The inner petal that covers the uterus is called the endometrium and exhibits changes from the action of hormones secreted by the ovaries during the menstrual cycle. Estrogens (estradiol) and progestagens (progesterone) contribute to the endometrium growth and preparation for the implantation of the fetus.
If no conception takes place, endometrial apoptosis is the blood of the period. In some cases, endometrial growth occurs outside the uterus, and the condition is called endometriosis.
There are several theories on the development of endometriosis, trying to explain the ectopic positions that may occur as well as why it occurs in specific women.
The prevailing theory describes the regurgitation of endometrial tissue through the fallopian tubes and implantation – penetration into the surface and deeper layers.
Where is endometriosis detected?
Endometriosis looks like black or red spots containing blood or degradation products. The most common area of endometriosis outbreaks is the ovaries forming cysts. Other sites may be the tubal walls creating adhesions that affect fertility, bladder, and intestine.
It is a benign condition, and all clinical endometriosis symptoms usually do not co-exist.
The location and extent of endometriosis may not cause any symptoms and even occur as a random finding during an operation. Symptoms show periodicity and are more intense near the days of the period.
- Contact pain (dyspareunia),
- pain regardless of the period,
- pain during the period (dysmenorrhea – non-specific symptoms),
- and bowel disorders (painful bowel movements, diarrhea, constipation, or gut bleeding) are often present.
- painful urination,
- premenstrual syndrome,
- abnormal hemorrhages,
- and, quite often, infertility, may co-exist.
Infertility and endometriosis
In the infertile couples responsible for the female factor, about 30% of the patients co-exist with endometriosis. The intensity and the repetitive nature of the symptoms may become characteristic of chronic pelvic pain and may create emotional difficulties and slight depression.
The palpation of the uterus and its components (ovaries, fallopian tubes), although it may be particularly painful, reveals the possible existence of adhesions or foci of endometriosis.
Ultrasound is used to diagnose mainly for endometriotic masses in the ovaries. Other adjuvant examinations may include hysterosalpingography and colonoscopy, as well as MRI.
The gold-standard procedure for the diagnosis of endometriosis is laparoscopy. In this process, a tissue biopsy is obtained, and the diagnosis confirmed.
Treatment depends on the severity of the symptoms, the extent of endometriosis, the age of the woman, and her desire for fertility.
On intense symptoms, the goal is to improve the quality of life of the woman and reduce the extent of the disease.
Treatment may be pharmaceutical or surgical.
The medicines used can:
• Regulate the cycle and symptoms, including oral contraceptives, anti-inflammatory, painkillers and
• Quit the period altogether, aiming at the complete reversal of endometriosis outbreaks. These include special hormone treatments (antigens, etc.).
Surgically, today, large endometriomas are treated laparoscopically. Diagnostic laparoscopy occurs very often in cases of unspecified infertility to exclude all pathologies
Very often, a combination of surgery and medication is performed.
Surgeons dedicated to performing minimally invasive procedures are committed to personalized treatment for every individual patient. Robotic-assisted procedures are considered safe and effective. It is appropriate for most patients, but not for all.
If you are a surgical candidate for robotic surgery, skilled robotic surgeons with high-end equipment will be able to offer you treatment and relief of your symptoms.