Endometriosis is a disease that is often very painful for affected women. According to the Endometriosis Association Germany, an estimated 200 million people worldwide are affected.
The disease develops when endometrium-like cells begin to grow outside the uterus. Normally, such tissue only grows inside the uterus. The pelvic cavity and reproductive organs are usually affected. In some cases, the disease can also reach other areas such as the rectum, ovaries or intestines.
During the menstrual cycle, the endometrium-like tissue thickens. Before menstruation, it is broken down so that it can leave the body during menstruation.
In the case of endometriosis, however, this type of tissue grows outside the uterus. It therefore cannot be broken down in the normal way. As a result, the tissue becomes trapped, irritating the surrounding tissue and causing scarring and adhesions.
Illustration of foci of endometriosis on the uterus, bladder and bowel © TuMeggy | AdobeStock
This can lead to chronic pain, which is at its worst around the time of the period.
The causes of endometriosis are not yet fully understood. Genetic factors may play a role, as endometriosis is more common in some families.
Other symptoms of endometriosis are
To diagnose endometriosis and other conditions that can cause pelvic pain, the first step is to take a medical history. Your doctor will first ask you about your symptoms. The location of the pain and the time at which it occurs are also important for the diagnosis.
The consultation is followed by a physical examination and further tests.
Palpation of the pelvis is a gynecological examination. The doctor inserts their hand through the vagina into the vaginal tract and palpates the abdomen and pelvic area from the inside for abnormalities. He looks for cysts on the reproductive organs or scars behind the uterus, for example.
Smaller endometriosis lesions can often not be felt unless they have already caused the formation of a cyst.
Endometriosis can cause severe abdominal pain © georgpfluegl | AdobeStock
Ultrasound examinations are an important tool in the diagnosis of endometriosis. This examination uses high-frequency sound waves to produce images of the inside of the body.
To record the images, a device known as a transducer is either
Both types provide an optimal view of the internal reproductive organs.
With a standard ultrasound scan, your doctor cannot definitively determine whether you have endometriosis. However, it can detect cysts associated with endometriosis(endometriomas).
An MRI uses a magnetic field and radio waves to create detailed images of the organs and tissues inside the body.
In some cases, an MRI helps with surgical planning as it provides the surgeon with detailed information about the location and size of endometriosis lesions.
An endometriosis examination is recommended if you suffer from one or more of the symptoms listed above. These include, in particular, severe pain during menstruation.
If you have been diagnosed with endometriosis, you may need to try different treatments to find the one that works best for you.
There is no cure for endometriosis yet, and surgery remains the only way to remove excess tissue.
Before recommending surgery, your doctor will probably advise you to try conservative therapies first. Non-surgical treatments can also relieve symptoms.
These include
You can also try alternative treatments such as home remedies and dietary changes.
However, if nothing seems to help, your doctor may suggest surgery to remove displaced tissue and scarring. This procedure can usually be performed laparoscopically. This procedure is significantly less invasive than open surgery.
Surgery can relieve symptoms and increase the chance of pregnancy. However, the endometriosis and symptoms can still return at any time.
In some cases, the procedure is performed laparoscopically , i.e . as part of a laparoscopy.
Under general anesthesia, the surgeon makes a tiny incision near the navel. He then inserts a slim laparoscope (a small camera) through the incision. This allows him to view the inside of the abdomen directly. The surgeon then looks for signs of endometrial tissue outside the uterus.
A laparoscopy can provide information about
The surgeon can also take a tissue sample (biopsy) for further examination.
With good surgical planning, endometriosis can be completely treated during the laparoscopy. This means that only one procedure is necessary.
Illustration of a laparoscopic procedure © bilderzwerg | AdobeStock
If you suffer from an advanced stage of endometriosis, it may not be possible to treat it with a laparoscopy. In this case, a laparotomy will be performed instead. This is a major surgical procedure involving a large incision in the abdomen.
As with a laparoscopy, you will be given a drug to put you under anesthesia. Your doctor will cut through the skin and muscle tissue to see inside the abdomen and remove the affected tissue.
After the operation, the incision will be closed and you will be taken to a recovery room. You will need to stay in hospital for at least one night.
You will recover more quickly after laparoscopic surgery than after a laparotomy. Regardless of the type of surgery, your activities will be limited in the first few days or weeks after the procedure. After a laparoscopy, you may feel well recovered after 1 to 2 days. However, you may need more time before you can resume your normal activities.
It is very important that you talk to your doctor about when you can resume activities such as driving, working and sports.
If you follow the instructions carefully, this can contribute to a smooth recovery.
Complications from endometriosis surgery are extremely rare, but the following problems can occur:
Endometriosis is a chronic disease that cannot yet be cured. We do not yet know what causes it. However, this does not mean that the disease has to affect your daily life.
There are effective treatments to manage pain and fertility problems, such as
The symptoms of endometriosis usually improve after the menopause.
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