Endometriosis

Endometriosis is a chronic, benign condition that primarily affects women of reproductive age. It occurs when tissue similar to the endometrium the lining of the uterus that is shed during menstruation grows outside its normal location.

This tissue can implant on the ovaries, fallopian tubes, or other areas of the pelvis. In some cases, it can also affect other organs, such as the bowel, urinary tract, diaphragm, or chest.

Although endometriosis is a common condition, its exact cause remains unknown. It is currently considered a multifactorial disease involving hormonal, immunological, and genetic factors.

Symptoms

Symptoms can vary greatly from one person to another and are not always related to the extent of the disease. Some women with small lesions experience severe pain, while others with more extensive disease may have few symptoms.

The most common signs and symptoms include:

• Severe menstrual pain that interferes with daily activities
• Pelvic pain during menstruation
• Pain during sexual intercourse
• Pain when urinating or having a bowel movement during menstruation
• Digestive or urinary symptoms that occur cyclically with menstruation
• Fatigue
• Difficulty becoming pregnant or infertility

Any symptoms that occur repeatedly in association with menstruation should be assessed by a healthcare professional.

Who does it affect?

Endometriosis primarily affects women of reproductive age and is estimated to affect approximately one in ten women.

Diagnosis is often delayed because severe menstrual pain has traditionally been considered a normal part of menstruation. In addition, the disease can present in many different ways, and some patients may have no symptoms.

Endometriosis can also affect fertility. The inflammation caused by the disease and the anatomical changes it may produce in the ovaries or fallopian tubes can make pregnancy more difficult, although many women with endometriosis are able to conceive with appropriate treatment and follow-up.

Diagnosis

Diagnosis begins with a clinical assessment of symptoms and a gynaecological examination.

When necessary, imaging tests are performed, particularly a specialised gynaecological ultrasound and, in some cases, magnetic resonance imaging (MRI), to identify the lesions and determine the extent of the disease.

In more complex cases, a multidisciplinary assessment involving specialists in gynaecology, radiology, reproductive medicine, urology, and general surgery is essential.

Early diagnosis is key to starting treatment before pain becomes chronic and to reducing the impact of the disease on quality of life.

Usual treatment

Treatment depends on the symptoms, the location and severity of the disease, and each patient's individual needs and expectations, particularly regarding future pregnancy.

The first-line approach is usually medical treatment, mainly hormonal therapies that help control symptoms and improve quality of life.

In some cases, surgery may be necessary, particularly when other organs are affected, pain persists despite treatment, or complications develop.

For women who wish to have children, treatment is planned on an individual basis to preserve fertility whenever possible. If necessary, fertility preservation techniques may be considered before surgery.

Follow-up in specialised units and a multidisciplinary approach allow treatment to be tailored to each patient's needs.

Prevention

There is currently no known way to prevent endometriosis because its cause remains unknown.

However, recognising symptoms early and consulting a healthcare professional when menstrual pain interferes with daily activities can help achieve an earlier diagnosis and appropriate treatment.

In addition to medical treatment, maintaining a healthy lifestyle, engaging in regular physical activity, and complementing treatment with physiotherapy or psychological support when needed may help improve quality of life.

It is recommended to consult a healthcare professional if you experience:

• Severe menstrual pain that interferes with daily activities
• Pain during sexual intercourse
• Digestive, urinary, or chest pain related to menstruation
• Difficulty becoming pregnant
• Symptoms that recur with each menstrual cycle

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