Endometriosis is one of the most common gynecological conditions affecting women – and he is one of the leading specialists in this field: Professor Dr med. Dr h.c. mult Diethelm Wallwiener, as Medical Director at the University Gynecological Clinic in Tübingen, heads the supra-regional center of excellence for all areas of gynecology and obstetrics. In endometriosis, the lining of the womb grows outside the uterus, which can lead to adhesions or cysts – so-called endometriotic lesions, which often grow unnoticed over a long period of time. It can therefore take years before a diagnosis of endometriosis is made. The renowned specialist answered questions for the Leading Medicine Guide.
Many women experience natural menstrual pain, which can range from mild to severe. Pain caused by endometriosis is often mistaken for period pain by many sufferers, particularly during puberty or in the run-up to the menopause. Endometriosis symptoms usually occur two to three days before the onset of monthly bleeding.
Recurring pain during or after sexual intercourse can also be a sign of endometriosis. Such pain often leads to difficulties in relationships. In some cases, the pain may radiate in a cramp-like manner to the back or legs. Those affected often say it feels like “a thousand knife stabs”.
Diarrhea or nausea may also occur. Chronic pain can also lead to fatigue, irritability or even depressive moods.
The lining of the womb (endometrium) builds up during the first half of the menstrual cycle and is shed again at the end.
These growths of the uterine lining are usually benign. They attach themselves, much like moss, to the fallopian tubes, the ovaries, the ligaments supporting the uterus, on or within the uterine wall, the vagina, the bladder, the bowel or the peritoneum. In principle, however, they can also affect other organs in the female body, such as the lungs (although this is rare). Depending on the severity of the endometriosis, the lesions are often no larger than a pinhead. However, larger, blood-filled cysts may also form, leading to adhesions in the fallopian tubes and ovaries.
Blood in the stool, for example, can be a sign of endometriosis, particularly when the condition spreads to the intestinal lining.
Tragically, affected women often suffer from an unfulfilled desire to have children. This is because when the ovaries or fallopian tubes are affected by endometriosis, successful fertilization usually does not take place.
There are three forms of endometriosis:
1) Endometriosis genitalis interna (internal genital endometriosis) – Here, the growths are located within the uterine muscle.
2) Endometriosis genitalis externa (external genital endometriosis) – In this form, the genital areas outside the uterus are affected, for example the outer wall of the uterus, the ligaments of the uterus, the ovaries, the fallopian tubes, the so-called ‘Douglas’ pouch’ between the rectum and the uterus, and the vagina.
3) Extragenital endometriosis – This refers to organs outside the pelvis, such as the lungs or scar tissue following a cesarean section.
The likelihood of endometriosis developing into a malignant condition is very rare. If it does, it is usually the ovaries that are affected, which in some cases can also lead to ovarian cancer.
As an expert in the field of endometriosis, Professor Dr med. Dr h.c. mult Diethelm Wallwiener describes the condition as the ‘chameleon’ of women’s diseases, as it is often not recognized immediately and, unfortunately, leads to many misdiagnoses.
“One in ten women in Germany suffers from endometriosis symptoms,” explains Professor Wallwiener, urging all women to consult their gynecologist at the first sign of symptoms to enable early diagnosis and appropriate treatment.
Endometriosis: often a difficult diagnosis
“Endometriosis can only be diagnosed via a laparoscopy,” explains Professor Wallwiener, warning against therapeutic measures without first establishing a clear diagnosis. “Today, minimally invasive diagnosis via a keyhole procedure lasting just a few minutes is so low-risk that women need not worry about this minor operation. It is far worse when women carry around a suspected diagnosis of endometriosis and put themselves under physical and psychological strain.”
“I have endometriosis – what can I do?”
“The most important thing is for the patient to go to a certified endometriosis center to receive comprehensive treatment. A decision will be made as to whether, in addition to the usually unavoidable surgery, drug or hormone therapy should be used. Often, anti-endometriosis hormone treatment is administered even before the surgical removal of the endometriosis lesions, to shrink them so that the operation can be carried out with even greater precision,” explains Professor Wallwiener, who wishes to encourage women not to hide behind the condition and possibly develop feelings of guilt. He continues: “The patient’s subsequent follow-up treatment is also best ensured by a certified center.”
Conclusion: Many theories surround the development of endometriosis, ranging from hormonal causes to a compromised immune system. Why the endometrium grows outside the uterus has not yet been fully researched.
Did you find this information helpful? Would you like to find out more about University Professor Dr Wallwiener? Then visit his profile page in the Leading Medicine Guide!
Image source: (c) Africa Studio, (c) Leonid, (c) nenetus, (c) chajamp – Adobe Stock.
