Women's Health

Managing Symptomatic Endometriosis

Managing Symptomatic Endometriosis

Key Takeaways

  • Endometriosis is the most common cause of chronic pelvic pain
  • It is a complex medical condition with a great variability when it comes to its signs and symptoms. 
  • Diagnosis of endometriosis is purely based on clinical features.

Endometriosis is known as a disease that affects women through their reproductive age. It is the most common cause of chronic pelvic pain,  usually beginning in adolescence. It is also one of the main causes of infertility among women. It is a complex condition with a great variability when it comes to its signs and symptoms, as well as its presentation. In many cases, this variability leads to difficulties diagnosing it. It usually takes longer to diagnose it when the signs and symptoms begin in adolescence. Aside from the variability in presentation of its signs and symptoms, a major reason for the delay in diagnosing it is also the prevalence of pelvic pain symptoms in the community and a lack of many health professionals about the onset of its signs and symptoms in adolescence.

An early recognition of its signs and symptoms allows a medical management in order to reduce the progression of the disease and its consequences, especially regarding fertility. Diagnosis of endometriosis is purely based on clinical features. If classical signs and symptoms of endometriosis are present, especially when there is a family history of endometriosis, its diagnosis is highly likely.

An initial assessment required a detailed history of the nature and duration of the pelvic pain. Sometimes, there might be an overlap between various medical conditions, like pelvic inflammatory disease, irritable bowel syndrome, and endometriosis, which makes it even harder to diagnose and a distinguish among them.

Initial tests and examinations recommended by your health care provider may include urine analysis, screening for sexually transmitted infections, trans-vaginal ultrasound, etc. Diagnostic laparoscopy is the best way of confirming the diagnosis, as well as excluding other possible medical conditions.

The management of endometriosis is influenced by the signs and symptoms. As it is a chronic medical condition, it requires lifelong management. Medical treatment is based on suppressing ovulation and inducing a steady hormonal environment. Routinely used drugs include oral progesterone as well as combined oral contraceptives. There is no medical evidence so far that one combined oral contraceptive is superior then others.

Potentially there is a need of surgical treatment as well, when the signs and symptoms are severe and especially when infertility results due to endometriosis. The goal of the surgical treatment is to remove the endometrial tissue which is growing outside of the uterus, as well as to get rid of the adhesions between various organs of the pelvis and abdominal cavity. Surgical treatment requires either laparoscopy or laparotomy. Repeated surgical treatments are not recommended as it also increases the risk of adhesions and a creation of scar tissue at the incision site.

Every woman should know that endometriosis tends to recover even after surgery. In 10% to 20% of patients who had a surgical treatment for endometriosis developed signs and symptoms again within one year.

The main problem of endometriosis is fertility. Women who are having a hard time conceiving should go and visit a fertility specialist. Often assisted fertilization techniques are required. Once the women gets pregnant, the pregnancy tends to run normally like in any other healthy woman.