Endometriosis

Endometriosis is a gynaecological disease that causes chronic pain, and up to 10% of fertile women are diagnosed with the disease. The exact cause of endometriosis is unknown, but it is associated with a genetic predisposition.

In endometriosis, tissue that resembles the endometrial mucosa exists outside the uterus, most commonly on the surfaces of the uterus and its adjacent tissues, the ovaries, the bladder and the intestines. This tissue reacts to the hormonal changes of the menstrual cycle as the endometrial tissue would. This causes a chronic inflammatory response in the endometrial tissue outside the uterus, which may lead to the development of scar tissue and tissue adhesions. Endometriosis can also manifest as endometrial cysts in the ovaries, also known as endometriomas.

Symptoms of endometriosis

Typical symptoms of endometriosis include:

  • painful menstruation and lower abdominal pain
  • pain during defecation
  • pain during urination
  • pain during intercourse
  • incontinence
  • infertility

The symptoms of endometriosis typically depend on the location of endometrial tissue outside the uterus. In most cases, menstrual pain is present, and it can begin several days before bleeding occurs. Endometriosis can also involve pain during intercourse, urination and defecation. It is also possible to experience more urinary incontinence than usually. The first symptoms may manifest in adolescence. In some cases, the only symptom of endometriosis is infertility.

The symptoms and the results of a gynaecological examination indicate the onset of endometriosis. The uterus and its adjacent tissues are hypersensitive in the examination, and an ultrasound scan can be used to detect endometrial cysts in the ovaries. An accurate endometriosis diagnosis can be made with an endoscopic surgery. However, this is not often necessary, as the treatment can already be initiated when the presence of endometriosis is suspected.

Treatment of endometriosis

Endometriosis is a chronic diseases that lowers the quality of a woman’s life and can cause infertility, which is why it is treated actively. You should book an appointment with a gynaecologist if you experience intense menstrual pains (in Finnish).

Curative pharmacological treatment of endometriosis does not exist, but the symptoms can be eased effectively. The progress of the disease can be prevented or slowed down by using hormonal contraceptives (including birth control pills and a hormonal intrauterine device (in Finnish)) and the related pain can be treated with pain medication.

In the most severe cases of endometriosis, surgical treatment might be necessary. If a woman with endometriosis wishes to become pregnant, hormonal contraceptives are not used, but the treatment is symptomatic. Endometriosis usually subsides during menopause.

Endometriosis and infertility

Circumstantial childlessness is an increasingly common problem among couples. Most endometriosis patients can become pregnant spontaneously, but endometriosis can also cause infertility by disturbing the functionality of the ovaries and the fallopian tubes. Approximately one in four patients who suffer from infertility are diagnosed with endometriosis. The more severe the endometriosis is, the more likely it is to cause infertility.

Infertility caused by endometriosis can be treated. After initiating the treatment of endometriosis, approximately 20% of patients become spontaneously pregnant within 6 months. If, despite the treatment, a spontaneous pregnancy is not possible, the most effective mode of treatment is in vitro fertilisation.

Read more:

Information about infertility 
Frequently asked questions about infertility 

Experiences with endometriosis

Endometrial pains have placed certain limitations on Tiia’s life ever since she was a teenager. She had to become accustomed to the idea of not having any children before she suddenly got pregnant.

The story of endometriosis patient Tiia (in Finnish)

Learn more:

Gynecologist
Menstrual pains and heavy menstrual bleeding (in Finnish)
Lower abdominal pain in women
Intrauterine device as a mode of contraception (in Finnish)

Expert consulted for the article Tuuli Soini, D.Med.Sc., gynaecologist and obstetrician

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