Endometriosis, the characteristic symptom is pain

By Cristiano Antonino On Mar 26, 2023

Endometriosis is a benign condition that exclusively affects females and develops when endometrial cells (i.e. cells lining the uterine cavity) proliferate outside the uterus

A characteristic symptom of endometriosis is pain, which can be particularly disabling for patients and severely affect their quality of life.

Often, however, this disease remains silent and is diagnosed incidentally in the course of other specialist investigations.

Moreover, endometriosis is also particularly complex to treat, as treatment courses must always be customised according to the clinical condition of the individual patient, the stage of the disease and the reproductive desire.

What is endometriosis?

Endometriosis occurs when endometrial tissue, the tissue that normally lines the uterine cavity, spills into abnormal sites outside the uterus.

The most frequent site is the ovary, but endometriosis may also be located

in the pelvic peritoneum
in the intestine
in the recto-vaginal septum
in the bladder
in extra-pelvic locations.

Women between the ages of 25 and 35 are particularly affected by this chronic inflammation: endometriosis very rarely occurs before puberty and after the menopause.

Diagnosis, as we have said, occurs in many cases only as a result of investigations performed outside the gynaecological sphere or, again by chance, during routine gynaecological examinations.

This difficulty in diagnosis stems from the fact that endometriosis is often asymptomatic.

When, on the other hand, the patient with endometriosis presents symptoms, the main and most characteristic one is always pelvic pain.

For this reason, in the presence of particularly painful symptoms during the menstrual cycle or during sexual intercourse, the gynaecologist should be consulted as soon as possible.

What are the causes of endometriosis?

The most common cause is retrograde menstruation, i.e. a condition in which menstrual blood flows through the fallopian tubes and colonises the peritoneum and the areas surrounding the uterus and ovary.

Retrograde menstruation, however, is not enough to explain all cases of endometriosis; immune, inflammatory and genetic predisposition factors also come into play.

It is accepted that endometriosis may also arise ex novo from the lining tissue of the pelvis (due to a kind of metaplasia, i.e. change, of the tissue itself) or from dissemination of endometrial cells via the lymphatic or bloodstream (almost like a true metastatic mechanism).

What symptoms does it manifest itself with?

Symptomatology is linked to the process of action of endometriosis; the foci in fact behave like menstrual blood and therefore menstruate.

The characteristic symptom of endometriosis, where present because the disease can also be asymptomatic, is pain

at menstruation
in the peri-menstrual period
at defecation
during sexual intercourse.

It is a chronic pain that for some women becomes a disabling factor.

In fact, the endometriosis patient may experience particularly intense localised pelvic pain, both during the menstrual cycle and in the days before or after the cycle itself.

Another frequent symptom of endometriosis is dyspareunia, i.e. pain during sexual intercourse, which can go so far as to significantly impair the couple’s sexual life, even to the point of eliminating sexual intercourse, thus bringing severe stress to the patient and interfering with a good quality of life.

Infertility and endometriosis: what are the correlations?

Women with endometriosis may have irregular menstrual cycles, because the inflammatory process that sets in can affect the proper functioning of the ovulatory cycle.

In addition to ovulatory problems, the influence of endometriosis on fertility is mainly related to the more severe phases of the disease, when pelvic localisation and the presence of ovarian endometriomas interfere with tubal patency.

It is therefore important that all patients with endometriosis who are planning to become pregnant refer to a gynaecological specialist to assess the most suitable treatment options, also in relation to the condition and well-being of the couple.

It should be borne in mind that although endometriosis is one of the risk factors for infertility, there are many women affected by the condition who have not experienced difficulties in conceiving.

Diagnosis and treatment of endometriosis

Diagnosis is made by means of an accurate anamnesis, thorough gynaecological examination and transvaginal ultrasound.

Treatment of endometriosis can sometimes be observational and therefore there is no need to intervene, especially if the woman is not particularly symptomatic and/or is not seeking a pregnancy.

There are also medical therapies aimed at alleviating pain, such as the estroprogestin birth control pill or progestin-only preparations.

Surgery (laparoscopy) is used when strictly necessary, such as in the presence of disabling symptoms or particularly large cysts that create a pelvic obstruction.

Reference is made to surgery only in the absence of other alternatives, since the side effects of the procedure include possible alterations in the vascularisation of the ovary and a decrease in ovarian reserve, which has the consequence of reducing reproductive potential.

Also relevant to curbing the symptoms of endometriosis is the diet, in which detoxifying and anti-inflammatory foods must be present in large quantities.

Foods rich in fibre, such as whole grains, fruit, vegetables and pulses, and those rich in Omega 3 fatty acids, found mainly in fish, should therefore be included in the daily diet.

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