Endometriosis

Endometriosis is a chronic condition affecting women, in which tissue growths similar to the lining of the uterus (endometrium) is found outside the uterus. These abnormally located tissue deposits can settle in various parts of the body, such as on the ovaries, the peritoneum, or the intestines. Although endometriosis is classified as a benign condition, meaning it is not cancerous, it can still cause significant discomfort. This is because the tissue responds to the woman’s hormonal cycle in much the same way as the uterine lining: it thickens, breaks down, and bleeds. However, unlike menstrual blood, this internal bleeding has no natural way to leave the body, which can result in inflammation, tissue swelling, and, over time, the formation of scar tissue. Endometriosis is one of the most common benign, chronic diseases in women of reproductive age, affecting about one in ten women. Unlike infectious diseases, which are caused by pathogens such as bacteria or viruses, endometriosis is not contagious. It is a non-infectious condition influenced by hormonal changes, in which tissue resembling the uterine lining grows outside the uterus, leading to various symptoms.

The exact causes of endometriosis are still not fully understood. However, it is believed that a combination of both physical and genetic factors may contribute to the development of the disease. While not all underlying mechanisms are fully understood, several explanations are considered especially likely.

The fact that endometriosis may affect a wide range of bodily locations contributes to its multifaceted nature and often makes detection difficult. The abnormal tissue deposits are almost always found outside the uterus, most commonly in areas located close to the internal reproductive organs. Depending on their location, the symptoms can vary greatly, this makes individualized diagnostic approaches crucial for accurate assessment.

Endometriotic lesions, which are abnormal tissue changes that can cause pain, inflammation, or scarring, typically develop in the pelvic region. They are most commonly found around the uterus, fallopian tubes, and ovaries. Because these areas lie in close proximity to the uterus, endometrial cells can more easily implant there: for instance, through retrograde menstruation or via the bloodstream and lymphatic system.

The frequent involvement of these regions can primarily be explained by their proximity to the uterus. Furthermore, these types of tissues are well supplied with blood and highly responsive to hormonal changes. Both factors support the implantation and growth of endometrial-like tissue outside the uterus.

The most frequent localization of endometriosis is within the pelvic region, but in rarer cases, tissue deposits can develop in unusual parts of the body. Depending on the location of the lesions, they may cause a variety of symptoms. As a result, manifestations such as digestive issues, pain during urination, or even respiratory difficulties may also occur. Although such atypical locations are rare, they should be taken into account when symptoms remain unexplained.

Endometriosis and hydrometra (also referred to as hidrometriosis) are two distinct medical conditions, that may be interconnected in some cases. Endometriosis is a chronic disease in which tissue similar to the lining of the uterus grows outside the uterus. These lesions respond to hormonal cycle changes, often leading to pain, inflammation, and in some cases, infertility.

Hydrometra refers to a condition where fluid accumulates inside the uterus. This usually occurs when the normal outflow through the cervix (entrance to the womb) is obstructed, for example by a narrowing, clinically known as cervical stenosis, caused by a tumor, adhesions, or as a result of surgical procedures. The fluid buildup can either lead up to a feeling of pressure in the lower abdomen, or go entirely unnoticed.

A possible link between endometriosis and hydrometra arises when endometriosis causes structural changes in the uterus or cervix. Lesions or scar tissue may narrow the cervical canal, preventing the normal outflow of endometrial secretions. This leads to hydrometra, a fluid buildup inside the uterus. Anatomical abnormalities or adhesions in the pelvic region, which could be provoked by endometriosis, may also contribute to this manifestation.

It is important to emphasize that endometriosis is a systemic, hormonally driven disease that can affect the entire body. Unlike endometriosis, hydrometra is not affected by hormonal fluctuations but instead arises due to a mechanical blockage or constriction of the cervical canal. Nevertheless, it is important to recognize the possible connection between these two conditions, especially in women experiencing unexplained lower abdominal symptoms or infertility.

Endometriosis is a chronic and often painful condition. Because endometriotic lesions can appear in very different parts of the body, the range of symptoms is extremely diverse. Symptoms may include pain, menstrual irregularities, or gastrointestinal issues, depending on where the endometriosis is located. This variability often makes diagnosis difficult, especially since many women suffer from vague symptoms for years without knowing the underlying causes. Typical symptoms include:

If several of these symptoms occur simultaneously or recurrently each month, it is essential to seek medical advice. An early diagnosis can help alleviate severe pain, prevent possible complications, and improve overall quality of life.

Endometriosis is not limited to the reproductive organs, as it can also spread to other structures within the abdominal cavity. The rectum or the junction between the small and large intestines are particularly often affected, should this be the case a wide range of non-specific symptoms can be observed.

Typical complaints include abdominal pain, which may or may not be linked to the menstrual cycle and is often especially intense before or during menstruation. Affected individuals frequently report cramping, bloating, a feeling of pressure in the lower abdomen, or pain during bowel movements. Diarrhea or constipation may also occur. Should endometriosis spread to regions located deeper in the abdominal cavity, such as the rectum, blood in the stool or a painful sensation during defecation may also be present.

Since these symptoms are often mistaken for gastrointestinal disorders, such as irritable bowel syndrome (IBS), precise diagnosis by experienced specialists is essential. Especially when the symptoms correlate with the menstrual cycle, which is a red flag for possible endometriosis. Early detection is crucial to prevent complications such as adhesions or reduced bowel function, by initiating appropriate treatment.

Lower abdominal pain is one of the most common and most disruptive symptoms of endometriosis. One of the greatest challenges is that the pain varies greatly from one individual to another. It can differ in its type, intensity, and frequency, making it difficult to clearly identify. A characteristic symptom is a pulling, cramp-like pain in the lower abdomen that occurs in a wave-like pattern and can severely impact daily life. These pains are often hard to localize, since endometriotic lesions may form in various parts of the pelvic area. A defining characteristic of endometriosis-related abdominal pain is its dependence on the menstrual cycle. Many women experience pain before or during menstruation, as the endometrial-like tissue outside the uterus responds to hormonal fluctuations. These cycle-related pains may appear as a constant feeling of pressure, a deep pulling sensation, or sharp, stabbing pain. The discomfort often radiates to the lower back, legs, or the area located between the genitals and the anus, also known as the perineal region.

Pain that occurs independently of the menstrual cycle should still not be overlooked. This may indicate that endometriosis has progressed further and is already triggering chronic inflammatory processes. Such persistent symptoms should always be taken seriously and medically evaluated to prevent long-term complications, such as adhesions or infertility.

Because endometriosis is associated with a wide range of symptoms, many of which are non-specific, making an accurate diagnosis can often be challenging. For many women, it is a long journey before the true cause of their discomfort is identified. This makes a targeted and thorough diagnostic process all the more important, one that includes not only a detailed assessment of symptoms, but also imaging techniques and, if necessary, surgical procedures.

In general, the diagnostic process involves several steps. It typically begins with a comprehensive medical history (anamnesis), focusing especially on cycle-related pain, unexplained infertility, and bowel or bladder symptoms. The next step often includes imaging techniques, such as a transvaginal ultrasound or, in certain cases, a magnetic resonance imaging (MRI) scan. These methods can help detect larger endometriotic lesions or cysts.

In cases of unclear or overlapping symptoms, a careful differential diagnosis is also essential. This helps distinguish endometriosis from other gynecological, urological, or gastrointestinal conditions that may present with similar symptoms. An early and accurate diagnosis is crucial for initiating the right course of treatment, which leads to significantly improving the quality of life for those affected.

Ultrasound examination is a key component of the initial evaluation when endometriosis is suspected to be present. In particular, transvaginal ultrasound is considered the most important non-invasive technique for detecting certain forms of the disease. This method is especially effective in identifying endometriomas, which are cysts on the ovaries formed by encapsulated endometrial tissue. Even deeply infiltrating lesions, such as those located in the vaginal wall or near the rectum, can be visualized using ultrasound. Despite its diagnostic value, ultrasound imaging may not always be able to detect superficial lesions on the peritoneum or smaller, scattered lesions of endometriosis. Nevertheless, ultrasound remains an important part of the diagnostic process, as it helps evaluate both the location and the extent of suspected endometriotic tissue.

Laparoscopy is a minimally invasive abdominal surgery, which is considered the most reliable method for diagnosing endometriosis. This procedure allows doctors to visually inspect the abdominal cavity directly, enabling a definitive diagnosis. Even the smallest endometriotic lesions, whether on the peritoneum, ovaries, fallopian tubes, or even the bowel, are detectable via laparoscopy. When necessary, a tissue sample (biopsy) or even the removal of the lesion is possible during the procedure. Laparoscopy is performed under general anesthesia, during which a small camera is inserted into the abdomen through a tiny incision in the abdominal wall. This provides a clear view of the internal organs. When clear symptoms, such as chronic lower abdominal pain or unexplained infertility, are present, but non-invasive tests fail to provide a conclusive diagnosis, laparoscopy is especially recommended.

Diagnosing endometriosis can often be challenging, especially because a clear diagnosis has traditionally required more complex procedures, such as a laparoscopy or detailed imaging techniques. However, since 2024, a new, non-invasive saliva test has become available to help with the early detection of the condition. This test analyzes a saliva sample to look for biological markers that may be linked to endometriosis. It offers a non-invasive and accessible option, particularly for women who experience recurring symptoms, like strong menstrual pain or digestive discomfort, but have not yet received a confirmed diagnosis.

The test is easy to perform. You simply collect a small amount of saliva using a special container. To get the most accurate results, it is recommended to do the test in a calm state, ideally in the morning right after waking up. The sample is then sent to a specialized laboratory, where it is checked for specific markers that could indicate endometriosis.

While the saliva test is promising, it is currently considered an additional tool, not a replacement for established diagnostic methods like ultrasound or laparoscopy. Still, it may help identify potential cases earlier, allowing women to seek further testing and treatment sooner.

The treatment of endometriosis is highly individualized and depends on each patient’s specific symptoms and personal needs. The main goal is to develop a treatment plan that fits both the patient’s lifestyle and clinical picture as closely as possible. Since endometriosis can affect the body in many different ways, it is often helpful to combine conventional medical treatments with complementary approaches. This integrated strategy aims to provide long-term symptom relief and improve overall quality of life. Conventional medical treatments typically focus on directly addressing the symptoms and underlying causes: through options such as medication, hormone therapy, or surgery. Complementary therapies, on the other hand, play a supportive role, enhancing general well-being and promoting the body’s natural healing processes.

Conventional (Western) medical treatment for endometriosis focuses on relieving symptoms, controlling the growth of endometrial tissue, and in some cases, preserving fertility. The choice of treatment depends on several factors, including the severity of the condition, the woman’s age, her desire to have children, and her individual symptom profile.

The most common symptom associated with endometriosis is severe pain, particularly during menstruation. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen are over-the-counter drugs, which are frequently used to manage the pain. These medications help reduce pain and inflammation and can be effective during acute flare-ups. A core element of endometriosis treatment is hormone therapy. By suppressing ovarian function, hormone treatments can slow down or even halt the growth of endometrial tissue. Some of the most commonly prescribed medications in this category include:

In case medication alone is not effective, a surgical procedure may be recommended as an additional treatment. The goal of surgery is to remove excess endometrial tissue, which can help relieve symptoms and prevent the condition from progressing. This is most commonly done using minimally invasive laparoscopy, a gentle surgical technique that allows for precise treatment with a short recovery time.

In severe cases of endometriosis, especially when other treatment options have not been successful or when a woman no longer wishes to have children, removal of the uterus (hysterectomy) and/or ovaries may be considered. This procedure eliminates the hormonal stimulation of endometriotic tissue, as the ovaries are no longer producing estrogen. However, this approach is generally considered a last resort and should be carefully discussed with a medical specialist.

Conventional medical treatments for endometriosis are diverse and often combined to achieve the best possible symptom relief. In many cases, with early diagnosis and a personalized treatment plan, women living with endometriosis can experience a significant improvement in quality of life.

In addition to conventional medical therapies, there are several complementary approaches that can help support the treatment of endometriosis. These methods aim to restore balance within the body, relieve pain, and enhance the overall quality of life for those affected.

While they do not replace standard medical care, complementary treatments can be a valuable addition to conventional therapy, offering a holistic approach to managing endometriosis and its symptoms.

Ozone therapy has been used in various medical fields as a supportive treatment and has also shown promise in the context of endometriosis. It may help reduce inflammation in the affected tissue, relieve pain, and slow the growth of endometrial lesions. This therapy is typically applied locally, often in the form of injections into the affected area.

Sanum therapy is a form of homeopathic treatment designed specifically for chronic conditions. It primarily uses isopathic remedies to strengthen the immune system and stimulate the body’s natural healing processes. In the case of endometriosis, it may help reduce inflammation and ease symptoms such as pain and irregular menstrual cycles.

Acupuncture, a key method in Traditional Chinese Medicine (TCM), involves inserting fine needles into specific points on the body to activate the body’s self-healing mechanisms. For people with endometriosis, acupuncture may help relieve pain, balance hormonal activity, and improve energy flow. Research suggests it can be particularly effective for managing painful symptoms commonly associated with endometriosis.

Neural therapy involves injecting local anesthetics into specific nerve points or trigger zones in the body. This can help block pain signals and support the body’s healing response. In the context of endometriosis, neural therapy may help calm pain receptors in affected tissues and reduce sensitivity to pain.

A balanced gut microbiome plays a key role in maintaining overall well-being and supporting a healthy immune system. Research has shown that women with endometriosis often have imbalances in their gut bacteria, which may contribute to inflammation in the body. Microbiome therapy, which involves restoring a healthy intestinal environment, can help strengthen the immune system and reduce inflammation. This typically includes targeted approaches such as intestinal cleansing protocols and the use of probiotics and prebiotics, which help rebuild and maintain a healthy balance of gut bacteria.

An adequate supply of micronutrients, such as vitamins, minerals, and trace elements, can play an important role in supporting the body’s healing process and strengthening the immune system. For individuals with endometriosis, antioxidants like vitamin C, vitamin E, zinc, and magnesium are especially beneficial. These nutrients help combat inflammation and support the body’s natural repair mechanisms. In addition, dietary supplements such as omega-3 fatty acids, whether from fish oil or plant-based sources, have been shown to have anti-inflammatory effects and may help relieve symptoms associated with endometriosis.

Staying physically active is an important part of managing endometriosis. Regular movement not only boosts circulation and strengthens the body, but it can also help to relieve pain. Gentle forms of exercise, such as yoga, Pilates, or swimming, can be especially beneficial, as they help relax the muscles and release built-up tension. In addition to physical activity, managing stress is also a key element of treatment. Chronic stress can increase inflammation in the body and may therefore worsen symptoms. Practices such as meditation, mindfulness, or deep breathing exercises can help lower stress levels and support the body’s healing process.

A healthy, anti-inflammatory diet can have a positive impact on endometriosis symptoms. It is generally recommended to eat foods that are rich in antioxidants and help support hormonal balance. An anti-inflammatory diet focuses on: fresh fruits and vegetables, omega-3-rich foods, such as fish and certain plant-based oils and high-quality whole grains. On the other hand, certain foods, such as sugar, refined carbohydrates, and red meat, may promote inflammation and are best limited or avoided entirely. Making dietary changes may reduce pain and contribute to better control of endometriosis over time.

Complementary therapies can offer a valuable addition to conventional medical treatment for endometriosis. They not only help relieve symptoms, but also support the body’s overall healing process by strengthening the immune system and balancing hormonal activity.

Nutrition plays an important role in managing endometriosis and easing its symptoms. A targeted dietary approach can help reduce inflammation, support hormonal balance, and improve the overall quality of life for those affected. Certain foods and nutrients have been shown to be particularly beneficial in relieving symptoms. Because endometriosis is a chronic inflammatory condition, following an anti-inflammatory diet is especially important. Foods that are rich in omega-3 fatty acids and fiber can help inhibit inflammation-related processes in the body. Fatty fish, such as salmon, mackerel, or sardines, are highly recommended due to their high omega-3 content. Plant-based sources of healthy fats, such as linseed oil, walnuts, and chia seeds also have anti-inflammatory properties. In addition, foods rich in antioxidants, such as berries, leafy greens, and nuts, may further help reduce inflammation. Phytoestrogens, plant compounds with estrogen-like effects, may also support hormonal balance. Since endometriosis is often influenced by hormonal imbalances, incorporating phytoestrogens into the diet may help regulate hormone levels. However, this should always be discussed and monitored by a qualified medical specialist. Good sources of phytoestrogens include soy, flaxseeds, sesame seeds, lentils, and beans.

Another approach that has shown potential benefits is the reduction or elimination of dairy and gluten. Some studies suggest that these foods may promote inflammation in certain individuals and worsen symptoms. Both gluten and dairy can contain compounds that stimulate the immune system, potentially leading to increased symptoms. For some women, a gluten-free or dairy-free diet may help alleviate symptoms. In addition to dietary changes, targeted supplementation can provide added support. Nutrients such as vitamin D, omega-3 fatty acids, and antioxidants like vitamin C and E play a crucial role in reducing inflammation and supporting the immune system.

By following a balanced, anti-inflammatory diet, combined with targeted nutritional supplements and the avoidance of inflammation-promoting foods, it is possible to positively influence the course of endometriosis and help manage symptoms more effectively.

Receiving an endometriosis diagnosis can present an additional challenge for women who wish to have children. Endometriosis can affect fertility, as the presence of endometrial-like tissue outside the uterus may disrupt normal reproductive processes. While not all women with endometriosis are infertile, many may find it more difficult to conceive. Therefore it is especially important for women with endometriosis to seek early guidance from a medical specialist, in order to explore their options and increase their chances of becoming pregnant.

Despite these challenges, pregnancy is still possible for many women with endometriosis. Some are able to conceive naturally, while others may benefit from medical support, such as in vitro fertilization (IVF) or other assisted reproductive technologies. However, pregnancy in women with endometriosis can carry certain risks. These may include an increased likelihood of miscarriage, preterm birth, or complications during delivery. For this reason, close medical monitoring throughout the pregnancy is highly recommended.

In the following section, we answer some of the most common questions about endometriosis to help provide a clearer understanding of the condition and how it can affect those who live with it.

The information listed contains relevant topics and serves to improve understanding.