Endometriosis

Endometriosis is a gynecological condition characterized by the growth of endometrial-like tissue (similar to the inner lining of the uterus) outside the uterus. Endometriosis is most commonly diagnosed in women of reproductive age (18–49 years), meaning that it primarily affects women who menstruate.

Genital endometriosis occurs when endometrial-like tissue is found within or on the reproductive organs, including the vagina, cervix, uterine wall, ovaries, and fallopian tubes.

Extragenital endometriosis is diagnosed less frequently and occurs when endometrial-like tissue develops in other areas or organs, such as the peritoneum, bladder, or intestines.

Symptoms of Endometriosis

Endometriotic lesions (heterotopias) located outside the uterus undergo cyclical changes influenced by the menstrual cycle. Endometriosis may cause the following symptoms:

severe pain during menstruation;

heavy and prolonged menstrual bleeding;

pain and discomfort during sexual intercourse;

spotting or bleeding before and after menstruation;

infertility.

Causes of Endometriosis

Hereditary predisposition;

Hormonal disorders;

Intrauterine procedures, including abortions and dilation and curettage of the uterine cavity.

The exact causes of endometriosis have not been fully established. Several mechanisms have been proposed to explain how endometrial-like tissue develops outside the uterus. The main theories include:

retrograde menstruation, in which menstrual tissue flows backward and may subsequently implant in tissues of the cervix, ovaries, fallopian tubes, vagina, and other areas;

transport of endometrial cells through the lymphatic vessels;

development from residual embryonic tissue of the urogenital system.

Diagnosis

Endometriosis is evaluated based on the patient’s symptoms and clinical findings.

Diagnostic methods may include:

Pelvic ultrasound, which can help diagnose internal endometriosis (adenomyosis) and endometriomas (endometriotic ovarian cysts);

Pelvic MRI in diagnostically challenging cases;

Hysteroscopy and laparoscopy for the diagnosis and treatment of certain forms of endometriosis.

Treatment

Treatment should primarily aim to improve the patient’s quality of life by reducing pain and other symptoms, as well as to achieve pregnancy when infertility is present.

The main treatment methods and medications include:

Progestin therapy;

Long-acting GnRH agonists;

Surgical treatment: laparoscopy with excision or coagulation of endometriotic lesions and treatment of endometriomas;

Experimental treatments that have demonstrated potential effectiveness, including antiestrogens, dopamine receptor agonists, and pineal hormones.

Treatments with limited or insufficiently proven effectiveness:

Progestin medications administered only during the second phase of the menstrual cycle;

Combined oral contraceptives.

*The role of preoperative medical therapy remains a matter of debate.