Endometriose

Endometriosis is a condition in which tissue similar to the lining of the womb grows outside it, most often on the ovaries, the ligaments behind the womb, the pelvic lining, and sometimes the bowel or bladder. This tissue responds to the monthly hormone cycle, causing inflammation, scarring and pain. It affects about one in ten women of reproductive age.

It is a long-term condition without a definitive cure at present. Hormonal treatment and surgery control symptoms well for many, but it can return. The average delay from first symptoms to diagnosis is still several years, largely because severe period pain is too often regarded as normal.

Symptome

• Period pain that stops you from normal activities and is not relieved by simple painkillers
• Pelvic pain between periods or around ovulation
• Deep pain during or after sex
• Pain on opening the bowels or passing urine during periods
• Heavy periods or spotting before periods
• Bloating, tiredness and low mood
• Difficulty getting pregnant

Ursachen und Risikofaktoren

The cause is not fully established. The leading explanation is that menstrual blood flows backwards through the tubes and cells implant in the pelvis, but since this happens in most women, immune, hormonal and genetic factors must decide who develops disease. Having a mother or sister affected raises the risk several fold. Early first period, short cycles and heavy long periods are associated. Adenomyosis, where similar tissue grows into the muscle of the womb, often coexists. Endometriosis depends on oestrogen and usually quietens after menopause.

Wie es diagnostiziert wird

• History and pelvic examination: The symptom pattern is the main clue. Examination may find tenderness, nodules behind the womb or a fixed womb, but is often normal.
• Transvaginal ultrasound: Shows ovarian endometriomas, known as chocolate cysts, and, in expert hands, deep nodules in the bowel wall and bladder. A normal scan does not exclude superficial disease.
• Pelvic MRI: Maps deep endometriosis before complex surgery, including bowel, bladder and ureter involvement.
• Diagnostic laparoscopy: Keyhole inspection under general anaesthetic with biopsy. No longer required before starting treatment, and ideally combined with removal of disease in the same operation.
• Fertility assessment: AMH and antral follicle count to gauge ovarian reserve before any ovarian surgery, with semen analysis for the partner.

Behandlungsmöglichkeiten

• Pain relief: Anti-inflammatory drugs such as ibuprofen or naproxen started at the onset of the period, together with heat and exercise.
• Hormonal suppression: Combined pill taken continuously, progestogens such as dienogest, or the levonorgestrel intrauterine system. These reduce pain but are contraceptive, so do not suit those trying to conceive.
• GnRH analogues and antagonists: Injections or tablets that induce a temporary menopause, used with add-back hormones to protect bone, for limited periods.
• Laparoscopic excision or ablation: Removal of visible disease, freeing of scar tissue and stripping of endometriomas. Relieves pain in most and improves natural conception rates in mild to moderate disease.
• Surgery for deep disease: Excision of nodules from bowel, bladder or ureter by a team with colorectal and urological surgeons. Carries higher risk and needs careful case selection.
• Fertility treatment: IUI or IVF, sometimes ahead of surgery to avoid reducing ovarian reserve. Egg freezing may be discussed before repeated ovarian operations.
• Hysterectomy: For those who have completed their family and have adenomyosis or persisting pain. It helps only if endometriosis outside the womb is removed too.

Wenn es dringend ist

Go to a local emergency department for sudden severe one-sided pelvic pain with vomiting, which may be a twisted or ruptured ovarian cyst, pelvic pain with a positive pregnancy test, fainting or shoulder-tip pain, which may be ectopic pregnancy, heavy bleeding soaking a pad an hour, or fever with pelvic pain.

Reisen nach Türkiye zur Behandlung

Planned laparoscopic excision by an experienced endometriosis surgeon is a reasonable thing to travel for. Allow 7 to 10 days for straightforward surgery and up to 2 weeks when bowel is involved. Imaging should be reviewed beforehand so the right team is present. IVF can also be combined with a visit. Long-term hormonal treatment and pain management afterwards should be continued by your own gynaecologist.

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