Endometriosis is a benign condition characterised by the proliferation of endometrial tissue (physiologically located within the uterus) in abnormal, pelvic sites or, more rarely, outside the pelvis.
Endometriosis is a condition that is often difficult to diagnose. There is a tendency to confuse it with symptoms of other diseases such as cystitis or inflammation of the colon. The diagnosis is mainly based on the evaluation and analysis of the symptoms reported by the patient. Endometriosis can be diagnosed and explored with imaging tests (second-tier ultrasound or MRI) by a gynaecologist who specialises in the treatment of this pathology.
How the Paideia Endometriosis Centre operates
At Paideia International Hospital’s International Endometriosis Centre ,a team of physicians highly specialised in treating and diagnosing endometriosis will accompany you through all stages of the disease, from the discussion of your medical history to post-operative care.
There are fundamentally four types of endometriosis localisations: in the uterine wall (adenomyosis), in the ovary (endometrioma), superficial endometriosis (hotspots, often associated with adhesions) and deep endometriosis (which can affect all pelvic structures – retro and parauterine area, sigma-rectum, bladder and urinary tract, vagina and recto-vaginal septum – and sometimes also remote intestinal segments and the abdominal wall).
These tissue localisations, referred to as endometriosis lesions, typically result in inflammation with the consequent symptoms:
- Dysmenorrhoea (pain during menstrual cycle)
- Dyspareunia (deep pain during sexual intercourse)
- Dyschezia (pain during defecation)
- Dysuria (pain during urination)
- Changes in bowel habits (Alternating constipation and diarrhoea)
- Hematochezia (blood in stools)
- Haematuria (blood in urine)
- Mucus in stools
- Irregular periods
- Infertility
Medical history
The first diagnostic approach for women with suspected pelvic endometriosis is a thorough examination of their medical history, aimed at highlighting the clinical elements that could be useful in guiding subsequent laboratory/instrumental diagnostics and treatment. This is a fundamental stage that not only assesses the presence, quality and intensity of the patients’ symptoms, but also the impact of this pathology on the woman’s psychological and physical well-being.
Endometriosis: medical treatment
The key to treating endometriosis is medical treatment to manage the symptoms and the progression of the disease, and to prevent relapses after surgery. This can include:
- Continuous oral progestin therapy
- Continuous or cycles (monthly break) of oral oestro-progestin therapy
- Medicated intrauterine device (LNG-IUS, IUD with gradual progesterone release)
- GnRH analogues (chemically induced temporary menopause)
In the event of failure to respond to drug therapy, contraindications to taking the drugs or poor tolerance, due to excessive side effects, or even in selected cases of patients who are trying to conceive (who are therefore unable to take drugs with contraceptive effects), there is the option of surgery.
Surgical treatment
Surgically treating endometriosis consists of completely removing macroscopically visible endometriosis lesions in a single surgery, performed using laparoscopy (minimally invasive technique). The aim of surgical treatment is to remove endometriosis lesions to reduce painful symptoms and restore the anatomy of damaged organs. In some cases this can increase infertile patients’ chances of conceiving.
Surgery for endometriosis is essential in three cases:
- Bowel obstruction with risk of sub-occlusiion or occlusion
- Ureteral stricture with risk of impaired renal function
- Adnexal growths with suspected non-benign characteristics
Surgery for endometriosis can relieve pain. There are two options for intervention:
- Conservative surgery: removes or destroys endometriosis deposits and is usually performed in laparoscopy. Endometriosis can be removed by the surgeon or it can be destroyed using heat or a laser. The surgery provides relief from the symptoms, although they can recur.
- Complex surgery: depends on the severity of the patient’s endometriosis. The surgery can affect different organs of the body affected by endometriosis, such as the intestine or bladder.
