Endometriosis and Its Symptoms: Causes, Diagnosis and Treatment

Endometriosis is a chronic disease in which tissue similar to the inner lining of the uterus, the endometrium, develops outside the uterus. It is found most often on the ovaries, in the pelvic cavity and in the wall of the uterus. The disease is frequently accompanied by severe menstrual pain and chronic pelvic pain. In some cases a patient may find it difficult to become pregnant.

What you should know:

• Severe pain during menstruation should not be considered normal;
• Endometriosis is sometimes diagnosed only years later, because the symptoms are put down to ordinary menstrual pain;
• Endometriosis can affect fertility, but having it does not rule out pregnancy;
• The disease is chronic. The main goals of treatment are controlling pain, improving quality of life and preserving fertility.

 

What is endometriosis and what does this diagnosis mean?

During the menstrual cycle the inner lining of the uterus, the endometrium, changes under the influence of hormones and prepares for a possible pregnancy. If pregnancy does not occur, the upper, functional layer of the endometrium breaks down and leaves the body as menstrual bleeding.

So what does endometriosis mean? It is a chronic disease in which tissue similar to the endometrium develops outside the uterus. It can be found on the ovaries, in the area of the fallopian tubes, in the pelvic cavity and in other nearby areas.

Endometriosis lesions respond to the hormonal changes of the menstrual cycle. This can lead to repeated bleeding inside the lesions, an inflammatory reaction and, over time, scar tissue and adhesions. These processes are what can cause pain and other symptoms. Sometimes the pain appears only during menstruation. In other cases pelvic pain continues on other days of the cycle too.

Endometriosis is a fairly common disease. Even so, reaching a diagnosis often takes a long time. One of the reasons is that severe menstrual pain is sometimes seen as normal, and patients delay going to a doctor.

 

Endometriosis and its symptoms: the main signs

The symptoms of endometriosis do not show up the same way in every patient. The most common complaint is severe menstrual pain. Sometimes the pain is so strong that it interferes with daily life.

The signs of endometriosis may include:

• Painful menstruation;
• Chronic pelvic pain;
• Pain during or after sexual intercourse;
• Pain when passing stool, especially during menstruation;
• Pain when urinating;
• Heavy menstrual bleeding;
• Bloating;
• A feeling of fatigue;
• Bowel complaints that get worse especially around the time of the cycle;
• Difficulty becoming pregnant.

Sometimes the only symptom of endometriosis is difficulty becoming pregnant. This is why you should not think of the disease only when pain is present.

 

Severe pain during the cycle is not normal

Many women can feel discomfort during menstruation, but very severe pain that stops you from getting on with your usual activities should not be considered normal.

Pay particular attention if:

• You miss work or cancel plans because of the pain;
• You cannot carry on with your usual activities without painkillers;
• Pelvic pain continues after menstruation has finished;
• You have pain during sexual intercourse;
• You have pain when passing stool or urinating;
• Your periods are very heavy or unusually painful.

With complaints like these, a visit to a gynaecologist is essential. If you need one, you can come to Todua Clinic. A gynaecologist at the Vera branch or a gynaecologist in Dighomi will help you identify the exact causes.

 

Endometriosis of the uterus: adenomyosis

The term "endometriosis of the uterus" is often used, although from a medical point of view adenomyosis and endometriosis are not the same condition.

In adenomyosis, tissue similar to the endometrium grows into the muscular layer of the uterus, the myometrium. Because of this the uterus can become enlarged and periods can become painful and heavy. Some women also experience a feeling of heaviness or pain in the pelvis.

Adenomyosis is also different from fibroids. A fibroid is a benign growth of the muscular layer of the uterus, whereas in adenomyosis the tissue grows into the muscle of the uterus.

Transvaginal ultrasound is often used for diagnosis. If necessary, the doctor may also order an MRI.

 

Endometriosis of the ovary: endometrioma

One form of ovarian endometriosis is an endometrioma. This is a cyst that forms in the ovary and fills up as a result of repeated bleeding within endometriosis lesions.

Blood collects in the cyst over time, gradually thickens and darkens. This is why the contents of an endometrioma are often brown and viscous.

An endometrioma deserves attention for several reasons:

• Effect on ovarian reserve: the cyst presses on healthy tissue and reduces the supply of eggs;
• Risk of rupture: a break in the wall of the cyst can cause acute pain and irritation of the abdominal cavity.

Surgery is not always necessary for ovarian endometriosis. The treatment options depend on the symptoms, the size and features of the cyst, the course of the disease, previous surgery and any plans for pregnancy.

Ovarian reserve can also be reduced by surgery on the ovary itself. This is why the need for an operation has to be assessed individually, and reproductive plans must always be taken into account.

 

What causes endometriosis: risk factors

The exact cause of endometriosis is not yet known. Researchers are looking at several possible hypotheses:

• Retrograde menstruation: instead of leaving the body through the cervix, part of the menstrual blood flows back through the fallopian tubes into the abdominal cavity;
• Genetic predisposition: if family members (a mother, a sister) have this diagnosis, the likelihood of developing the disease increases;
• Immune system disturbance: the body fails to recognise and destroy endometrial tissue that has ended up outside the uterus;
• Hormonal imbalance: high oestrogen levels encourage the lesions to grow.

Still, having one of these risk factors does not necessarily point to the disease, just as their absence cannot rule endometriosis out.

 

Diagnosis: from ultrasound to laparoscopy

Diagnosing endometriosis starts with a consultation with a gynaecologist. The doctor needs to know exactly when the pain begins, how long it lasts and whether it is linked to the menstrual cycle.

Keeping a symptom diary is useful too. You can note down the days of your period, the intensity of the pain and any other complaints.

At the next stage a transvaginal ultrasound is often performed. It is especially useful for detecting endometriomas and some other forms.

It is important to know that ultrasound does not fully rule out endometriosis. This is why the doctor always assesses the result of the scan together with the symptoms and other data.

Ultrasound makes it possible to assess the uterus, the ovaries and other structures of the pelvic cavity.

In some cases an MRI is needed. This is especially important when the doctor needs to assess deep endometriosis or adenomyosis.

Laparoscopy is a minimally invasive surgical method in which a special camera and surgical instruments are inserted into the pelvic cavity through small incisions in the abdominal wall.

Today, laparoscopy is not considered a necessary first step towards a diagnosis for every patient. The need for it is decided case by case. For example, it may be considered when the symptoms and the results of other tests point to endometriosis but the diagnosis is still unclear, or when surgical treatment is required.

Gynaecological surgery and laparoscopy may be considered in cases where surgical treatment is needed.

An ordinary blood test is not enough to diagnose endometriosis. No blood test is used as a stand alone method to confirm the disease.

Biopsy is not a routine method for diagnosing endometriosis. However, histological examination of tissue removed during surgery can be carried out and can give the doctor additional information.

 

Endometriosis, infertility and pregnancy

Endometriosis and infertility can be connected. The disease can cause adhesions and change the normal anatomical position of the pelvic organs.

In some cases it affects the function of the fallopian tubes. Ovarian endometriosis, and surgery for it, can also affect ovarian reserve.

If a woman is planning a pregnancy, relieving pain is not the only thing that matters when choosing treatment. The first priority is preserving her fertility potential.

Treatment tactics are chosen individually. In some cases conservative management is enough. In others, surgery or other methods may be needed.

 

Endometriosis and pregnancy

Having endometriosis does not mean that pregnancy is impossible. Many women conceive naturally despite this diagnosis.

When planning a pregnancy, age, the form and extent of the disease, ovarian reserve, previous surgery and other reproductive factors all matter.

During pregnancy, pain related to endometriosis improves for some women. This does not happen with every patient, though, and pregnancy is not considered a treatment for endometriosis.

After childbirth the symptoms may return. This is why follow up also matters.

 

Endometriosis during menopause

There is a belief that endometriosis disappears completely as soon as menopause begins. This is not always the case.

Because oestrogen levels fall, the activity of endometriosis lesions often decreases. Even so, old adhesions and other structural changes can remain. This is why symptoms may continue.

In addition, in specific cases the use of hormone replacement therapy can affect the symptoms. You will find more information about menopause in the article Menopause: symptoms and ways to manage it.

Pelvic pain appearing after menopause mustn't be automatically put down to endometriosis. In such cases a visit to the doctor is needed so that other causes can be ruled out.

 

Treatment of endometriosis

Endometriosis is a chronic disease. At present there is no universal method that cures it completely. The main goals of treatment are controlling the symptoms, improving quality of life and taking reproductive plans into account.

Non steroidal anti inflammatory medicines can be used to manage pain. Hormonal treatment is also often used, including combined hormonal products and progestins.

Hormonal treatment aims to reduce the hormonal changes that act on endometriosis lesions.

In some cases surgical treatment is considered. Laparoscopy makes it possible to remove endometriosis lesions.

The need for ovarian surgery is assessed with particular care, because the procedure can reduce ovarian reserve.

When choosing treatment, it also matters a great deal whether the woman is planning a pregnancy in the near future. This is exactly why the same treatment plan is not suitable for every patient.

With chronic pain, additional approaches can be used as well. For example, physiotherapy and psychological support.

The specific medicine, the dose and the treatment plan should be chosen by a doctor. Self treatment is not recommended.

 

When should you see a gynaecologist?

A visit to a gynaecologist becomes necessary when the pain interferes with daily life or gets worse over time.

Do not postpone a gynaecologist consultation if you notice the following symptoms:

• The pain during your cycle is so severe that ordinary painkillers do not help;
• The pain interferes with your daily activities;
• You feel discomfort or pain during sexual intercourse;
• You have not been able to conceive for more than 12 months of regular sexual activity.

The experienced team at Todua Clinic includes  gynaecologist Irine Gagua, whom you can consult if needed.

At the first visit the doctor takes a detailed history and assesses the symptoms. If necessary, ultrasound diagnostics, an MRI or another examination will be ordered.

It is important to remember that you should not put up with severe pain. The more precisely the symptoms are described, the easier it is to choose the right diagnostic path.

 

 

Book an appointment with a gynaecologist at Todua Clinic: consultation and ultrasound in a single visit. If needed, have your MRI and laparoscopy at the same branch. Call 032 2 57 57 57 and reserve your consultation.

 

Frequently asked questions

 

What are the first signs of endometriosis?

The most common first signs are severe menstrual pain and pelvic pain. There may also be pain during sexual intercourse, when passing stool or when urinating. For some women, difficulty becoming pregnant appears at the very first stage.

 

Is pregnancy possible with endometriosis?

Yes, in most cases pregnancy is possible with endometriosis. The disease can make conception harder, though. With the right treatment, laparoscopy or assisted reproductive technologies (IVF), the majority of patients conceive successfully.

 

Does endometriosis go away during menopause?

During menopause, because oestrogen levels drop, endometrial lesions usually atrophy and stop being active. However, if a patient has old adhesions or is taking hormone replacement therapy, pain and symptoms may persist after menopause as well.