Endometriosis

Many women are familiar with this: lower abdominal pain during their period. For about two million women in Germany, however, the symptoms go far beyond that. Endometriosis is a chronic condition that is still rarely discussed, but one that significantly limits the lives of many women. This article provides an easy-to-understand overview of symptoms, diagnoses, and treatment options, and shows where those affected can find help.

In endometriosis, tissue similar to the lining of the uterus grows outside the uterus. Endometriotic lesions are often found on the ovaries, fallopian tubes, or the peritoneum. The intestines, ureters, pleura, vagina, and other organs may also be affected. This tissue reacts to hormonal changes during the menstrual cycle. This can lead to inflammation, adhesions, and scarring.

The condition is benign but is often accompanied by severe pain. It is estimated that 10 to 15 percent of girls and women of childbearing age are affected. Some affected women have few symptoms, while others experience significant limitations in their daily lives and in their relationships.

Symptoms can be complex and variable. Common signs of endometriosis include:

• Cramping abdominal pain before and during your period
• Heavy or prolonged bleeding
• Circulatory problems associated with menstrual cramps
• Abdominal and back pain before and during menstruation
• Pain during ovulation in the middle of the cycle
• Pain during sexual intercourse
• Involuntary childlessness
• Digestive problems during menstruation
• Other accompanying symptoms such as headaches, nausea, and fatigue

Not all affected women experience symptoms. Some conditions are never diagnosed or are only discovered by chance, for example, when a woman is unable to conceive.

When it comes to endometriosis, women affected by the condition often wonder about the possibility of pregnancy. In fact, the condition can affect a woman’s ability to conceive, for example, if adhesions or cysts impair the function of the ovaries and fallopian tubes.

However, endometriosis does not automatically mean that pregnancy is impossible. Many women with endometriosis do become pregnant, sometimes with medical assistance.

If you are trying to conceive and are unable to do so, you should seek medical advice early on. Specialized centers and fertility clinics can identify and support individualized treatment options even in cases of endometriosis.

If endometriosis is suspected, there are various methods available to diagnose the condition:

• Medical history: Observation of pain symptoms and their timing in relation to the menstrual cycle
• Ultrasound: Abnormalities in the tissue structures of the uterus, ovaries, and fallopian tubes can now be easily detected using ultrasound; however, not all forms of the disease can always be identified. 
• Magnetic Resonance Imaging (MRI): An MRI can provide additional information for diagnosis. 
• Laparoscopy: A surgical laparoscopy may be performed for a histological examination. During this procedure, any visible lesions can also be removed.

Because the symptoms are complex and nonspecific, diagnosis is often difficult and can sometimes take several years.

There are various treatment options available for endometriosis:

• Medication, e.g., hormonal therapy
• Pain management
• Surgical procedures
• Complementary measures such as physical therapy,  
• dietary adjustments, or relaxation techniques

The goal of treatment is to alleviate symptoms and improve quality of life. The appropriate treatment depends on the individual case, the severity of the condition, and which organs are affected. All therapies have advantages and disadvantages. The treatment strategy should therefore be discussed with the treating physician and tailored to the individual.

Pain associated with endometriosis is not a “normal” part of your period. Early evaluation can help better understand your symptoms and provide targeted treatment. The first step is to talk to your gynecologist or a specialized counseling center. If endometriosis is suspected, you may be referred to an endometriosis center. These centers are staffed by specialists who have experience dealing with the complexities of the condition.

Endometriosis is often associated with shame. Many of the symptoms relate to issues such as menstruation, pelvic pain, and sexuality. Talking about these things isn’t easy for some people because the symptoms are very personal.

On top of that, menstrual cramps have long been considered “normal.” Many people with endometriosis hear comments like: “Menstrual cramps are nothing unusual,” “Don’t make such a big deal out of it,” or “You’re just too sensitive.” This downplays their symptoms.  

This makes it all the more important to talk about the symptoms and share information about endometriosis. Greater understanding can help those affected find support sooner.