Dr Olga Sambolska*

Endometriosis is a long-term inflammatory disease caused by endometrial cells (cells from the inner lining of the uterus) growing outside the uterus.

These growths can be found on the ovaries, fallopian tubes, bladder, bowel, and rarely, in areas outside the pelvis such as the lungs or brain.

Endometriosis is common, affecting about one in 10 women. Many women live with symptoms for years before receiving a diagnosis. It is estimated that only 50 per cent or fewer women with endometriosis are formally diagnosed, meaning around one in two women with the condition remain undiagnosed.

Symptoms of endometriosis

Symptoms of endometriosis vary from person to person. Some women have mild symptoms, while others experience severe pain that significantly affects daily life.

Painful periods (dysmenorrhea)

This is the most common symptom of endometriosis symptoms and treatment concerns. Pain may:

• Begin several days before the period starts
• Continue throughout menstruation
• Become worse over time
• Not respond well to simple painkillers

Painful periods as a common sign of endometriosis symptoms and treatment needs. — Photo canva.com

Pelvic pain

• Pain in the lower abdomen or pelvis
• Pain in the lower back or sacral area
• Pain may occur only during periods or become constant over time

Pain during or after sex

• Especially pain with deep penetration
• Often described as deep pelvic pain from deep tissue scarring

Bowel symptoms

When endometriosis affects the bowel, symptoms may include:

• Pain during bowel movements, especially during periods
• Constipation or diarrhea that worsens around menstruation
• Bloating or a feeling of pressure in the rectum
• Rarely, blood in the stool during periods

Bladder symptoms

If the bladder or urinary tract is involved:

• Pain or burning during urination, especially during periods
• Frequent urination around menstruation
• Cyclical pelvic or bladder pain
• Rarely, blood in the urine during periods

Other symptoms

• Difficulty becoming pregnant
• Chronic fatigue, commonly worse before and during period and not relieved by rest
• Reduced concentration and mood changes
• Significant impact on work, relationships and quality of life

A key feature of endometriosis symptoms and treatment planning is that symptoms often follow the menstrual cycle and worsen before or during periods.

How endometriosis is diagnosed

In the past, surgery was often required to confirm endometriosis. Today, this is no longer necessary for most women.

Medical history

Diagnosis often begins with pelvic pain during or around periods that worsens over time.

Physical examination

A pelvic exam may show tenderness or pain, but a normal examination does not rule out endometriosis.

Imaging tests

• Transvaginal ultrasound is usually the first test. When performed by an experienced specialist, it can detect ovarian cysts and deeper forms of endometriosis.
• MRI may be recommended if bowel, bladder, or deep pelvic involvement is suspected.

It is important to note that normal imaging does not exclude endometriosis. Around 50-70 per cent of women with normal scans may still have the condition.

Laparoscopy

Surgery is reserved for specific situations, such as:

• Symptoms that do not improve after 6 months of treatment
• Suspected involvement of the bowel, bladder, or kidneys
• Persistent infertility lasting more than 12 months
• Unclear diagnosis after full evaluation

Treatment options for endometriosis

There is no single cure, but endometriosis symptoms and treatment can usually be well controlled.

Medical (non-surgical) treatment

• Pain relievers (NSAIDs) may help mild pain by reducing inflammation
• Hormonal treatments reduce or stop periods, helping control symptoms:
• Birth control pills taken continuously
• Progestin tablets or hormonal IUDs
• Other hormone-blocking medications in selected cases

These treatments can be effective even without surgical confirmation.

Surgical treatment

Surgery may be recommended if:

• Pain is severe and does not respond to medication
• Organs such as the bowel or bladder are affected
• Improving fertility is a treatment goal

When to see a doctor

• Endometriosis is a common cause of painful periods and chronic pelvic pain
• Symptoms are often cyclical and worsen during menstruation
• Diagnosis is mainly clinical and imaging-based, not surgical
• Effective treatments are available, and early care improves quality of life.

If you experience painful periods or chronic pelvic pain, it is important to consult an OB-GYN specialist to assess endometriosis symptoms and treatment options. Early evaluation and appropriate endometriosis symptoms and treatment can help reduce pain, improve quality of life, and protect fertility in the long term. — Family Medical Practice

Dr. Olga Sambolska. — Photo courtesy of Family Medical Practice

*Dr Olga Sambolska graduated from Lviv National Medical University in 1996 and began her medical career at the Volyn Regional Maternity Hospital in Ukraine. Since 1998, she has been a registered obstetrics and gynaecology doctor, providing health care to women in relation to pregnancy, birth control, menopausal issues, contraception, menstrual cycle disorders and sexually transmitted diseases. She is fluent in English, Ukrainian, Polish and Russian.

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Visit FMP Hà Nội 24/7 at 298I Kim Mã Street, Ngọc Hà Ward, Hà Nội.

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