Endometriosis: Symptoms, Diagnosis, and Modern Treatment Methods

What is endometriosis?

Endometriosis is a chronic gynecological condition in which tissue similar to the endometrium (the inner lining of the uterus) grows outside the uterus. These lesions can be located on the ovaries, fallopian tubes, peritoneum, intestines, bladder, and even in rarer places such as the lungs or brain. Like normal endometrium, this ectopic tissue responds to the hormonal changes of the menstrual cycle, thickening, breaking down, and bleeding. However, because this blood has no way to exit the body, it causes inflammation, scarring, adhesions, and cysts, leading to severe pain and other complications.

The exact cause of endometriosis is not fully understood, but several theories exist, including retrograde menstruation (when menstrual blood containing endometrial cells flows into the pelvic cavity), genetic predisposition, immune system disorders, and metaplasia (the transformation of one type of cell into another).

Symptoms of endometriosis: Pain and beyond

The symptoms of endometriosis can vary significantly in intensity and type, but the most common and debilitating is chronic pain. Key manifestations include:

• Dysmenorrhea (painful menstruation): One of the most frequent complaints. The pain can be significantly worse than normal menstrual cramps, starting a few days before menstruation and continuing after it ends.
• Chronic pelvic pain: Constant or periodic pain in the lower abdomen and pelvic region not exclusively related to menstruation.
• Dyspareunia (painful intercourse): Pain during or after intimacy, especially with deep penetration.
• Dyschezia (painful bowel movements) and dysuria (painful urination): If endometriosis lesions are located on the intestines or bladder, pain may occur during bowel movements or urination, particularly during menstruation.
• Heavy or irregular periods: Endometriosis can lead to menorrhagia (heavy menstrual bleeding) and metrorrhagia (bleeding between periods).
• Infertility: Endometriosis is one of the leading causes of female infertility. It can disrupt pelvic anatomy, damage the ovaries and fallopian tubes, and affect egg quality and embryo implantation.
• Fatigue and depression: Chronic pain and persistent inflammation often lead to exhaustion, a reduced quality of life, anxiety, and depression.

Diagnosis: How to detect endometriosis?

Diagnosing endometriosis can be complex and often takes a long time due to the non-specific nature of the symptoms. The process typically includes:

• Medical history and physical examination: The doctor will ask about symptoms, their intensity, and their impact on quality of life. A pelvic examination may reveal tenderness, nodules, or adhesions in the pelvic region.
• Ultrasound imaging (US): Transvaginal ultrasound is the first step and can detect ovarian endometriotic cysts (endometriomas) as well as provide indirect signs of deep infiltrative endometriosis.
• Magnetic resonance imaging (MRI): Pelvic MRI more accurately visualizes deep infiltrative endometriosis lesions, especially on the intestines and bladder, which is important for planning surgical treatment.
• CA-125 blood test: CA-125 levels may be elevated in endometriosis, but this marker is not specific and is used more as an adjunct, especially for monitoring.
• Laparoscopy: The gold standard for diagnosing endometriosis remains laparoscopy. This is a minimally invasive surgical procedure in which a thin optical instrument (laparoscope) is inserted through a small incision in the abdominal wall. The surgeon can visually identify endometriosis lesions, take a biopsy for histological confirmation, and, if necessary, remove them immediately.

Modern approaches to endometriosis treatment

Treatment for endometriosis should be individualized and depend on the patient's age, symptom severity, desire to preserve fertility, and the extent of the disease. The main goals of treatment are pain relief, slowing disease progression, and, if necessary, restoring fertility.

Medical treatment:

• Nonsteroidal anti-inflammatory drugs (NSAIDs): Used to manage pain, especially during menstruation.
• Hormonal therapy: Aims to suppress the growth of endometriotic lesions by lowering estrogen levels or inducing a state of "pseudo-pregnancy" or "pseudo-menopause":
  • Combined oral contraceptives (COCs): Often prescribed continuously to suppress menstruation and reduce pain.
  • Progestins: Can be used as pills, injections, or intrauterine systems (e.g., levonorgestrel-releasing IUDs) to suppress endometrial growth.
  • Gonadotropin-releasing hormone (GnRH) agonists and antagonists: Cause temporary medical menopause, significantly lowering estrogen levels. They are effective for pain reduction but have side effects related to estrogen deficiency (hot flashes, decreased bone mineral density), which is why they are often prescribed with "add-back" therapy (low doses of estrogens and progestins).

Surgical treatment:

• Laparoscopy: The main method of surgical treatment. During laparoscopy, the surgeon can remove or destroy endometriosis lesions (coagulation, excision), dissect adhesions, and remove endometriotic cysts. The goal is the maximum possible removal of all visible lesions while preserving healthy tissue and reproductive function.
• Hysterectomy with oophorectomy: In rare, severe cases when other methods are ineffective and the woman does not plan pregnancy, removal of the uterus and ovaries may be considered.

Assisted reproductive technologies (ART):

For women with infertility caused by endometriosis, ART procedures such as in vitro fertilization (IVF) may be recommended.

Living with endometriosis: Managing the condition

Endometriosis is a chronic condition requiring long-term management. In addition to medical and surgical treatment, the following aspects are important:

• Psychological support: Chronic pain and infertility can greatly affect emotional well-being. Psychological counseling, support groups, and relaxation techniques can significantly improve quality of life.
• Lifestyle changes: Regular physical exercise, a balanced diet, quitting bad habits, and stress management can help reduce symptoms and improve overall well-being.
• Interdisciplinary approach: Effective treatment often requires the involvement not only of a gynecologist but also of other specialists, such as a gastroenterologist, urologist, physical therapist, and psychologist, especially in cases of deep infiltrative endometriosis.

It is important to remember that early detection and timely initiation of treatment significantly improve the prognosis and quality of life for patients with endometriosis.

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The information presented in this article is for reference purposes only and cannot replace professional medical consultation. Before starting any treatment or changing your current therapy, be sure to consult a specialist.