Endometriosis
Endometriosis is a chronic, benign condition in which tissue similar to the lining of the womb (endometrium) grows outside the uterus – for example on the peritoneum, the ovaries or the fallopian tubes. This tissue reacts to the monthly hormone cycle just like the uterine lining: it builds up, bleeds and breaks down, but – unlike a normal period – cannot leave the body.
An estimated two million women in Germany are affected – making endometriosis one of the most common gynaecological conditions among women of reproductive age. On average it takes several years to reach a definitive diagnosis, as symptoms are often non-specific and long mistaken for „normal“ period pain.
Important information:
Symptoms
The typical signs of endometriosis are cyclical, often severe pain – though the intensity can vary greatly from woman to woman.
- Severe period pain (dysmenorrhoea)
- Pain during intercourse (dyspareunia)
- Chronic pelvic pain, also independent of the period
- Pain when urinating or during bowel movements, especially during menstruation
- Unfulfilled desire to have children / fertility problems
- Pronounced exhaustion (fatigue) and irregular, sometimes heavy bleeding
Endometriosis - what exactly does it mean?
The name derives from the Greek „endo“ (inside) and „metra“ (uterus). It refers to tissue that resembles the lining of the womb but settles outside the uterine cavity – most commonly in the pelvis (e.g. ovaries, fallopian tubes, peritoneum), less often on other organs.
Despite decades of research, the exact causes are still not fully understood. Several explanations are discussed, including so-called retrograde menstruation (menstrual blood flowing back through the fallopian tubes into the abdominal cavity), a genetic predisposition, and changes in the immune system.
Who is affected?
Endometriosis affects women of reproductive age, most commonly between 25 and 40. After menopause, symptoms usually recede due to falling oestrogen levels.
An estimated two million women are affected in Germany – overall, around 10 percent of women of reproductive age are thought to have endometriosis, rising to 30 to 50 percent among women struggling to conceive.
What stages of endometriosis are there?
Doctors classify endometriosis into four stages depending on the extent and severity of the findings:
Stage I (minimal)
Few, superficial lesions, little or no adhesions.
Stage II (mild)
Somewhat more and deeper lesions, minor adhesions.
Stage III (moderate)
Multiple, partly deep lesions, endometriosis cysts on the ovaries (endometriomas), more pronounced adhesions.
Stage IV (severe)
Extensive, deep lesions, large endometriomas, pronounced adhesions, sometimes involving the bowel or bladder.
Good to know: The stage does not necessarily reflect how severe the pain is – even small lesions can cause very strong symptoms.
Are there risk factors?
Besides a genetic predisposition (endometriosis in the family), factors such as an early first period, short cycle lengths, no previous pregnancy, and high oestrogen levels are considered to increase risk. Anatomical features that make it harder for menstrual blood to drain are also discussed.
Frequently Asked Questions
Frequently asked questions relating to endometriosis.
When should I see a doctor?
As a general rule: see your gynaecologist promptly if you experience one or more of the following symptoms:
- Severe period pain that interferes with daily life
- Pain during intercourse
- Chronic pelvic pain
- Unfulfilled desire to have children
What happens at the doctor's?
First, a detailed conversation about your medical history takes place, followed by a gynaecological examination and usually a vaginal ultrasound.
Important points include:
- What exactly are your symptoms, and when do they occur?
- How long have you had these symptoms?
- How much do the symptoms affect your daily life?
- Do you wish to have children?
- Is there a history of endometriosis in your family?
- Which method of contraception do you currently use?
A definitive diagnosis can ultimately only be made through laparoscopy (keyhole surgery), during which tissue samples can be taken and lesions treated at the same time.
What can be done about endometriosis?
There are various treatment approaches, broadly divided into conservative (medical) and surgical procedures. The goal is to relieve pain, slow the progression of the disease and, if pregnancy is desired, preserve or improve fertility.
Consulting a specialist is necessary to clarify which approach is right for you.
Is endometriosis curable?
According to current medical knowledge, a complete cure is usually not possible, as individual lesions can recur even after treatment. With the right therapy, however, symptoms can in most cases be significantly relieved and quality of life noticeably improved. Close contact with a specialist is important here.
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