Endometriosis: causes, symptoms, complications and treatment

Endometriosis is a disorder that affects approximately 10% of women of reproductive age. It is one of the most common reasons for women to visit a gynecologist. The new material of the Encyclopedia of the School of Women's Health is about one of the most mysterious diseases.

Maria Zavialova

What is endometriosis?

Endometriosis is a widespread chronic inflammatory disease that affects reproduction, health and quality of life. This is a condition when endometrium-type tissue grows outside of the uterus. At the same time, this diagnosis is made with a delay of 4-5 years in 70% of cases. During all this time, the woman goes in circles from the gynecologist to the neurologist and the gastroenterologist, treating the consequences and complications of endometriosis and not working at all with the causes of the endometriosis itself.

Endometriosis may be asymptomatic, or it may be painful, cause inflammation and even infertility. Women in their 30s and 40s suffer from it the most, statistics in the United States show that approximately 11% of women have faced this problem.

It is important that this condition can become more complicated over time.

Stages of endometriosis

Please note that these stages are conditional. When choosing a treatment, doctors are guided by the woman’s reproductive plans and clinical manifestations.

  • Minimal: parts of the endometrium are detected in the pelvic organs without or almost without scar formations.
  • Mild: there are more parts of the endometrium outside the uterus than in the previous stage. They are more deeply implanted, the presence of scar formations is possible.
  • Moderate: large areas of parts of the endometrium outside the uterus. Small cysts on one or both ovaries and thick bands of scar tissue called adhesions are possible.
  • Severe: many deeply implanted parts of the endometrium and thick adhesions. Large cysts on one or both ovaries. Possible fusion of organs, spread of endometrial tissue into the vagina and intestines.
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Foci of endometriosis outside the uterus

Types of endometriosis

This disorder is distinguished by the areas of the organs it affects. There are four main types:

  • Superficial peritoneal endometriosis. Our internal organs are covered with a thin membrane – the peritoneum. Parts of the endometrium are attached to it.
  • Endometriomas. These are fluid-filled, dark-colored cysts, also called “chocolate cysts”. They differ in size and appear in different parts of the pelvis or abdominal cavity, but most often in the ovaries.
  • Deeply infiltrating endometriosis (HIE). In this type, endometrial tissue is implanted in organs inside or outside the pelvic cavity. It can be ovaries, bladder or intestines. That is exactly the type of endometriosis that often influences a woman’s quality of life, causing constant pain in the lower abdomen and pain during sex.
  • Abdominal wall endometriosis. Sometimes endometrial tissue can grow on the abdominal wall. Cells can also attach to a surgical incision, such as after a cesarean section. In my practice, there were several cases when women after this operation had endometrioid damage to the subcutaneous fatty tissue accompanied by a constant pain syndrome.

I even had a patient who had the endometrium spread into the pleura – the tissue that covers the lungs!

What causes endometriosis

Science still has not found an exact answer to the question: why this disorder occurs. There are several theories.

  • Retrograde or “reverse” menstruation. This is a fairly common condition, when menstrual blood is not released outside, but inside – through the fallopian tubes into the pelvic organs. Usually, a woman does not even notice when this happens, but sometimes endometrial cells contained in the blood can attach to these organs and cause endometriosis. However, it is important to remember that up to 75% of women have retrograde flow of menstrual blood into the abdominal cavity. And not everyone has endometriosis.
  • Genetic origin. Endometriosis is usually a family problem. Therefore, if your mother and grandmother suffered from this pathology, you also have a chance to get it. At the same time, thanks to modern medicine, you have more chances to avoid serious complications.
  • Immunodeficiency. Endometrial cells outside the uterus must be destroyed by our immune system. Accordingly, if immunity is low, our body cannot cope with this work.
  • Surgical intervention. Abortions, C-sections, and abdominal surgeries can also cause the development of endometriosis.
  • Hormonal influence. High estrogen production is an endocrine feature of endometriosis, so endometriosis is considered an estrogen-dependent gynecological condition.

Interesting fact: a recent study in Italy found a connection between pigmentation and endometriosis: women with green eyes and blond hair have 5 times more risk of developing ureteral endometriosis! Previous studies have also linked the disorder to tall stature and thinness.


The main symptom of endometriosis is pain in the lower abdomen, especially during menstruation. I emphasize once again that pain these days is not the norm! If it interferes with normal activity and increases over time, contact your gynecologist.

In addition, the following symptoms may indicate the problem:

  • Abundant menstruation
  • Painful sex
  • Bleeding after sex
  • Painful defecation or urination during menstruation
  • Bleeding between periods
  • It is difficult or impossible to get pregnant
  • Digestive problems: bloating, constipation or diarrhea, nausea, especially if it occurs during menstruation


You can’t ignore this problem, even if you don’t have any symptoms. Any disorders of your reproductive system influence your general health and cause various inflammations or complications of other diseases.

The main complication is a decrease in a woman’s quality of life. The above symptoms are constant stress and malaise. According to the study, 29% of women with endometriosis have an anxiety disorder, 14.5% are diagnosed with depression. At the same time, certain symptoms of depression and anxiety disorder were detected in 86.5% and 87.5% of women, respectively. So be sure to consult a doctor!

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The diagnosis of “endometriosis” is frightening and very often causes mental health disorders due to women’s lack of proven knowledge about this disease


Endometriosis is considered one of the main reasons for impossibility to get pregnant. In particular, this applies to types when the endometrium interferes with the release of eggs, the patency of the fallopian tubes, or the ability of a fertilized egg to attach to the walls of the uterus. Studies show that 30-50% of women with this diagnosis have infertility.


This is not proven! However, certain studies link endometriosis with a higher risk of developing cancer. So don’t leave it a chance.

Also earlier doctors associated the presence of this disorder with the risk of premature birth. However, a recent study by French scientists refuted these assumptions.


Treatment of endometriosis is always about a comprehensive approach, because drugs only relieve symptoms. It includes stabilization of the emotional state, a healthy lifestyle, sufficient physical activity and various hormone therapy.

In addition, the treatment will depend on your reproductive plans – whether you plan to become pregnant in the near future.

Your doctor may prescribe you the following treatment:

  • Lifestyle balance: work and rest regime, physical and psychological therapy.
  • Pain relievers to reduce symptoms. It will also increase the quality of life and reduce stress, which is an aggravating factor. Painkillers should be from the group of non-steroidal anti-inflammatory drugs, because endometriosis, like an invader, tries to seize more territories and burn out everything in its path. It is important to remember that endometrioid areas always produce inflammatories that increase pain not only during menstruation.
  • Contraceptives: an intrauterine spiral with a hormone or a special regimen of oral contraceptives.
  • Hormonal therapy.
  • Surgical intervention: only if the risks of its absence exceed the threats of its implementation. If the doctor immediately prescribes you an operation, consult with other specialists to be sure of the prescribed therapy.
ендометріоз endometriosis
Bleeding Roses by Salvador Dali for me personally is not just a symbol of the suffering of women from the consequences of endometriosis.

This piece is a reminder of how important it is to take your time with surgical treatment of this disease. Over the past eight years, up to 20% of the cases in my medical practice were with women who were advised exclusively to undergo surgical treatment. So they turned to me with the question “do I really need an operation?”.

“Endometriosis surgery should be done once in a lifetime, not more”

The main thing is to contact a specialist. Never try to self-medicate!

You can learn more about your health and body from my courses: A girl becomes a woman, All about you. What it’s like to be a Woman, All about you 35+.

You can always find your doctor at the Lior Medical Center.

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