Η endometriosis is a very common gynecological condition. The mucosal tissue that lines the inner wall of the uterus (the endometrium) grows in other areas of the woman’s body, such as the ovaries, fallopian tubes, the outer surface of the uterus, the cervix, the vulva, the peritoneum, the intestine, the bladder, or the rectum. It is estimated that endometriosis occurs in approximately 10% of women of reproductive age and in 25–35% of women experiencing infertility.
Symptoms of Endometriosis
Pain is the most common symptom of endometriosis. Women typically experience pain in the lower abdomen. The severity of the pain does not depend on the extent of the condition. Some women have no pain symptoms at all, even though endometriosis may be widespread over large areas.
The symptoms of endometriosis include:
- Severe dysmenorrhea (period pain)
- Chronic pelvic pain
- Dyspareunia (pain during intercourse)
- Painful gastrointestinal discomfort and painful urination during menstruation
- Heavy and prolonged menstrual bleeding
- Infertility
Diagnosis of Endometriosis
The doctor will take the patient’s medical history, which may raise suspicion of possible endometriosis. Diagnosis is made through a gynecological examination during which endometriotic lesions can often be palpated. Ultrasound imaging can identify endometriosis lesions on the ovaries and fallopian tubes.
The definitive diagnostic method is laparoscopy. Through laparoscopy, all lesions, as well as the size and extent of the endometriosis, can be clearly visualized.
Treatment of Endometriosis
The treatment selected for each woman is individualized and depends on her symptoms, reproductive age, and family planning goals.
Painkillers
For women with mild symptoms, the doctor may recommend painkillers such as ibuprofen or naproxen. If these are not effective, stronger pain medications may be prescribed.
Hormonal Therapy
Hormonal therapy is recommended for women who are not planning a pregnancy in the near future. It is most effective for small-scale endometriosis without severe pain.
- Contraceptives and Progesterone: Contraceptives reduce the natural hormones that affect the endometrium. They decrease menstrual flow and duration, and have the same effect on endometriotic cysts. This reduces the amount of blood and tissue retained in ectopic lesions each month. Progesterone is used by women who cannot take estrogen and has the same effect as contraceptives.
- Gonadotropins: Gonadotropins place the female body into a “pseudo-menopause” by temporarily stopping menstruation. This causes ectopic endometriotic cysts to shrink, and when the treatment continues for 3–6 months, they often disappear. After stopping the therapy, menstruation returns automatically, and fertility typically improves.
Surgical Treatment
Surgical intervention is performed using:
- Laparoscopic method: All visible endometriosis lesions and cysts are removed or destroyed. Postoperative pain is minimal, and this method significantly reduces the likelihood of postoperative adhesions.
- Laparotomy: Laparotomy is used in cases of very extensive endometriosis, when numerous adhesions have formed in the organs of the female pelvis, and laparoscopy is not feasible.
