Endometriosis is a benign but often painful chronic condition in women. It is characterized by growths of endometrial tissue outside the uterine cavity. The disease is one of the most common causes of infertility.
Here you will find further information as well as selected endometriosis specialists.
Endometriosis is a benign but often painful chronic condition affecting women. In this disease, endometrial tissue (the lining of the uterus) grows outside the uterine cavity.
These non-cancerous tissue growths, known as endometriotic lesions, usually appear in the pelvic area, such as on the:
They can, in principle, also affect other organs in the female body, such as the lungs.
Depending on the severity, endometriotic growths may be as small as a pinhead. However, they can also develop into larger, blood-filled cysts, sometimes leading to adhesions of the fallopian tubes and ovaries.
Unlike endometrial tissue within the uterus, which is shed through menstruation, endometriotic tissue residues remain in the body. These can cause adhesions and inflammation. Many affected women therefore struggle with infertility.
Common sites of endometriotic lesions © Henrie | AdobeStock
Depending on which organs are affected by the abnormal endometrial growths, physicians distinguish three different types of the disease:
Endometriosis genitalis interna occurs when growths develop within the uterine muscle wall.
Endometriosis genitalis externa affects the genital regions outside the uterus.
Typical sites of endometriotic lesions in this form include:
In endometriosis extragenitalis, organs adjacent to the uterus are affected by endometrial growths.
These may include:
It is estimated that between 7 and 15 percent of all women of reproductive age suffer from endometriosis. After uterine fibroids, endometriosis is the second most common gynecological disorder.
In Germany alone, between 2 and 6 million women are affected. Each year, more than 30,000 new cases are diagnosed.
Since endometriosis is hormone-dependent, it primarily affects women between the ages of 20 and 40. With the onset of menopause, symptoms usually diminish or disappear.
Endometriosis is also one of the most common causes of infertility.
Many women with endometriosis remain involuntarily childless © zinkevych | AdobeStock
The exact cause of endometriosis is still unknown despite extensive research. However, several theories attempt to explain how endometrial tissue can grow outside the uterus.
These include:
The metaplasia theory suggests that growths arise when one type of tissue or cell transforms into another.
In endometriosis, immature body cells transform into endometrial cells (metaplasia).
The transplantation theory suggests that endometrial cells spread from the uterus to other areas of the body via blood vessels, lymphatic channels, or during surgery.
Depending on the location and severity, endometriosis can cause various symptoms and chronic pain. In many cases, growths remain undetected for years because there are no obvious signs.
The timing, occurrence, and symptoms of endometriosis depend on the woman’s menstrual cycle and the location of the lesions.
Typical symptoms of endometriosis include:
Endometriosis often causes severe pain during menstruation © Pixel-Shot | AdobeStock
Because hormonal changes during the menstrual cycle affect endometriotic lesions, symptoms typically appear shortly before or during menstruation.
If endometriotic growths are located in the peritoneal cavity between the rectum and uterus, back pain and painful intercourse may occur.
When endometriotic lesions affect the bladder or intestines, possible symptoms include:
Infertility can also be caused by endometriosis.
If endometriosis is suspected, the process begins with a detailed medical history. The physician interviews the patient about her symptoms, followed by a gynecological examination.
During this exam, the doctor assesses the size, position, and mobility of the reproductive organs to check for endometriotic lesions in the vagina, cervix, or ovaries.
Further diagnostic procedures may include imaging studies such as:
These methods help assess the extent of tissue growths and organ involvement.
A definitive diagnosis of endometriosis requires a histological examination of tissue samples. A laparoscopy allows tissue removal for microscopic analysis.
Since the cause of endometriosis remains unclear, there is no definitive cure.
Treatment therefore focuses on removing or reducing lesions and relieving symptoms. Both surgical and medical approaches are available.
Surgical treatment is usually minimally invasive via laparoscopy, during which lesions in the uterus, ovaries, or peritoneum are excised or destroyed with lasers.
A hysterectomy provides permanent relief but eliminates the possibility of pregnancy, making it an option only for women with completed family planning.
The most modern drug treatment is ulipristal acetate, also used in treating fibroids. Pain management includes analgesics.
Long-term hormonal therapy with estrogen-progestin combinations (oral contraceptives) can also relieve symptoms by reducing uterine lining tissue.
Certain oral contraceptives can improve symptoms during treatment © zenstock | AdobeStock
Whether therapy is necessary and which treatment approach is chosen depends on several factors, including:
A combination of medical and surgical treatment may improve the chances of successful fertility treatment.
Endometriosis is neither life-threatening nor fatal and does not always require treatment. If asymptomatic, it does not impair quality of life or life expectancy. However, it can affect fertility and contribute to infertility even without noticeable symptoms.
The disease course is unpredictable. In some women, endometriotic lesions regress spontaneously.
Treatment often improves symptoms. However, after discontinuation of medication, symptoms frequently return (high recurrence rate).
Surgery also rarely ensures complete cure: in up to 80% of patients, new lesions may develop later.
With the onset of menopause and cessation of menstruation, symptoms often disappear or improve significantly.
Endometriosis specialists are highly qualified gynecologists who treat patients suffering from painful, benign endometrial growths outside the uterus.
They possess extensive expertise and experience in the diagnosis and treatment of endometriosis.
Endometriosis specialists consistently adhere to strict quality standards and treatment guidelines defined by medical societies. They work interdisciplinarily with other specialists in related medical fields.
Due to their qualifications, endometriosis specialists are most often found in certified endometriosis centers. Medical institutions awarded the “Certified Endometriosis Center” quality seal have received recognition from:
the Endometriosis Association Germany, the Endometriosis Research Foundation, and the European Endometriosis League.
To ensure optimal care at all stages of the disease, interdisciplinary collaboration among specialists is essential.
This multidisciplinary approach is best provided in certified endometriosis centers.
Specialists involved include:
