The hidden disease that affects many women

What is endometriosis?

In endometriosis, tissue similar to the lining of the uterus grows outside the uterus. These so‑called endometriotic lesions are often found in the abdominal and pelvic area, for example on the ovaries, in the fallopian tubes or in the layers of the uterine wall. Adjacent organs such as the bowel or the bladder can also be affected.

In rare cases such mucosal cells can even appear in unusual locations like the diaphragm or the lungs. During the menstrual cycle these cell clusters undergo cyclical growth and bleed. Because the blood that is released usually cannot drain away, collections of blood and cysts can form.

The continuous activity of the lesions promotes inflammatory reactions and the formation of scar tissue, which changes throughout the cycle. These processes can cause adhesions between organs. Endometriosis is therefore classified as a chronic inflammatory condition that typically occurs in women of reproductive age. The severity of symptoms can vary and may improve after the menopause, but in some cases the lesions persist long‑term.

How does endometriosis present?

Symptoms of endometriosis are very diverse and vary from person to person. Most commonly there are pelvic pains, which often occur before or during menstruation, but may also be noticeable in the premenstrual phase or at other times during the cycle. These pains often have a cramp‑like quality and can radiate to the back or the legs.

In addition, accompanying symptoms such as nausea, vomiting or diarrhoea may occur. Depending on the location of endometriotic lesions, pain can occur during physical activities such as sexual intercourse, bowel movements or urination, particularly during menstruation. Menstrual irregularities and possible difficulties conceiving are also part of the symptom spectrum.

Besides physical symptoms, affected people may also experience fatigue, headaches or psychological strain such as depressive moods. While symptoms often decrease with the onset of the menopause, individual courses vary widely. Some women have few or no symptoms, while others are significantly limited in daily life or at work.

There is no direct relationship between the size or spread of the lesions and the severity of symptoms, so even small lesions can cause severe impairment. If lesions are located outside the pelvis, symptoms such as chest pain or breathing problems are conceivable in rare cases.

What causes endometriosis?

The exact mechanisms of development of endometriosis are not yet fully understood. However, it is believed that several factors interact, including hormonal influences, genetic predisposition and a possible dysfunction of the immune system.

The female sex hormone oestrogen promotes the growth of islands of lining outside the uterus, while progesterone normally inhibits this process. In affected individuals this inhibitory effect is often disturbed, allowing the tissue to spread unchecked. The immune system also appears to be insufficiently able to recognise and remove detached uterine lining cells, allowing them to establish themselves in other parts of the body.

A recognised theory of origin is so‑called retrograde menstruation: menstrual blood flows not only outwards but also backwards through the fallopian tubes into the abdominal cavity. In this way cells of the uterine lining reach sites where they are not normally found. This triggers inflammation and favours the formation of endometriotic lesions. In addition, increased or uncoordinated contractions of the uterine muscle may cause small injuries that promote the transport of lining cells.

Hereditary factors also play a role, as the condition occurs more frequently in some families although no single gene has been identified. In exceptional cases endometrial cells can also develop in distant organs such as the liver or the lungs, possibly through local transformation of certain precursor cells. Environmental factors and early‑life influences are also discussed as possible triggers, but this is not yet conclusively established.

Why can endometriosis be dangerous?

Although endometriosis is not malignant, it can substantially impair the lives of those affected. Recurrent severe pelvic pain often leads to limitations in everyday life and at work. Social life can also suffer, as the physical burden can cause fatigue, irritability and depressive symptoms.

Moreover, sexual life can be affected by pain during intercourse, which in turn can negatively affect emotional well‑being and partnerships. Unfulfilled desire for children, which occurs in many women due to endometriosis, often represents an additional psychological burden. Over time the disease can lead to persistent inflammation and damage to affected organs, especially if endometriotic lesions invade surrounding tissue or organs.

How is endometriosis diagnosed?

Diagnosis of endometriosis is often challenging, because several years may pass between the onset of symptoms and the definitive confirmation of the condition. First, a detailed medical history discussion forms the basis for further investigations. The type, location and time course of symptoms are discussed.

This is followed by a thorough gynaecological examination, during which the vagina, abdominal wall and rectum are palpated among other areas. Larger lesions can often be identified by means of atransvaginal ultrasound examination. With more pronounced symptoms or additional indications, imaging methods such as abdominal ultrasound or magnetic resonance imaging are also used to obtain a better overview of possible changes.

Because the disease can present in very varied ways and smaller lesions may sometimes not be visible or palpable, a laparoscopy is often performed to confirm the diagnosis. In this minimally invasive procedure small instruments are introduced into the abdominal cavity to search directly for endometriotic lesions. At the same time a tissue sample can be taken and examined in the laboratory to secure the diagnosis.

Treatment of endometriosis: useful tips

• Agree the treatment plan with your doctor to choose the appropriate form of therapy. Use anti‑inflammatory painkillers selectively to relieve acute pain. Bear in mind, however, that these only treat the symptoms, not the cause of endometriosis.
• Hormonal therapy can inhibit the growth of endometriotic lesions and is often used to reduce symptoms in the long term.
• For treatment success it is crucial to take the prescribed hormonal preparation regularly and at the recommended dose.
• Be aware that symptoms often recur after stopping such therapy. Therefore long‑term follow‑up is advisable.
• Surgical procedures, particularly laparoscopy, allow the removal of endometriotic lesions. They are used mainly in more severe cases or when important organs are involved.
• Only in very severe cases and after completion of childbearing may a hysterectomy be considered. In this procedure the uterus, ovaries and fallopian tubes are removed completely. This is done only after careful consideration of all options.
• In addition to conventional therapies, alternative approaches such as acupuncture, homeopathy or Traditional Chinese Medicine (TCM) may help relieve symptoms. These approaches can be used as adjuncts to reduce pain.
• It is advisable to eat more fresh fruit and vegetables, as these foods are rich in antioxidants and can reduce inflammatory processes in the body. Aim for a balanced and as natural as possible diet.
• Avoid highly processed foods and foods high in saturated fats, refined sugar, white flour, alcohol and caffeine as much as possible. They can promote inflammation and negatively affect hormonal balance.
• Omega‑3 fatty acids, found for example in linseed oil, rapeseed oil or fatty fish such as salmon, as well as selected vitamins and trace elements like vitamins D and C, zinc, selenium and magnesium, have anti‑inflammatory properties. They can therefore be incorporated into the diet as supportive measures.
• As endometriosis is not curable, the focus is on optimal symptomatic treatment and improving your quality of life.

Endometriosis requires patience and attention, but it is treatable. Being informed and listening to your body lays the foundation for greater well‑being and quality of life.