, regardless of your reproductive plans.
