Endometriosis - still an enigma

With the start of the new year we also begin a new collection of articles. This month, we will focus on endometriosis. Endometriosis, such an enigmatic disease that affects up to 15% of women of reproductive age yet there is no cure for it currently. Only a treatment to alleviate the symptoms exists. Endometriosis has significant effects on the social, occupational, psychological, and physiological life of women.

What is it and what are the symptoms? Let’s find out!


Endometriosis is characterized by the presence of functional tissue similar to endometrium (the inner lining of the uterus) outside of the uterus. Endometriosis develops in women of reproductive age and can sometimes regress after menopause or ovariectomy. This suggests that the evolution of endometriosis is estrogen dependent. It is a chronic and relapsing condition that affects up to 15% women of reproductive age, with a peak between 25 and 35 years of age.


This condition is marked by an inflammatory process that is accompanied by the production of new blood vessels, fibrosis (wound healing that turns into a scarred tissue) scarring and anatomical deformation, resulting in pain and infertility.


Endometriosis is classified into 4 categories: stage I (minimal disease), stage II (mild disease), stage III (moderate disease) and stage IV (severe disease). It can even be compared to cancerous cells. Endometriosis is progressive and grows very fast, its growth is estrogen-dependent, can recur even after treatment and has a tendency to metastasize (to spread to other tissues and organs).


Symptoms of endometriosis


1. Pain related to endometriosis

  • Painful menstruation (dysmenorrhea)

  • Painful intercourse (dyspareunia)

  • Painful micturition/urination (dysuria)

  • Painful defecation (dyschezia)

  • Lower back or abdominal discomfort

  • Pelvic pain

  • Rarely: cyclic leg pain (during menstruation), cyclic rectal bleeding, cyclic dyspnea

2. Infertility

3. Dysfunctional uterine bleeding

4. Gastrointestinal symptoms

5. Urinary tract symptoms


Still, many women are asymptomatic and sometimes symptoms may only develop over time.


Currently, there is no clear explanation as to why endometriosis happens. Suggested mechanisms are retrograde menstruation, immune system abnormalities, genetic causes, environmental and lifestyle factors, prolonged exposure to estrogen (because of first menstruation at an early age, late menopause or obesity), short menstrual cycles, low birth weight. Sometimes endometriosis coexists with other reproductive tract anomalies such as obstruction of menstrual flow or Mulleri