- MEDICINE ATHENS MED4WOMAN ATHENS
- MEDICINE VOLOS MED4WOMAN VOLOS
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Obstetrician Gynaecologist
Doctor of Medicine, University of Athens Medical School
Panagiotis Polyzos, Gynaecologist Obstetrician, is active at the Institute of Life - IVF Unit of Iaso Maternity Hospital.
Endometriosis occurs when tissue similar to the lining of the uterus (the endometrium) is found outside the uterine cavity. It is a common gynecological condition that can cause menstrual irregularities and pain.
Often, an endometrioma (a cyst related to endometriosis) may appear on or inside the ovaries, or even behind the uterus. Endometrial tissue can also be found on the peritoneum, or more rarely, in the bowel, bladder, or rectum.
These abnormal endometrial implants trigger inflammation in the pelvic area, leading to dysmenorrhea (painful periods) and heavy menstrual bleeding, which sometimes does not respond to pain medication.
The most common symptom of endometriosis is lower abdominal pain during menstruation, as well as a feeling of heaviness or pressure in the pelvis even outside the menstrual period, due to the presence of endometrial lesions. Interestingly, the severity of the symptoms does not always correspond to the extent of the disease — a woman with a small lesion may suffer severe pain, while another with extensive adhesions may feel no pain at all.
In many cases, women discover they have endometriosis during a fertility evaluation. Not all women with endometriosis are infertile, but infertility affects a significant percentage of patients.
Common symptoms include:
It is not necessary to experience all of these symptoms — however, many women with endometriosis report several of them as part of their condition.
According to various studies, women with endometriosis often have a history of painful periods. The average age of symptom onset is around 27 years old. They typically have regular menstrual cycles, often shorter ones (approximately 25 days), and the condition is usually diagnosed 2–4 years after the first appearance of symptoms.
These women frequently report that their mother, aunt, or grandmother also experienced heavy periods or had been diagnosed with endometriosis, suggesting a hereditary component. Most patients have their first menstruation at an early age, around 12 years old. Women in menopause, due to the absence of hormones, rarely experience symptoms of endometriosis.
Each month, the endometrium (the lining of the uterus) thickens in preparation to receive a fertilized egg, becoming rich in nutrients to support a potential pregnancy.
If fertilization occurs, the egg attaches to the uterine wall, and the embryo begins to develop. However, if pregnancy does not occur — which is the usual case — the uterine lining sheds during menstruation. At the same time, the endometrial lesions located outside the uterus behave in the same way — they bleed as well.
These bleeding lesions have no outlet for the blood to escape, unlike the menstrual flow that exits through the vagina. As a result, the trapped blood remains within the pelvic organs, gradually leading to blockages, adhesions between organs, or obstruction of the fallopian tubes, which can prevent the fertilized egg from traveling to the uterus — hence the link with infertility.
In addition, there is a genetic predisposition, since a woman with a sister, mother or grandmother with endometriosis has 6 times the risk of developing it.
Other theories suggest that during menstruation, some endometrial tissue may flow backward through the fallopian tubes and implant in other areas of the pelvis (known as retrograde menstruation).
Finally, some researchers support the immunological theory, proposing that the woman’s immune system fails to recognize and destroy endometrial tissue that grows outside the uterus.
In some cases, a gynecological ultrasound can detect an ovarian endometrioma, but it cannot identify endometriosis in other pelvic organs. A definitive diagnosis — and at the same time, treatment — can only be achieved through laparoscopy. During this minimally invasive day surgery, the gynecologic surgeon locates and removes the endometrial lesions, with excellent results.
Ο gynecologist may suspect endometriosis based on the patient’s medical history. An ultrasound scan is usually performed to confirm certain findings, but even if this is not possible due to the location of the lesions, laparoscopy will provide clear answers.
The biochemical marker CA 125 may be elevated in cases of endometriosis; however, this is not a reliable diagnostic tool on its own. As an alternative to laparoscopy, a magnetic resonance imaging (MRI) scan may be used, though it offers less accurate diagnostic results.
Ultimately, laparoscopy remains the most definitive method, as it allows the surgeon to visualize the lesions directly and assess the extent of the disease. Moreover, it often restores fertility and removes the endometrial foci, relieving the patient from severe symptoms in subsequent menstrual cycles.
The pain and symptoms of endometriosis can lead to sadness, isolation, and even relationship difficulties with friends, partners, and colleagues. Women often miss work and withdraw from social activities because of their discomfort.
Endometriosis can also be associated with Infertility. In such cases, appropriate treatment can help alleviate severe symptoms and preserve fertility, addressing one of the main concerns many women face. Many women report that, after receiving the recommended treatment, their social life, relationships, and overall quality of daily living improved significantly.
Every woman is different and may seek treatment at various stages of her life. For example, the therapeutic approach will vary between a woman who wishes to conceive immediately and another who is 20 years old and not currently interested in pregnancy. Treatment options are primarily aimed at reducing pain and addressing infertility associated with the condition.
The doctor may recommend anti-inflammatory medication or, if those are ineffective, stronger pain-relieving drugs.
If pregnancy is not planned, hormonal therapy may be advised, which is particularly effective in treating small endometrial lesions. Hormones can be administered orally (pills) or through injections.
The most common medications used against endometriosis are oral contraceptives, which act on the endometrium, reducing both menstrual flow and the activity of endometrial implants.
This hormone reduces the thickness of the endometrium both within the uterus and in the lesions outside it. In particular, dienogest 2 mg has shown significant effectiveness in reducing pain.
These hormones temporarily suppress menstruation, thereby reducing endometriotic cysts for the duration of treatment. Once therapy is discontinued, menstrual cycles and fertility return to normal.
This medication is now used rarely, as it may cause side effects such as weight gain, fatigue, and headaches. However, it preserves fertility.
Unfortunately, the answer is no. However, women who exercise regularly, maintain a healthy diet, and limit alcohol and caffeine consumption tend to experience less severe menstrual symptoms.
Surgery is indeed the only definitive method that can both diagnose the condition in depth and treat it simultaneously. A woman may undergo two main types of surgical procedures depending on the severity of the disease.
During laparoscopy, the surgeon makes three very small incisions in the abdomen. The endometrial lesions are removed and then sent for histological (biopsy) examination. The procedure is performed under general anesthesia, and the woman can move around shortly after surgery and usually returns home the following day.
Exercise plays a significant role in managing endometriosis because it helps regulate estrogen levels, which can prevent the recurrence of symptoms or, if they persist, reduce their intensity. Simple painkillers or anti-inflammatory medications may help in certain cases, while non-pharmaceutical or homeopathic therapies have been reported to offer some relief — although no scientific evidence currently supports their effectiveness.
Diet is also very important in the management of endometriosis. Recent research has shown that frequent consumption of red meat significantly increases the development and progression of the disease, as does the excessive intake of iron, whether from food or supplements. In contrast, fruits and vegetables, as well as vitamins E and C, are considered beneficial.
Fruits such as cherries and vegetables like broccoli, green peppers, and tomatoes appear to help relax the pelvic muscles and reduce the likelihood of disease progression, although the exact mechanism remains unclear. Finally, reducing caffeine intake has also been shown to be helpful.
Panagiotis Polyzos is a Founding Member of the Institute of Life.
Laparoscopy is a surgical procedure used for both the diagnosis and treatment of various gynecological conditions, including endometriosis. During laparoscopy, a long, thin viewing instrument called a laparoscope is inserted into the abdomen through a small surgical incision near the navel. This allows the doctor to visually examine the pelvic organs and, with minimal bleeding, remove cysts, lesions, or scar tissue caused by endometriosis.
Laparoscopic surgery for endometriosis is a low-risk, minimally invasive procedure. It is typically performed under general anesthesia by a surgeon or gynecologist. Most patients are discharged the same day, although in some cases, an overnight hospital stay may be required.
Your gynaecologist may recommend laparoscopy if:
You regularly experience severe abdominal pain that your doctor suspects is caused by endometriosis.
Endometriosis or its symptoms have persisted or recurred after hormonal therapy.
Endometriosis is believed to have spread to nearby organs, such as the bladder or bowel.
Endometriosis is thought to be affecting fertility.
An abnormal mass, known as an ovarian endometrioma, has been detected on the ovary.
You will be asked to refrain from eating or drinking anything for at least six hours before the procedure. Most laparoscopies are outpatient surgeries, meaning you won’t need to stay overnight in the clinic or hospital. It’s a good idea to pack a few essential personal items for your short hospital visit. You should also arrange for a family member or friend to drive you to and from the hospital and stay with you afterward.
General anesthesia may cause nausea or vomiting in some people. You may also be advised not to shower or bathe for a few days after the procedure to allow the incision to heal properly. Taking a shower just before the procedure can help you feel more comfortable.
Laparoscopy is almost always performed under general anesthesia, which is typically administered through an intravenous (IV) line. During the procedure, your surgeon will make a tiny incision in your abdomen, usually just below the navel.
A small tube is then inserted through the opening and used to inflate the abdomen with gas, usually carbon dioxide. This allows the surgeon to see the internal organs more clearly.
Next, the laparoscope is inserted through or just below the navel. The laparoscope has a small camera at its tip, enabling the surgeon to view the internal organs on a monitor in real time.
Your surgeon may make additional small incisions to improve visibility and access. Once endometriotic tissue or scar tissue is identified, the surgeon will typically use one of several techniques to treat it — such as excision (removal) or cauterization (burning) of the lesions.
The surgeon will then remove the affected tissue and send samples for pathological examination. Once the procedure is complete, the incisions are closed with sutures.
Immediately after the surgery, you may experience side effects from the anesthesia, including restlessness, nausea, or vomiting. Some women also report discomfort caused by excess gas, mild vaginal bleeding, slight pain at the incision site, abdominal pain, or mood changes.
You should avoid certain activities right after the procedure, such as intense exercise, bending, stretching, lifting heavy objects, or sexual intercourse. It may take a week or more before you feel fully ready to return to your normal routine. Your first period after surgery may be longer, heavier, or more painful than usual. Try not to worry — your body is still healing internally, even if you already feel much better.
After surgery, you can facilitate the recovery process by:
Your gynecologist will likely schedule a follow-up appointment 2–3 weeks after the procedure. If you had extensive endometriosis, this is an excellent time to discuss with your doctor a long-term follow-up and treatment plan, and, if necessary, fertility options.
While the relationship between endometriosis and infertility remains unclear, 30–50% of women who experience infertility are also diagnosed with endometriosis. In a small 2014 study, 71% of women under the age of 25 who underwent laparoscopic surgery for the treatment of endometriosis were able to conceive and give birth afterward.
Having endometriosis does not necessarily mean you will have difficulty conceiving. However, if you do face challenges, speak with your doctor to learn about the many available options for individuals who wish to become parents.
The risks of laparoscopic surgery are rare, but as with any surgical procedure, some complications may occur.
You should contact your doctor immediately if you experience any of the following symptoms after laparoscopic surgery:
To conclude, laparoscopy is a surgical procedure used to diagnose conditions such as endometriosis and to treat symptoms like pain. In some cases, it may also improve fertility and increase the chances of pregnancy. Complications are rare, and most women recover quickly and fully.
Talk to your doctor to learn more about the risks and benefits of laparoscopic surgery.
