Endometriosis: symptoms, causes, diagnosis and treatment

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What is endometriosis

The name of this disease is associated with the word endometrium – this is the internal mucous membrane lining the cavity of the body of the uterus, and richly supplied with blood vessels. The growth of cells in the lining of the uterus beyond its limits, for example, into the ovaries, fallopian tubes, rectum, bladder and other organs, is called endometriosis. Very rarely, but it happens that endometriosis spreads to the skin, lungs and even the brain.

There are various ways to measure the severity of endometriosis. The most widely used scale is the American Society for Reproductive Medicine. Doctors evaluate its manifestations on a point scale, depending on the area of ​​\u200b\u200bdistribution of endometrial tissue and the depth of its penetration into the affected areas of the body.

Stage 1 – minimum

It is diagnosed in cases of a small number of single foci of endometriosis on the muscular surface of the uterus, without penetrating deep into.

stage 2 – mild

The lesions increase in size and begin to grow deep into the tissues of the abdominal cavity.

Stage 3 – moderate

The lesions begin to actively spread into the deeper layers of tissues, causing scarring and contributing to the formation of small cysts on one or both ovaries.

stage 4 – severe

This is the most widespread stage of endometriosis, when its multiple foci spread not only to all layers of the uterus, but also to nearby organs, causing massive adhesions and cysts.

According to experts, endometriosis does not always begin with the first stage and end with the last. The insidiousness of this disease is that its signs and symptoms can either get worse or get better, whether you treat it or do nothing.


The main symptom of endometriosis is pelvic pain, very similar to what some women experience during menstruation. Many describe it as a spasmodic pain that waxes and wanes in intensity.

It is important to remember that the intensity of pain is not a reliable indicator of the stage of endometriosis. For example, in some women, mild endometriosis may present with unbearable pain, while in others, the severe stage of this disease may be almost asymptomatic.

Common symptoms of endometriosis include but are not limited to the following:

  • Painful menses. It usually manifests itself in the form of pelvic pain and cramps, which can begin before and last for several days during menstruation.
  • Pain during or after sexual intercourse
  • Unexplained chronic pelvic pain during defecation and urination. Rarely, small blood clots may appear in the stool or urine.
  • Heavy menstrual and intermenstrual bleeding
  • Irritable bowel syndrome. This symptom often accompanies endometriosis and completes the picture of its clinical manifestation.
  • Reproductive problems. Despite the fact that with a diagnosis of endometriosis, conception is quite problematic, with the right approach and the help of specialists, many women still manage to get pregnant and bear a healthy baby.

Causes of endometriosis

Despite the fact that there is no definite answer to the question of the causes of endometriosis, experts find several explanations for its appearance:

  • Retrograde menstruation is the flow of menstrual blood back into the tube. During retrograde menstruation, menstrual blood containing endometrial cells is thrown back through the fallopian tubes and into the pelvic cavity instead of leaving the body. These endometrial cells adhere to the walls and surfaces of the pelvic organs, where they grow and continue to thicken and bleed during each menstrual cycle.
  • Transformation of peritoneal cells. Under the influence of hormones or immunological processes in the body, the peritoneal cells that line the inner surface of the abdomen transform into endometrial-like cells, causing disease.
  • Transformation of embryonic cells This process usually occurs during puberty, when hormones such as estrogen transform embryonic cells into endometrial-like ones.
  • Implantation of endometrial cells in the postoperative scar. This often happens after operations such as caesarean sections and hysterectomy, when endometrial cells attach themselves to the area of ​​the surgical incision.
  • Transfer of endometrial cells to other organs and parts of the body using blood vessels and the lymphatic system.
  • Immune system disorders, when the body is not able to recognize endometrial-like tissue growing outside the uterus.

Risk factors

No one is immune from endometriosis, it can develop in any menstruating girl or woman. But still, most often this disease affects women aged 30 to 40 years.

Among the main risk factors for endometriosis, doctors distinguish the following:

  • Absence of children
  • Heavy menstruation lasting more than 7 days
  • Short menstrual cycle – 27 days or less.
  • Heredity. A woman has an increased risk of endometriosis if her mother, aunt or sister suffers from this disease
  • Health problems that block the normal flow of menstrual blood out of your body during your period

Diagnosis of endometriosis

Because of the similarity of symptoms, endometriosis can sometimes be confused with conditions that cause pelvic pain, such as pelvic inflammatory disease, polycystic ovaries, and irritable bowel syndrome.

The diagnosis of “endometriosis” can only be made by a doctor after a thorough examination.

The first step in diagnosing endometriosis is a gynecological exam, during which the doctor probes the vagina for large cysts and scars outside the uterine cavity.

Since the small areas affected by endometriosis are not always palpable, your doctor may prescribe one of the types of visual diagnostics, such as ultrasound or MRI.

In some cases, visual diagnosis is not possible, then the only way to confirm or exclude endometriosis is laparoscopy. This is a minimally invasive surgical procedure that allows doctors to see the affected endometrium. In some cases, only one glance at the tumor is enough to make a diagnosis, in others, a tissue sample is taken for biopsy.


Unfortunately, there is no magic way to get rid of endometriosis once and for all, but methods are available to treat the symptoms that it causes.

If you’re not trying to conceive, then hormonal birth control is usually the first step in relieving the symptoms of endometriosis. However, it should be remembered that hormonal treatment only works as long as you take it regularly. It is suitable for women in whom endometriosis does not cause any other symptoms, except for moderate pain during menstruation.

If you decide to go this route, your doctor will most likely prescribe you hormone pills or injections to help prolong your menstrual cycle. This means that menstruation will occur only a few times a year or completely stop, respectively, and the pain caused by its arrival will be much less.

Some hormonal IUDs also help reduce pain and bleeding caused by endometriosis.

Surgical intervention

If hormonal treatment does not bring the expected relief of symptoms, or you are trying to get pregnant, in this case, you can try to solve the problem with surgery. During the operation, the surgeon localizes the endometrium that has sprouted beyond the uterus and excised it as much as possible. After the operation, it is usually recommended to resume hormonal treatment, unless the woman is planning a pregnancy.

For a more radical solution to the problem, some patients go for the removal of the uterus and ovaries.

Photo: Vostock-photo

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