Symptoms, causes, treatment and research

Endometriosis is a chronic disease that affects as many as 10% of women. Dr.Dropin want to increase knowledge amongst women and healthcare professionals so that more people can get help with the symptoms as early as possible.

In patients with endometriosis, tissue similar to the lining of the uterus (endometrium) grows outside the uterine cavity. It can grow in one or more other places in the body and the most common places to find the tissue are in the fallopian tubes, ovaries, peritoneum, intestines, bladder and vagina. Adenomyosis is another condition in which endometrium grows into the uterus's muscle wall. This article focuses on endometriosis.

Book appointment

What is endometriosis?

Dr. Azita Mahmoudan explains.

Symptoms of endometriosis

The symptoms of endometriosis can vary from person to person, and some people can have endometriosis without any symptoms. Endometriosis can cause a variety of symptoms, including:

  • Pain in the abdomen and lower back, especially during menstruation
  • Menstrual cramps that are worse than normal
  • Pain during intercourse
  • Infertility or difficulty conceiving
  • Irregular bleeding
  • Constipation, diarrhoea and bloating
  • Bloody urine during menstruation
  • Pain during urination during menstruation
  • Fatigue and anaemia are also common complaints.

It is important to point out that the symptoms mentioned here can also be signs of another disease and it is important to rule out other conditions as part of the investigation.

Book appointment

How is the diagnosis made?

Endometriosis can sometimes be seen through a gynaecological examination and with the help of ultrasound. Ultrasound can reveal endometriosis cysts, but can also show other causes of pain. Your gynaecologist can base the suspicion of endometriosis on your medical history and description of the pain you experience. Still, the only way to make a definite diagnosis is to take tissue samples through a laparoscopy (peephole surgery) and send them for analysis, which the gynaecologist can refer you to.

Before having a laparoscopy, together with the gynaecologist, you should have mapped as much as possible. It will also be important to keep a diary of the menstrual cycle, symptoms and pain - then you and the doctor will have a better starting point to see connections early in the process.

In Norway, it takes an average of 7 years before a diagnosis is made. Early diagnosis is important to choose treatments that can help preserve fertility and prevent worsening of the condition. If you experience symptoms of endometriosis, you should contact a doctor or gynaecologist. Early treatment can reduce pain and improve quality of life.

Treatment of endometriosis

There is treatment for endometriosis, but it is important to remember that it is a chronic disease that cannot be cured. But the course, symptoms and consequences can be mitigated. The treatment options depend on the severity of the endometriosis, whether or not the patient wants to become pregnant, and the patient's age and general health. Treatment options for endometriosis include:

  • Hormones can be used to reduce the growth of the endometrium and relieve pain.
  • Painkillers can also be used to relieve pain during ovulation and menstruation.
  • Surgery may be needed to remove endometriosis tissue and relieve symptoms. There are different types of surgery that may be appropriate, including laparoscopy and hysterectomy (removal of the uterus).

Pain management and physical activity have also had a good effect on other pain conditions. A study currently underway is looking at the direct effect of physical exercise and pain management against challenges related to endometriosis.

Read more

Endometriosis and infertility

How is it connected?

How can Dr.Dropin help?

Dr. Dropin has gynaecologists who can help, guide and examine you who feel severe pain related to ovulation and menu construction.

Our physiotherapists with special expertise in women's health can also help you relieve muscle tension and pain in the pelvic area.

sanity imagesanity image

Frequently asked questions about endometriosis

What causes endometriosis?

It is not known what causes endometriosis, but it may be genetic and may be related to hormones. There are treatments for endometriosis, but there is no cure for the condition.

Why does endometriosis cause pain?

When you have your period and the endometrium bleeds in the uterus, it will also bleed in the other locations where the abnormal tissue grows. It leads to inflammation, blood accumulation, scar tissue and pain.

The mucosa-like tissue that makes up endometriosis is affected by hormones in the same way as the normal tissue in the uterine cavity. When you are affected by hormones in your cycle, your endometriosis will also be affected. In the uterus, the blood will be pushed out when bleeding from the vagina, but in the case of endometriosis, which is located elsewhere where the blood does not have the opportunity to find a way out, small blood cysts will form.

How and how much pain is common?

Women with endometriosis often experience severe pain during menstruation and have a poor effect on painkillers. Some also experience pain during ovulation and in the days before menstruation. The pain outside the uterus is localized where the endometriosis grows – be it in the bowel during defecation, shock pain during intercourse or pain during urination. If the endometriosis has been allowed to develop over many years, the pain can become constant. This also applies if the endometriosis presses on nerves and painful areas. Walking with pain over time can lead to reduced sleep quality, altered appetite and fatigue.

Why can it be difficult to make the diagnosis?

The symptoms of endometriosis can easily be confused with conditions from the organs that are affected. For example, endometriosis in the bladder can be confused with a urinary tract infection. In the gut, it can be interpreted as part of irritable bowel. Often the symptoms can worsen over time when you have had many periods that have affected the tissue time and time again. This will make the diagnosis clearer as the years go by and it is easier to link it to e.g. cyclical pain.

Estrogen is a prerequisite for the development of endometriosis. The symptoms appear in childbearing age and will for most people decrease with menopause. Birth control pills can be used as part of the investigation, if the pain subsides when using the pills, it could provide a good clue.

What is the difference between endometriosis and adenomyosis?

Endometriosis is a condition where tissue similar to the lining of the womb (the endometrium) grows outside the womb. This tissue can be found on the ovaries, fallopian tubes, peritoneum or other organs near the uterus. Adenomyosis, on the other hand, is a condition where the endometrium grows inside the muscle tissue of the uterus (the myometrium). This leads to thickening of the uterus and can cause increased bleeding during the menstrual cycle. Adenomyosis can also lead to painful periods, chronic pelvic pain and in some cases infertility. The exact cause of adenomyosis is unknown, but hormonal and genetic factors may play a role. You can read more about adenomyosis here.

Why isn't there more research on women's health?

We have had a conversation with researcher Jan Mellembakken about why women's diseases are not prioritized in research.

Watch our video interview with our gynecologist and consultant, Jan Mellembakken, who is one of the Nordic region's leading researchers in women's health (in Norwegian)
sanity imagesanity image

Author: GP Anne Marte Ladim
Last updated: 14.06.2023