Updated | February 2023 Author: Antonio Setúbal In endometriosis, the endometrium (internal lining tissue of the uterus) develops in a variable location outside the uterus, forming masses / lesions with benign characteristics (with the exception of the ovary). In extra-uterine locations, this tissue undergoes transformations similar to those that occur in the uterus during the menstrual cycle, which more cause pain, infertility and serious complications involving other organs. What areas are most affected by endometriosis? Although it is described in all organs of the body, the most common places where endometriosis occurs are essentially in the pelvis: The ovaries; The fallopian tubes; The areas surrounding the uterus; The uterus (adenomyosis); The rectum; The vagina; The sigmoid colon; The ureters; The bladder; Superficial and deep nerves. Some forms of distant endometriosis may also involve other organs, for example the diaphragm, lung, ileocecal appendix, bowel, nose, and many others. It is estimated that the incidence of endometriosis in Portugal is around 700,000 cases. What are the symptoms of endometriosis? In some uncommon cases, endometriosis may not have any symptoms. However, the most common symptomatology of this disease is characterized by pain, which can occur: During menstruation (dysmenorrhea) or between menstrual periods; During or after intercourse and orgasm; During urination or defecation. 35% to 70% of women with endometriosis also have difficulty conceiving. In severe forms of endometriosis, other symptoms may be present, related to the organs that are affected. Serious complications can also occur slowly or acutely, such as intestinal perforation, intestinal obstruction, pneumothorax (lung collapse at the time of menstruation), progressive loss of renal function, and others. How is endometriosis diagnosed? The symptoms associated with endometriosis can occur with a number of other diseases. Thus, the diagnosis of endometriosis requires: A detailed medical assessment; Carrying out complementary diagnostic tests; A surgical investigation (exploratory laparoscopy). Are there treatments for endometriosis? Endometriosis can be treated in several ways , depending on: The symptoms and their severity; The location and extent of the endometriosis masses; Passive complications from adjacent organs (rectum, kidney, etc.); Patients' wishes regarding future pregnancies; Age; Other specific characteristics of each case. The treatment of endometriosis aims to solve problems of pain and infertility, as well as to eliminate masses of endometriosis. General treatment options are: Medical, analgesic and/or hormonal therapy – alleviates symptoms but does not reduce the extent of endometriosis masses, nor improves fertility; Surgical treatment – usually indicated for severe cases, namely, invasion of other organs and complaints of infertility; Conservative treatment – with the aim of removing endometriosis masses, improving pain and facilitating access to pregnancy; Radical treatment In patients with endometriosis, infertility may be associated with: Endometriosis masses; Anatomical changes due to the disease; Production of substances that interfere with normal ovulation, fertilisation or implantation. Thus, normally, the treatment of infertility associated with endometriosis may involve more than one of the aforementioned options, in addition to other resources, such as assisted reproduction techniques. It should be noted that, contrary to what is often claimed, pregnancy does not cure endometriosis and there may be serious complications during pregnancy itself. Endometriosis: surgery Although endometriosis is defined as a chronic disease, in reality, many severe forms of this disease can be completely cured with surgery. As a rule, surgical treatment of endometriosis is indicated when: Symptoms are severe and disabling; Medical therapy does not relieve symptoms; Masses of endometriosis and formed and invade other organs; There are many complaints of infertility. As already mentioned, and depending on the specifics of each case, the surgical treatment of endometriosis can be: Conservative – the endometriosis masses are removed but the uterus and ovaries are spared; Radical – the uterus, fallopian tubes, ovaries and endometriosis masses are removed. In young women undergoing radical treatment, attempt is made to preserve the ovaries , to prevent early menopause. After conservative surgery, the recurrence rate - which globally varies between 6% and 30% - is (in the case of ovaries sparing) inversely proportional to age. Meet the obstetrics-gynecology team from Hospital da Luz. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
