Endometriosis

Disease Description

Endometriosis is a pathology in which the endometrium lining the uterus grows beyond its borders. This leads to inflammation and the formation of scar tissue (adhesions and fibrosis) in the pelvic area. The disease may begin with the first menstruation (menarche) and continue until menopause.

According to The World Health Organization, endometriosis is diagnosed in 10% (190 million) of women of reproductive age worldwide.

Symptoms indicating the need for diagnosis and treatment

Endometriosis is a chronic disease, the symptoms of which include acute or chronic pelvic pain, abdominal bloating, nausea, excessive fatigue, and a feeling of anxiety.

Pain is especially intense during menstruation and prevents a woman from performing usual daily activities. Pain may also be present during sexual intercourse, urination, or defecation.

Endometriosis is a common cause of infertility. According to global statistics, 40% of patients who underwent laparoscopy due to inability to conceive were found to have endometriosis. If pregnancy does not occur after treatment, a doctor may recommend IVF. Where and on what terms it is available abroad is covered in “IVF Abroad: When Fertility Treatment Is Restricted, Expensive or Unavailable at Home”.

Diagnosis and treatment methods

Diagnosis

A histological diagnosis of endometriosis is made only after laparoscopy, which is the gold standard for diagnosis according to international guidelines. However, in order to avoid subjecting the patient to surgery, gynecologists in many European clinics make the diagnosis based on a combination of symptoms and non-invasive diagnostic methods (laboratory indicators, ultrasound, ultrasonography, MRI).

Treatment

Gynecologists in leading clinics follow international protocols, in which asymptomatic endometriosis (diagnosed solely by ultrasound findings) is not treated with any medications. In the presence of symptoms, treatment is selected based on the woman’s individual preferences, as well as long-term safety considerations.

To reduce pain, nonsteroidal anti-inflammatory drugs (NSAIDs) are prescribed.

In addition to analgesic therapy, hormonal medications, including contraceptives of the most advanced pharmaceutical forms, are prescribed. The patient can choose the most convenient method of administration: orally (tablets), intrauterinely (IUD), vaginally (ring), subcutaneously (implant), or transdermally (patch).

In some cases, lesions are surgically removed. In Europe, laparoscopic surgery is widely practiced. In some clinics, laparoscopic surgery for endometriosis is performed using robotic da Vinci systems, allowing the surgeon to operate with greater precision in hard-to-reach areas of the pelvis. To learn more about how robotic surgery works and where else it is used, read our article “Robotic Surgery Abroad: Da Vinci, ROSA, ARTEMIS“.

Advanced medical centers also use alternative methods of treatment, such as acupuncture (targeting specific points), dietary adjustments, and lifestyle changes.

Innovations of world clinics

The newest approach in endometriosis treatment is immunotherapy, aimed at strengthening the immune system and reducing the inflammatory response. The calmer the body reacts to irritants, the fewer lesions (adhesions and scars) develop.