Endometriosis is a benign but often painful chronic female disease. It is characterized by growths of the uterine lining (endometrium) outside the uterine cavity. The disease is one of the most common reasons for an unfulfilled desire to have children
Here you will find further information and selected endometriosis specialists.
Endometriosis is a benign but often painful chronic female disease. It involves growths of the uterine lining (endometrium) outside the uterine cavity.
These benign endometrial growths, known as endometriosis lesions, usually occur in the lower abdomen, for example on
In principle, they can also affect other organs in the female body, such as the lungs.
Depending on how severe the endometriosis is, the growths can be the size of a pinhead. However, larger, blood-filled cysts can also form, sometimes leading to adhesions in the fallopian tubes and ovaries.
Unlike the endometrium in the uterus, which is shed via the vagina, endometriosis lesions leave residues in the body. They can lead to adhesions and inflammation. Affected women therefore often suffer from an unfulfilled desire to have children.
Endometriosis lesions often occur in these places © Henrie | AdobeStock
Depending on the organs in which the endometrial growths typical of endometriosis occur, three different forms of the disease are distinguished:
In internal genital endometriosis, the growths occur within the uterine muscles.
In endometriosis genitalis extrena, the genital areas outside the uterus are affected by growths. In this form of the disease, the endometriosis lesions occur on
occur.
In endometriosis extragenitalis, the organs adjacent to the uterus are affected by endometrial growths. The following can be affected
It is estimated that between 7 and 15 percent of all women of reproductive age suffer from endometriosis. This makes endometriosis the second most common gynecological disease after fibroids.
In total, between 2 and 6 million women in Germany are affected by endometriosis. More than 30,000 women are newly diagnosed with this gynecological disease every year. As endometriosis is dependent on a woman's hormonal cycle, it mainly occurs in women between the ages of 20 and 40. In most cases, the symptoms disappear again with the onset of the menopause.
Endometriosis is also one of the most common reasons for an unfulfilled desire to have children.
Many women with endometriosis remain involuntarily childless © zinkevych | AdobeStock
Despite intensive research, it is not yet clear what causes endometriosis. However, there are various theories that attempt to explain how endometrial growths can occur outside the uterine cavity. These include the theory of tissue change and the theory of carry-over.
The theory of tissue change assumes that the growths are caused by the transformation of one type of tissue or cell into another. In the case of endometriosis, this process (known as metaplasia) transforms immature body cells into cells of the uterine lining, according to the theory.
The theory of metaplasia is based on the assumption that cells of the uterine lining are transferred from the uterus to other areas of the body via the blood or lymph vessels or through surgical interventions.
Depending on its location and degree of severity, endometriosis can cause various symptoms. Often there are no symptoms at all for years, so that in many cases endometriosis remains undetected for a long time. Whether, when and with which symptoms endometriosis finally manifests itself depends mainly on the woman's menstrual cycle and the location of the growths.
The typical symptoms of endometriosis include
Endometriosis often causes very severe pain during menstruation © Pixel-Shot | AdobeStock
As endometriosis lesions are affected by hormonal changes during the female menstrual cycle, these symptoms usually occur shortly before or during menstruation.
If endometriosis lesions are located in the peritoneal cavity between the intestine and the uterus, low back pain and pain during sexual intercourse may occur.
Endometrial growths in the bladder or bowel can lead to symptoms such as
Endometriosis can also be responsible for an unfulfilled desire to have children.
If endometriosis is suspected, a medical history is taken first. The doctor will ask the patient about her symptoms. The doctor then performs a gynecological examination. He will feel the size, position and mobility of the internal reproductive organs. In this way, he can determine whether there are endometrial growths in the vagina, on the cervix or on the ovaries.
For further endometriosis diagnostics, imaging procedures can be used, such as
These examinations can be used to determine the extent of the growths and organ changes.
In order to diagnose endometriosis conclusively, a histological examination of the growths is necessary. During a laparoscopy, tissue samples of the growths can be taken for subsequent microscopic examination.
As the cause of endometriosis has not yet been clarified, it cannot be treated effectively and conclusively. Endometriosis therapy should therefore remove or reduce the growths and alleviate the patient's symptoms. In principle, two different treatment methods are available for this purpose : endometriosis surgery and drug therapy.
The operation is usually minimally invasive and is performed as part of a laparoscopy. The aim is to cut out as many endometriosis lesions as possible or to destroy them using laser beams. Removal of the uterus provides lasting relief from the symptoms, but pregnancy is no longer possible afterwards, so the procedure is only an option if family planning has been completed.
The most modern drug approach is ulipristal acetate, which is also used in the treatment of fibroids. The patient is given painkillers to relieve the pain. Long-term hormone treatment with a combination of oestrogen and progestogen (contraceptive pill) also leads to pain relief due to the regression of the uterine lining.
Certain preparations of the contraceptive pill lead to an improvement in symptoms for the duration of the treatment © zenstock | AdobeStock
Whether treatment is necessary and which treatment method is used depends on various factors, including
A combination of medical and surgical treatment can increase the chances of fertility treatment.
Endometriosis is not a life-threatening or fatal disease and does not necessarily need to be treated. If endometriosis does not cause any symptoms, it does not affect the patient's quality of life or life expectancy.
It is not possible to predict the course of the disease. In some women, the endometriosis lesions regress spontaneously.
Treatment often improves the symptoms, but after stopping the medication they often return after some time(high recurrence rate). Even surgery often does not promise a complete cure: in up to 80 % of all treated women, endometriosis lesions form again later.
With the onset of the menopause and the associated cessation of menstruation, the disease disappears completely in many women or the symptoms are significantly reduced.
Endometriosis specialists are highly qualified gynaecologists who specialize in the holistic treatment of patients suffering from benign but painful growths of the uterine lining outside the uterus.
As endometriosis specialists, these specialists have proven expertise and experience in the diagnosis and treatment of endometriosis. Endometriosis specialists always adhere to the strict quality criteria and guidelines for endometriosis treatment defined by specialist associations and work together with specialists from other medical disciplines.
Due to their special qualifications, endometriosis specialists can be found in certified endometriosis centers in particular. These are medical facilities that have been awarded the "Certified Endometriosis Center" quality seal by the Endometriosis Association Germany (EVD), the Endometriosis Research Foundation (SEF) and the European Endometriosis League (EEL) as part of the certification process for endometriosis centers offered since 2005.
In order to be able to guarantee that affected patients receive comprehensive and optimal care in all phases of their disease and a therapy tailored to their individual needs, interdisciplinary cooperation between all participating specialists from the various medical fields is necessary. This interdisciplinary cooperation can best be implemented in certified endometriosis centers. In addition to endometriosis specialists from the fields of gynecology and urology, pain therapists, reproductive physicians, radiologists, pathologists, abdominal surgeons and psychosomatic specialists also work there.
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