Endometriosis is a condition that primarily affects women of reproductive age. Unfortunately, its symptoms are often underestimated, leading to chronic discomfort and a reduced quality of life for patients.

On average, it takes more than 7 years from the onset of symptoms for a proper diagnosis to be made.

Many women either never seek medical help or receive ineffective treatments due to misdiagnosis.

Endometriosis is considered the second most common gynaecological condition, affecting approximately 157 million women worldwide.

Endometriosis occurs when the endometrial tissue, which is normally found only inside the uterus, is present in other locations outside the uterus, such as the ovaries, fallopian tubes, peritoneum, ligaments, bladder, rectum, ureters, pelvic nerves, or other organs. This leads to inflammation and the formation of adhesions.

It is important to note that the symptoms of endometriosis are not solely related to the size of the lesions but also to their location. For instance, a woman with a large endometriotic cyst on her ovary may experience minimal symptoms, while another woman with diffuse small lesions may suffer from chronic pelvic pain.

The main symptoms of endometriosis include:

• ◉ Dysmenorrhea (pain during menstruation)
• ◉ Pain during urination or bowel movements
• ◉ Constipation or diarrhoea
• ◉ Blood in the urine or stool
• ◉ Nausea
• ◉ Heavy menstrual bleeding
• ◉ Lower abdominal pain radiating to the hips and legs
• ◉ Pain during or after intercourse
• ◉ Infertility

Adenomyosis, a special category of endometriosis, refers to the presence of endometrial tissue within the uterine wall. Adenomyosis often coexists with endometriosis and shares similar symptoms, including abdominal pain, infertility, dysmenorrhea, and menstrual irregularities.

Treatment options for endometriosis include medication, surgery, or a combination of both. The choice of treatment depends on factors such as the patient’s age, desire for pregnancy, symptom intensity and duration, and ultrasound findings. Pharmacological treatment aims to alleviate symptoms and may involve analgesics and hormonal therapy. Hormonal therapy, including birth control pills, progestogens, and GnRH agonists, is used to induce amenorrhea and reduce estrogen levels.

Surgical intervention is necessary for patients who experience persistent symptoms despite medication or those who wish to preserve or enhance their reproductive capacity. Minimally invasive endoscopic surgery is the preferred method, offering advantages such as lower morbidity and decreased postoperative adhesions. The surgical goal is to excise or ablate visible endometriotic lesions, resolve adhesions, remove endometriomas, and restore normal pelvic anatomy.

It is worth noting that endometriosis has a high recurrence rate. To mitigate recurrences, postoperative medication is often recommended.