Endometrial tissue growing outside of the uterine lining is called ectopic endometrial tissue causing the disease called endometriosis. Endometriosis is a diasese of reproductive age women. As endometriosis is a hormone dependent disease,  endometriosis is not seen after menopause. Endometriosis at postmenopausal stage is a very rare occasion.

The hormonal mileu is altered in endometriosis. The endometriosis hormones are estrogen and progesterone, where endometriosis is related with accumulation of estrogen at the ectopic endometrial tissue with progesterone resistance.

Endometriosis causes rely on many hypotheses. Retrograde menstruation, immunological defects, inflammation and genetic factors, coelamic metaplasia are some of the endometriosis causes.

Endometriosis Symptoms

Endometrioma symptoms are usually pain related. The signs and symptoms of endometriosis is very typical. Endometriosis cases usually suffer from  menstruel pain and sometimes pain during sexual intercourse (endometriosis dyspareunia), rectal pain (dyschezia endometriosis) and cramps. Endometriosis  pain can be severe.

Endometriosis symptoms are irregular bleeding, infertility, menstruel pain, and pelvic pain. Infertility is also one of the signs of endometriosis. Endometriosis related infertility is present in half of the cases. In atypical forms chest pain or back pain can be the presenting symptoms. Endometriosis can also cause shoulder pain or stomach pain.

There are silent endometriosis cases also (asymptomatic endometriosis). Deep infiltrating endometriosis symptoms can be explained as severe pain in all forms. Severe endometriosis pain can cause depression and worsen the quality of life. Endometriosis pain after menopause will cease.

What is an Endometriosis? Can Endometriosis Cause Cancer? Endometriosis Treatment

Endometriosis can cause ovarian cyst. Endometrioma is the name of the cyst in the ovaries. Endometrioma is also known as chocolate cyst. Endometrioma cyst symptoms are also pain related.  Endometriosis pain during ovulation might occur and the patient can also have ovulatory problems. Endometrioma has a typical diagnostic view at the ultrasound (us). The ovarian endometrioma is clearly visible at ultrasound. Differential diagnosis of endometriosis and endometrioma are easy with imaging techniques.

Endometriosis Diagnosis

The endometriosis diagnosis is usually easy with transvajinal ultrasound. In some cases magnetic resonans imaging (MRI) is required for diagnosis. Endometrioma diagnosis does not require a computerized tomography (ct) unless there is a suspicion of malignancy. CA125 is an endometriosis marker in blood. CA125 does not have diagnostic value but high levels of CA125 support endometriosis diagnosis. Very high levels are suspicious for ovarian malignancy. The certain diagnosis of endometriosis is by laparoscopy.

Endometriosis staging (endo stages)

Endometriosis has four stages. Stage of endometriosis is determined by surgery.

The different stages of endometriosis evaluated at laparoscopy documents the extension of the disease in the abdomen. Early endometriosis or mild/minimal endometriosis is stage 1,2. Severe or advanced endometriosis are stage 3,4.

Endometriosis treatment options

Endometriosis treatment is medical or surgical. Endometriosis has no natural cure (no natural treatment) or endometriosis has no herbal treatment. The progression of the disease change in every patient. Endometrioma treatment (removal) is performed by laparoscopy. Laparoscopic surgery for endometriosis consists of surgical excision of the endometrioma and all implants of endometriosis. Endometriosis treatment prices in Turkey range from 2500 to 3000 dollars on average.

Endometriosis pain treatment

Endometriosis pain relief can be achieved with medical treatment. Mefenamic acid like nonsteroid anti-enflamatory drugs (NSAID) are first line treatment for pain in endometriosis. Hormone treatment for endometriosis is mainly based on progesterone supplementation with different products. Treating endometriosis without birth control is not possible. If the patient desires child birth, then medical or hormone treatment is not an option.

Oral contraceptive pills can be used for treatment of pain in endometriosis if the patient desires birth control. The best birth control for endometriosis is oral contraceptive pills. Birth control for endometriosis has numerous choices.

Hormone therapy for endometriosis

Intrauterine device (iud) and endometriosis is also feasible for treatment.  IUD for endometriosis is levonerogestrel releasing intrauterine device which is quite effective, especially in postoperative period. Copper iud can be used as birth control in endometriosis but does not have any beneficial effect on symptoms. Nexplanon is also another birth control method with progesterone releasing device inserted the arm.  Nexplanon is not the first choice of birth control in endometriosis but can be used.

The new endometriosis treatment options are many drugs which have shown to be effective for symptom control of endmetriosis. Untreated endometriosis patients usually suffer from pain and disease progression.

When medical treatment fails, surgery (keyhole surgery for endometriosis) can be applied to all endometriosis cases for pain relief. After laparoscopic surgery for endometriosis, for longer periods of pain relief GnRH agonist treatment (decapeptyl endometriosis) can be used postoperatively.  GnRH, in endometriosis treatment creates a hormonal mileu mimicking menopause, which is temporary.

Surgical treatment for endometriosis

Endometriosis surgery is performed by laparoscopy. Very rare cases need laparotomy as endometriosis surgery.

Different lesions of endometriosis are visible at the pelvic cavity at surgery. Powder burn endometriosis is the black lesions on the peritoneum. Endometriosis cause adhesions in the abdomen. Endometriosis pain symptoms occur due to the endometriosis lesions in the pelvis.

Endometriosis cyst called endometrioma does not have natural treatment. The surgery with removal of endometrioma is the choice of treatment in may cases. Endometrioma surgery is performed by excision of the cyst capsula or removal of the whole ovary if the cyst is very big or suspicious of malignancy.

Severe endometriosis surgery needs to be performed by an endometriosis surgeon or in a specialized endometriosis clinic. Endometriosis and adhesions makes the  surgery quite complicated.

Endometriosis after surgery can reoccur. Therefore repeated surgeries might be required. Healing after endometriosis surgery is really quick and pain after endometriosis surgery is minimum when performed with laparoscopy.

Endometriosis treatment with surgery is definitively hysterectomy for women in older ages with no future fertility desire. Endometriosis and hysterectomy can resolve the pain symptoms of the disease. Endometriosis after hysterectomy is a very rare condition, which might occur if the ovaries are not removed simultaneously.

Endometriosis and infertility

Endometriosis cause infertility in many ways. The best treatment for endometriosis is planned by an endometriosis expert. If you desire to conceive, then endometriosis needs to be evalauted and treated by a reproductive endocrinologist. The  fertility endocrinologist will evaluate the ovarian reserve and the tubes by hsg in endometriosis. Endometriosis cases can have fallopian tube pathologies like tubal occlusion or hydosalpinx. If you are trying to conceive with endometriosis, the ovaries and tubes all need to be evaluated by tests.

Bilateral endometriosis is poor prognosis as these patients usually have low ovarian reserve. Conceiving with endometriosis, especially in bilateral endometriosis might necessiate IVF.

Endometriosis can accompany ovulation problems but endometriosis and pcos can be together in the same patient. The worse scenario is endometriosis together with adenomyosis in a woman of childbearing age. When endometriosis and adenomyosis are together in an infertile patient, the patient has an ovarian and endometrial factor. Fibroids(myoma) and endometriosis can be seen in the same patient.

Endometriosis infertility treatment

Endometriosis fertility treatment depends on the stage of the disease. In addition, the major factor affecting fertility outcomes are age of the women and ovarian reserve. Mild endometriosis is early stage disease (stage 1,2). After laparoscopy in early stage endometriosis the probability of pregnancy increases. In endometriosis, fertility can be restored after excision of all endometriosis lesions by laparoscopy. After surgery, endometriosis case can wait up to one year for concieving. Pregnancy after endometriosis surgery is a high chance only in early stage endometriosis.

Severe endometriosis (Stage 3,4) is usually treated with IVF. Endometriosis and IVF protocols depend on the ovarian reserve of the patient. Endometriosis IVF success rate is good as cases without endometriosis. Reproductive endocrinology and infertility specialist is the right choice for treatment of endometriosis.

Endometriosis fertility index is a new scoring system for infertile cases with endometriosis. This scoring system is based on surgery in accordance with patient history. The endometriosis fertility index can predict the pregnancy chances of a patient with infertility. The women with endometriosis can consult their reproductive performance to the reproductive endocrinologist near them.

Endometriosis pregnancy

Endometriosis pregnancy is associated with plasental complications. Endometriosis and ectopic pregnancy is quite common as endometriosis damages the Fallopian tubes in may cases. Endometriosis after birth is usually associated with symptom relief. If you have endometriotic cyst and pregnancy, the symptoms will pass and you will have symptom free period until the end of pregnancy and lactation. Endometriosis after pregnancy does not require any treatment until breastfeeding is completed.

Types of endometriosis

Endometriosis is a disease usually occuring in the pelvic organs. The most common sites of endometriosis are ovaries, uterosacral ligaments and peritoneum. In some cases atypical endometriosis forms can be seen. These atypical forms of endometriosis cases are at extrapelvic areas called extrapelvic endometriosis.

• Uterus with endometriosis is called adenomyosis (endometriosis inside uterus, internal endometriosis).
• Deep endometriosis (deep pelvic endometriosis): infiltration of the pelvic peritoneum more than 6 mm.
• Pelvic endometriosis, cul de sac endometriosis : endometriosis in the pelvic cavity.
• Umbilical endometriosis: endometriosis in belly button.
• Peritoneal endometriosis: endometriosis lesions in the peritoneum
• Cervical endometriosis: endometriosis in the cerviks
• Scar endometrioma, incisional endometriosis, subcutaneous endometriosis : Endometriosis in scar tissue
• Endometriosis after c section, cesarean scar endometriosis: Endometriosis in the skin or in the subcutenous tissue at the incision site
• Vulvar endometriosis: endometrial lesion on the vulva
• Cutaneous endometriosis: endometriosis in the skin
• Tubal endometriosis: endometriosis in the fallopian tubes
• Vaginal endometriosis: endometrial lesion in the vagina
• Endometriosis in the appendix
• Endometriosis on kidney
• Urinary tract endometriosis
• Hepatic endometriosis: endometriosis on liver
• Pleural endometriosis: endometriosis in the thorax
• Endometriosis on bowel

Frequently Asked Questions

Can endometriosis make it difficult for me to get pregnant?

Yes, endometriosis can sometimes lead to fertility problems, but not everyone with endometriosis will experience infertility. If you’re concerned about fertility, consult with a fertility specialist.

How is endometriosis diagnosed, and what should I expect during the process?

Endometriosis is usually diagnosed through a surgical procedure called laparoscopy. A small camera is inserted into your abdomen to check for endometrial tissue outside the uterus. The procedure is minimally invasive and done under anesthesia.

Is endometriosis hereditary? Should I be concerned if my mother or sister has it?

There’s evidence that suggests endometriosis can run in families, so if your close female relatives have it, you may be at a higher risk. It’s a good idea to discuss your family history with your doctor.

What are the available treatment options for endometriosis?

Treatment options for endometriosis include pain medication, hormonal therapies like birth control pills or hormone injections, and sometimes surgery to remove the endometrial tissue. Your doctor will help determine the best approach for you.

Can lifestyle changes help manage the symptoms of endometriosis?

While lifestyle changes cannot cure endometriosis, they can help alleviate symptoms. Eating a healthy diet, exercising regularly, managing stress, and getting enough rest can all contribute to your overall well-being.

Will endometriosis get worse over time, or can it stay the same?

Endometriosis can vary in its progression. Some people may experience worsening symptoms, while others may have stable symptoms. Regular check-ups with your doctor can help monitor any changes and adjust your treatment plan if needed.

Are there any natural remedies or alternative therapies that can help with endometriosis?

While some people find relief from symptoms with natural remedies or alternative therapies like acupuncture or herbal supplements, it’s important to consult with your healthcare provider before trying them. They can guide you and ensure your safety.

Can endometriosis increase the risk of developing other health conditions?

Women with endometriosis may have a slightly higher risk of certain conditions like ovarian cancer, but the overall risk remains relatively low. Regular check-ups and screenings with your doctor can help monitor your health and detect any potential risks early.