What is endometriosis? From diagnosis to treatment

Lower abdominal cramps, back pain, fatigue, intestinal problems: every month, women with endometriosis suffer these agonising symptoms. Since they can be mistaken for regular period pain, it often takes several years to get a diagnosis.

In endometriosis, the womb lining, also known as the endometrium, does not stay where it belongs – in the womb. It migrates around the body and grows anywhere, usually in the abdomen. It often attaches to the ovaries, peritoneum, bladder, the womb or between the vagina and intestines. These cells do not forget their original purpose, and subsequently grow and bleed during the cycle.

Unlike with periods, however, the blood and mucus cannot discharge through the vagina, but remain in the body. For many women, this results in cysts, infections and adhesions, which can cause severe pain. The growths are benign, but still potentially require treatment.

How the condition manifests varies from woman to woman. The extent of spread in the body is not related to the symptoms; smaller sites can cause severe pain, while women with extensive sites may not be aware of their condition.

Possible indications of endometriosis: 

• Severe lower abdominal pain before and during the period
• Pain during ovulation
• Heavy or prolonged periods
• (Significant) lower abdominal pain independent of periods
• Pain during or after sex
• Bloated stomach during periods
• Pain when passing water or stool
• Blood in the stool or urine
• Digestion problems (diarrhoea, constipation, nausea, a feeling of fullness)
• Inability to conceive children
• Lack of energy and drive
• Back pain

Women affected by severe symptoms may scarcely be able to cope with their work or everyday life. Their life is very restricted in the acute phase and depends wholly on their cycle. People often only find out about the illness when seeking medical advice due to an inability to conceive children. This is because the symptoms are frequently mistaken for normal period symptoms.

When is a consultation to check for endometriosis necessary?

In general, anything that goes beyond a slight twinge and discomfort and which prevents full participation in daily life should be examined by a doctor – because both endometriosis and period pain can be treated. If it is a case of endometriosis, this is progressive. The endometriosis sites can grow in to other tissue, causing permanent damage. Endometriosis also has an impact on hormonal balance and the immune system.

Medical history plays an important role in identifying endometriosis. Questions are asked about a family history of endometriosis, current symptoms, bowel movements, urination and sexuality.

Sometimes, sites of endometriosis between the intestine and vagina are palpable during gynaecological examinations. Larger sites and cysts outside the womb can be found with an ultrasound examination. However, small sites or endometrial cells that have grown in the womb muscles cannot be detected by ultrasound nor by magnetic resonance imaging (MRI).

In most cases, diagnosing endometriosis therefore requires a laparoscopy for a reliable detection of the illness.

The cause of endometriosis is still not fully understood by scientists. A common explanation is that during your period, some menstrual blood flows back along the Fallopian tubes into the abdomen.

The cells grow uncontrollably, attack organs, try to attach to the circulatory system and may spread locally or throughout the body. Endometriosis is a master of metamorphosis and difficult to recognise, which is why it is sometimes called a “medical chameleon”. Genes are also a factor in the development of endometriosis.

Statistically, women with the following characteristics often suffer from endometriosis:

• Their mother suffered from endometriosis
• Early first period
• Short cycle and longer bleeding
• Surgery on the womb
• Late first pregnancy

Endometriosis is a chronic inflammatory disorder. It can be treated but cannot always be cured. Treating endometriosis can involve medication, hormones or an operation. Specialists recommend a combination of different treatment methods. There is good news for older sufferers: normally, the symptoms disappear by themselves during menopause. After a woman’s last period, there should no longer be any risk of endometriosis.

Struggling to get pregnant? An inability to conceive can be caused by severe endometriosis. First, the good news: you can still get pregnant, even with endometriosis.

Endometriosis can cause mucosal spread, adhesions and scarring in the Fallopian tubes or ovaries and can prevent sperm from freely reaching the eggs. Inflammation can prevent fertilised eggs from implanting in the womb lining, or the quality of the eggs decreases. Infertility is particularly common when the peritoneum is inflamed by endometriosis.

The likelihood of pregnancy increases with an operation to remove the site of endometriosis. If you have endometriosis and are planning to have children, it is advisable to seek counselling at a fertility centre, in order to clarify whether endometriosis is the real reason for the infertility. And to see whether artificial insemination might be necessary – or whether you can get pregnant naturally despite having endometriosis.

Endometriosis also increases the risk of complications during pregnancy. It is therefore essential that you attend all check-up appointments.

The right diet can alleviate endometriosis symptoms and pain. Eating a mainly alkaline, anti-inflammatory diet is recommended to stop the inflammatory processes in the body and to have a positive influence on hormone balance. The following foods have a positive or negative effect on endometriosis and well-being. Try them out and see what works for you personally.

What should you eat when you have endometriosis?

• Healthy fats, such as olive oil and omega-3 fatty acids, improve the metabolism. Omega-3 polyunsaturated fatty acids, for example, are contained in linseed oil or rapeseed oil and fatty fish such as salmon and herring.
• Selenium, zinc and vitamins E and C have an anti-inflammatory effect. You can get these from food such as nuts, lentils and currants.
• Fibre in wholegrain products, fruit and vegetables lowers oestrogen levels. You can get the same effect from cutting out alcohol or losing excess weight. Oestrogen is a significant factor in the development of endometriosis.
• Wholegrain products, nuts and beans also contain a great deal of magnesium. Minerals help to prevent muscle cramps and support hormonal balance.

What should you avoid eating with endometriosis?

• Avoid products with cow's milk for one week before your period. This can help alleviate pain.
  
• Meat and other animal proteins enhance inflammatory processes. Sausages also contain a lot of histamine. This messenger substance also affects the womb and can intensify the pain.
• Sugar, white flour products and fast food (e.g. chips) influence hormones and inflammation levels via insulin, so these foods should be eaten in moderation.

Endometriosis is an often misjudged disease, but it is easily treatable – and, in the best case, curable. So talk to your gynaecologist about your symptoms to get to the bottom of them early on.