Endometriosis

What are the symptoms of endometriosis?

Endometrial cells can invade all kinds of tissues and cause endometriosis: from the deeper layers of the uterus, vaginal tissue and ovaries to the bladder, intestines, lungs or even the brain. The type of symptoms depends in particular on the localization. However, symptom-free courses are also possible.

Symptoms in the uterus - and in the menstrual cycle

Endometriosis cells react to the female hormonal cycle - they multiply under the influence of oestrogen. This is an important indicator when investigating the symptoms.

If the endometrium-like cell clusters migrate into the deeper layers of the uterus, they can trigger increased menstrual bleeding. Menstruation-related severe pain, which starts about two days before the bleeding and subsides with it, is a common symptom. The depth of infiltration of the foci correlates directly with the intensity of the bleeding.

Symptoms in the abdomen and gastrointestinal tract

Endometrial cells can reach the gastrointestinal tract and lead to gastrointestinal complaints. These include difficulty passing stools (dyschezia) as well as constipation and diarrhea. Blood in the stool (hematochezia) or extremely dark stools are possible due to endometriosis in the gastrointestinal tract. Nausea, vomiting and flatulence, a feeling of pressure or cramps can also occur.

As with other localizations, the biggest challenge is that all these symptoms are not very specific for endometriosis, which makes diagnosis difficult.

Symptoms in the bladder and pelvis

If the bladder is affected by foci of endometriosis, the symptoms are similar to those of a common urinary tract infection. These include pain in the lower abdomen, difficult or even painful emptying of the bladder (dysuria) and a frequent urge to urinate - sometimes with only small amounts of urine being passed (pollakiuria). The presence of blood in the urine is possible, but the amounts of blood are often small and not visible to the human eye. A urine test can provide clarity.

In addition to the bladder, the pelvis can also be affected by endometriosis. Chronic pelvic pain can occur independently of the menstrual cycle and can significantly impair quality of life.

Other localizations of endometriosis - diaphragm, lungs and co.

Endometriosis is most common in the regions of the body close to the genitals, but the cell foci can be located anywhere in the body. In addition to the uterus, ovaries, ovaries, pelvic cavity, vagina, peritoneum, bladder and gastrointestinal tract, the belly button, ureter, lungs, diaphragm, brain or scars can also be affected.

Symptoms in the diaphragm

When endometriosis affects the diaphragm, this can be accompanied by pain on the affected side of the chest and radiating pain in the shoulder, arm and neck. The pain is often irregular and independent of exertion.

In rare cases, the diaphragm may rupture or air may enter the pleural cavity. Both lead to obstructed breathing, as a result of which those affected complain of shortness of breath. The pleural cavity is a body cavity that fits around our lungs and is filled with fluid to make breathing easier.

Symptoms in the lungs

Outside of the pelvis, endometriosis is most commonly found in the chest. It can also affect the lungs. but there are usually only noticeable symptoms when the airways are affected (coughing up blood can be the result) or a lung collapses due to air entering the pleural cavity (also known as a “pneumothorax”). Symptoms such as chest pain or pain near the shoulder blade may then occur. Shortness of breath is the result of this generally rare scenario.

The symptoms usually occur within 72 hours before the start of menstruation - but not with every period. In fact, there can be months or years between incidents.

Psychological symptoms

For women with endometriosis, the disease is not only physically but also psychologically stressful. In addition to the physical symptoms, psychological stress plays a major role. Due to the often long odyssey of visits to the doctor, many women develop anxiety. Some even begin to think that they have imagined their symptoms. Of course, the opposite is true.

Other challenges are more indirect: endometriosis has been shown to have a negative impact on productivity at work. A job and even everyday tasks can become more stressful as a result of the disease. Around half of all women with endometriosis suffer from pain during sexual intercourse. Apart from the discomfort itself, this can lead to shame, avoidance and couple conflict.

List of typical symptoms

The most common symptoms of endometriosis:

Overview of typical symptoms of endometriosis

Other possible symptoms:

• increased menstrual bleeding
• prolonged duration of menstruation (over 7 days = menorrhagia)
• acyclic bleeding or continuous bleeding outside the expected menstrual phase (metrorrhagia)
• impaired fertility
• difficulties in the course of pregnancy (miscarriage, premature rupture of membranes, growth restriction, premature birth)
• difficulties with bowel movements (dyschezia) such as constipation or diarrhea
• visible blood in the stool (hematochezia)
• extremely dark stool
• vomiting
• flatulence
• feeling of pressure or cramps in the abdomen
• pain in the lower abdomen
• difficult or painful emptying of the bladder (dysuria)
• frequent urge to urinate - sometimes with only small amounts of urine being passed (pollakiuria)
• blood in the urine
• headaches
• pain radiating to the legs
• exhaustion
• frequent infections
• subfebrile temperatures (temperatures between 37.5 and 38 degrees Celsius)
• blood when coughing
• difficulty breathing
• pain in the shoulder

Symptoms when taking the pill

Endometriosis cells react to the hormonal cycle. It does not matter whether the cells are located in the lining of the uterus or outside it, as is the case with endometriosis. An increase in oestrogen levels leads to the growth of endometriosis cells. Among the various treatment approaches for endometriosis, the use of the pill (to lower oestrogen levels) therefore plays a central role.

The preparations used include so-called progestogens, GnRH analogs, combined oral contraceptives or aromatase inhibitors, whereby treatment with progestogens is usually preferred. By inhibiting oestrogen-dependent growth, an effective reduction in the size and activity of endometriosis lesions can be achieved. The procedure should always be discussed with the treating physicians.

Endometriosis in sexuality, the desire to have children and pregnancy

A common symptom of endometriosis is pain during sexual intercourse (dyspareunia). This makes pleasurable sexuality more difficult. Chronic pain can also make you tired and irritable or lead to depressive moods. This can put considerable strain on a relationship.

Women with endometriosis should seek advice beforehand if they wish to have children. The risk varies greatly depending on the severity and location of the endometriosis. Endometriosis can be relevant for fertility and the subsequent course of pregnancy, but this is not mandatory.

If the endometriosis lesions are located in the deeper layers of the uterus, the probability of becoming pregnant decreases by 30%. However, these are average values. Ultimately, it depends on the individual case. Endometriosis is one of the main causes of an unfulfilled desire to have children. But if a woman has difficulties getting pregnant, this is not necessarily due to endometriosis, as there are many possible causes. It is therefore important to determine the reason for the impairment of fertility.

In many cases, there is no increased risk during pregnancy. In fact, hormonal factors often lead to a significant reduction in symptoms. This improvement can also continue after the pregnancy. In the case that the endometriosis lesions are unfavorable, this can lead to serious problems such as loss of pregnancy, growth restriction, premature rupture of the membranes or premature birth. The gynecologist treating you can inform you in advance about any possible risks.

Symptoms during the menopause

Endometriosis usually occurs with the onset of menstruation and most often causes symptoms between the ages of 20 and 40. The symptoms disappear with the onset of the menopause. Only rarely can endometriosis remain an active disease even after the menopause. According to studies, around two percent of all suffering women with a surgically diagnosed initial diagnosis are postmenopausal. But a severe course of the disease is the absolute exception at this age, as oestrogen levels fall.

Test for symptoms of endometriosis

There is no test that can reliably diagnose endometriosis. The average time between the first symptoms and diagnosis is six years. There are many reasons for this. One reason is the wide range of possible symptoms. If one woman with endometriosis primarily has shoulder pain, but another has digestive problems, it is difficult to make the correct diagnosis.

It is not uncommon for affected women to consult doctors from other specialties first. Orthopaedists, gastroenterologists and even many gynaecologists often do not make the correct diagnosis at first. The stroke rate in the practices is usually high and the gynecological examination is often unremarkable. This is because the endometriosis lesions are usually hidden deep in the tissue.

Although the often cyclical occurrence of symptoms can be a decisive indication, this is by no means always the case. Women who take the pill do not have cyclically high oestrogen levels. The growth and pain symptoms of endometriosis lesions can therefore be decoupled from the menstrual cycle.

If endometriosis is suspected, the patient should be referred to a specialized center. The diagnosis can then be reliably confirmed with a careful medical history, examination, various imaging procedures and, in some cases, surgical sampling. The latest developments investigate the possibility of diagnosing endometriosis using stool samples. Such a non-invasive diagnostic method would also have the advantage of being less stressful for patients.

Treatment of symptoms

A complete cure for endometriosis is not yet possible. However, there are effective treatment options. Once the diagnosis has been confirmed, it is advisable to seek treatment at a specialized center with an interdisciplinary team. It is important that different doctors from different specialties work together, as endometriosis can affect different areas of the body.

Over the years, a pain memory can develop. This is because when strong pain signals repeatedly reach the spinal cord and the brain, pain processing can adapt there. This leads to sensitization, which can intensify the perception of pain - regardless of the treatment measures taken.

Keeping a symptom diary, yoga, wellness, acupuncture and neural, pain, physiotherapy or psychotherapy can help. Diet can also have an influence: Affected women report symptom relief from an anti-inflammatory and low histamine diet. Red meat and sausage in particular contain substances that promote inflammation. These include arachidonic acid, an omega-6 fatty acid that is mainly found in pork. Too much sugar also promotes inflammation.

Overall, endometriosis remains a complex disease. However, the number of endometriosis publications is growing rapidly:

This could mean promising breakthroughs for the future.