Endometriosis is a condition that is often very painful for women who have it. According to the Endometriosis Association of Germany, an estimated 200 million people worldwide are affected.
The condition develops when cells similar to those found in the uterine lining begin to grow outside the uterus. Normally, such tissue grows only inside the uterus. The pelvic cavity and reproductive organs are usually affected. In some cases, the condition can also spread to other areas such as the rectum, the ovaries, or the intestines.
During the menstrual cycle, the endometrium-like tissue thickens. Before menstruation, it is shed so that it can leave the body during menstruation.
In endometriosis, however, this type of tissue grows outside the uterus. It therefore cannot be shed in the normal way. As a result, the tissue becomes trapped, irritates the surrounding tissue, and causes scarring and adhesions.
Illustration of endometriosis lesions on the uterus, bladder, and intestines © TuMeggy | AdobeStock
This can lead to chronic pain that is worst around the time of menstruation.
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 include:
To diagnose endometriosis and other conditions that can cause pelvic pain, the first step is a medical history interview. During this interview, your doctor will first ask you about your symptoms. The location of the pain and the timing of its onset are also important for the diagnosis.
The consultation is followed by a physical examination and additional tests.
A pelvic exam is a gynecological examination. The doctor inserts a hand through the vagina into the vaginal tract and palpates the lower abdomen and pelvic area from the inside to check for abnormalities. For example, the doctor looks for cysts on the reproductive organs or scar tissue behind the uterus.
Smaller endometriosis lesions often cannot be felt unless they have already caused a cyst to form.
Endometriosis can cause severe abdominal pain © georgpfluegl | AdobeStock
Ultrasound is an important tool for diagnosing endometriosis. During this examination, high-frequency sound waves are used to generate images of the body’s interior.
To capture the images, a device called a transducer is either
Both methods provide an optimal view of the internal reproductive organs.
A standard ultrasound exam 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 endometriotic lesions.
An endometriosis evaluation is recommended if you experience 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 currently no cure for endometriosis, and surgery remains the only way to remove excess tissue.
Before your doctor recommends surgery, they will likely first advise you to try conservative therapies. Non-surgical treatments can also help 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 scar tissue. This procedure can usually be performed laparoscopically. This method is significantly less invasive than open surgery.
Surgery can alleviate symptoms and increase the chances of pregnancy. However, endometriosis and its 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. Through the incision, the surgeon inserts a slender laparoscope (a small camera). This allows the surgeon to view the inside of the abdominal cavity directly. The surgeon then looks for signs of endometrial tissue outside the uterus.
A laparoscopy can provide information about
During the procedure, the surgeon can also take a tissue sample (biopsy) for further testing.
With proper surgical planning, endometriosis can be completely treated during the laparoscopy itself. This means that only a single procedure is necessary.
Illustration of a laparoscopic procedure © bilderzwerg | AdobeStock
If you have advanced-stage endometriosis, it may not be possible to treat it with a laparoscopy. In this case, a laparotomy is performed instead. This is a more extensive surgical procedure involving a large incision in the abdomen.
As with laparoscopy, you will be given medication to put you under general anesthesia. Your doctor will cut through the skin and muscle tissue to view the inside of the abdomen and remove the affected tissue.
After the surgery, the incision is closed, and you will be taken to a recovery room. You will need to stay in the hospital for at least one night.
You’ll recover more quickly after laparoscopic surgery than after a laparotomy. Regardless of the type of procedure, your activities will be limited for the first few days or weeks following the surgery. After a laparoscopy, you may feel well enough to get up and about within 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 exercising.
Following the instructions carefully can help ensure a smooth recovery.
Complications from endometriosis surgery are extremely rare, but the following problems may occur:
Endometriosis is a chronic condition that currently has no cure. We do not yet know what causes it. However, that does not mean the condition has to interfere with your daily life.
There are effective treatments to manage pain and fertility issues, such as
The symptoms of endometriosis usually improve after menopause.
Every physician listed in the Leading Medicine Guide has attained the highest level of training and certification within their respective medical specialty society. Furthermore, we contacted this physician based, among other factors, on their case volume (surgeries, treatments, and therapies), which we determined by cross-referencing various publicly available sources. Following discussions with the selected physicians and the directors of the medical facilities, as well as a subsequent internal review, they were admitted to the Leading Medicine Guide.
The quality assurance of the Leading Medicine Guide is further ensured by 8 admission criteria. Each member must meet at least 6 of them:
