Endometriosis - symptoms, diagnosis and treatment options

Endometriosis is a mostly painful condition that affects millions of women worldwide. One in ten women suffers from the painful symptoms of endometriosis, and these women typically have a long ordeal before being diagnosed. Despite its prevalence, endometriosis often remains undetected for a long time—in Germany, up to 10 years—and is inadequately treated. In this blog post, we will take a closer look at endometriosis to explore its causes, symptoms, and treatment options.

Tigogreen is committed to endometriosis research

This topic has been particularly close to our hearts for years, as endometriosis is the second most common gynecological disease after fibroids and still receives too little public attention. Therefore, we are actively committed to advancing endometriosis research: among other things, we are working with Prof. Dr. Sylvia Mechsner from the Endometriosis Center at the Charité Berlin (book "Endometriosis - The Underestimated Disease"), and we are currently supporting clinical endometriosis research with our ENDOGREET study at the Vienna General Hospital , which we are conducting as a randomized, placebo-controlled trial with Prof. Dr. René Wenzl.

What is endometriosis?

Endometriosis is a condition in which tissue resembling the lining of the uterus grows outside the uterus. This endometrial-like tissue develops in various parts of the body, including the ovaries, fallopian tubes, bladder, abdominal cavity, and intestines. During the menstrual cycle, these patches of endometriosis often react in the same way as the endometrium (lining of the uterus) within the uterus: they bleed and become inflamed. This is the cause of the often severe pain, inflammation, and reduced fertility, as well as massive psychological distress. Endometriosis most commonly occurs in women of childbearing age between 35 and 45, affecting approximately 5–15%. The disease is chronic, but this does not mean that endometriosis is untreatable.

There are a wide range of treatment options that should be tailored to the individual, including surgical therapy, hormonal therapy, drug-based pain therapy, and complementary treatment options. The course of endometriosis is highly individual, which is why the effectiveness of treatment methods varies considerably. Conventional treatment methods often have severe side effects.

Causes of endometriosis

The exact causes of endometriosis are not yet fully understood. However, there are several theories being discussed, including:

• Retrograde menstruation: According to the transplantation theory, part of the uterine lining is transported into the abdominal cavity through retrograde menstruation. With retrograde menstruation, menstrual blood flows not only through the vagina but also in the opposite direction through the fallopian tubes into the abdomen. Retrograde menstruation is common in many women and usually causes no symptoms. However, if uterine tissue found in menstrual blood grows in other areas outside the uterus, this theory can lead to endometriosis.
• Immunological theory: Normally, the immune system prevents cells from a particular organ from growing in other parts of the body. It is believed that patients with endometriosis have a defect in this immune defense mechanism, allowing the endometrial cells to spread.
• Genetic factors: There is evidence that endometriosis occurs more frequently in some families, which could indicate a genetic predisposition.
• Metaplasia: The metaplasia theory states that cells do not migrate from the uterus into the abdominal cavity, but rather form directly at the affected site by converting existing cells into endometrial tissue. A further development of this theory states that such transformations can be triggered by stimuli such as the sex hormone estrogen, i.e., by hormonal imbalances.

Symptoms of endometriosis

The symptoms of endometriosis can vary from woman to woman and range from mild to severe. Some of the most common symptoms include:

• Main symptom: Severe menstrual pain (dysmenorrhea)
• Pain during sexual intercourse (dyspareunia)
• Pain when urinating or defecating during menstruation
• Chronic abdominal pain, pelvic pain, or lower back pain
• Indigestion
• Tiredness and exhaustion
• Reduced fertility

Endometriosis and psychological stress

The constant pain and impaired sexuality represent a significant psychological burden. Many women take a long time to receive a diagnosis, and some feel their symptoms are often dismissed as normal menstrual cramps. The ongoing physical and emotional strain caused by the symptoms of endometriosis can lead to fatigue and exhaustion.

Endometriosis and the desire to have children

Due to the reduced fertility of women with endometriosis, the disease is also a common reason for an unfulfilled desire to have children. In women with endometriosis, fertility is typically reduced by around 30-50%. The exact causes for this are not fully understood. It is suspected that adhesions in the uterus, ovaries, and fallopian tubes could be a possible cause of infertility. In some cases, surgery to remove the endometriosis lesions can restore fertility. If pregnancy does not occur after several months despite such surgery, artificial insemination (in vitro fertilization) can be considered. Many patients with endometriosis have been given the chance of becoming pregnant through this procedure.

Diagnosis and treatment of endometriosis

Diagnosis of endometriosis usually takes time, as the symptoms can be similar to those of other diseases. In Germany, it often takes 10 years from the onset of symptoms to diagnosis. A detailed medical history is important, in which the doctor records the patient's medical history and symptoms. A gynecological examination and imaging procedures such as ultrasound or magnetic resonance imaging (MRI) may also be performed. The only way to reliably diagnose endometriosis is through laparoscopy. This involves inserting optical instruments into the abdominal cavity through small incisions, allowing the doctor to precisely examine whether endometriosis lesions are present. Laparoscopy can also be used to remove and examine tissue samples.

Treatment for endometriosis aims to relieve symptoms, slow the progression of the disease, and preserve fertility. The following treatment concepts are currently used to treat endometriosis, depending on the progression and severity:

• Drug-based pain relief therapy: Pain relievers such as nonsteroidal anti-inflammatory drugs (NSAIDs, acetylsalicylic acid) are used to relieve inflammation and pain. These medications often have side effects when taken continuously.
• Surgical procedures: In severe cases, a laparoscopy can be performed, as is the case for diagnosis, to remove the abnormal tissue and dissolve adhesions. If there is no desire to have children or family planning is complete, removal of the uterus, fallopian tubes, and ovaries can also be considered. The pros and cons should be carefully weighed with a doctor.
• Hormonal therapy: Hormonal contraceptives such as the pill, hormonal IUD, or GnRH agonists are used to regulate the menstrual cycle and inhibit the growth of endometriosis lesions. Endometriosis lesions respond to hormones similarly to uterine cells, building up during the monthly cycle under the influence of estrogen and being shed during the second half of the cycle with bleeding. Hormonal therapies can suppress the activity of these lesions. However, the body's adaptation to such therapy can take several months before success can be assessed.
• Alternative medicine approaches: Many women find relief by switching to an anti-inflammatory diet, using herbal medicine, acupuncture, traditional Chinese medicine (TCM) methods, as well as regular osteopathic treatments, physiotherapy, massages, and certain exercise or relaxation techniques (e.g., yoga or tai chi).

Lifestyle and self-care

In addition to medical treatment, certain lifestyle changes and self-care are essential to alleviate the symptoms of endometriosis. First, detoxification, growth inhibition, and pain relief, followed by herbal hormone balancing, anti-inflammatory therapy, and relaxation.

• Regular exercise and physical activity can help relieve pain and regulate the menstrual cycle.
• Warm abdominal wraps provide relaxation
• A healthy diet rich in fresh fruits and vegetables, whole grains, and lean protein can reduce inflammation and improve overall well-being.
• Stress management techniques such as meditation, yoga, or qi gong can help reduce the stress that can worsen the symptoms of endometriosis.
• Dietary supplements: The targeted intake of anti-inflammatory, anti-proliferative nutrients and plant substances can help curb the growth of endometriosis lesions and relieve pain. There are also a number of proven medicinal plants that harmonize the cycle and support fertility in women trying to conceive.
• Support groups and networking: You are not alone. Connect with other women and exchange ideas. Together we are stronger.

Conclusion

Endometriosis is a complex and often painful condition that impacts the lives of millions of women. Although it is not yet fully understood, there are a variety of treatment options aimed at alleviating symptoms and improving the quality of life of those affected. If you experience symptoms of endometriosis, you should consult a doctor for appropriate diagnosis and treatment. With the right support and treatment, you can live a fulfilling life despite endometriosis. At Tigogreen, we hope that through our work in endometriosis research, such as our ENDOGREET study at the Vienna General Hospital, we can make a promising contribution to a broad range of treatment options for endometriosis.

Sources:

1. Mechsner, Sylvia (2021). Endometriosis. The underestimated disease. ZS-Verlag, Munich.
2. Fischer, Heide (2023). Phytotherapy: The Healing Powers of Plants. In: Becherer, E. and Schindler, AE (eds.). Holistic Understanding and Treatment of Endometriosis. A Guide (4th, expanded and revised edition).
3. https://frauen-naturheilkunde.de/gp/data/_uploaded/file/Endometriose.pdf
4. https://frauen-naturheilkunde.de/gp/data/_uploaded/file/Naturarzt_Endometriose_2011-5.pdf