Endometriosis: Causes, Symptoms and Treatment

We speak of endometriosis when the tissue that lines the uterine cavity, the endometrium, also develops in other sites. It is a typical pathology of the reproductive age, which can cause intense pain and can cause infertility. Read about the causes, symptoms and possible treatments.

Endometriosis is a little known but more frequent disease than is believed. It is not always easy to recognize.


  • what is it


  • what it entails


  • causes


  • frequency


  • risk factors


  • symptoms


  • infertility


  • pregnancy


  • diagnosis


  • must we necessarily intervene?


  • care


  • slow the disease and reduce symptoms


  • moms experiences with endometriosis

1 What is endometriosis?

The word endometriosis derives from endometrium , the tissue that lines the cavity of the uterus and that every month undergoes precise changes following the menstrual cycle : it grows little by little and then flakes off, bleeding with menstruation.

We speak of endometriosis when this tissue also develops in abnormal locations, outside the uterine cavity . Endometriosis most frequently affects:

  • the ovaries,
  • the uterine ligaments,
  • the fabric that lines the inside of the abdomen and pelvis,

but it can also relate

  • the area between the vagina and the rectum,
  • the intestine,
  • the bladder
  • and the ureter.

“A particular form of endometriosis is adenomyosis , which occurs when the endometrial tissue infiltrates the muscular wall of the uterus” explains Elena Zannoni, head of the gynecological surgery service of the Humanitas Clinical Institute in Rozzano (MI).

More rarely, more distant sites may also be affected.

Section of the fallopian tube with endometriosis

2 What does the presence of an endometrium outside the uterus involve?

“The endometrium present in abnormal locations behaves like the one that lines the uterine cavity” says Massimo Bardi, head of the Center for the diagnosis and treatment of endometriosis at the San Pietro Polyclinic in Ponte San Pietro (BG). “This means that every month, under the influence of the hormones of the menstrual cycle, it falls apart, causing small bleeding”.

Unlike what happens with the blood of menstruation, however, these micro-leaks cannot go out and tend to accumulate, inflaming the surrounding areas and in some cases causing the formation of nodules and cysts .

Furthermore, endometriosis can lead to the formation of adhesions between the various organs contained in the pelvis.

3 What does endometriosis depend on? What are the causes?

The main cause is believed to be the so-called retrograde menstruation . “In practice, during menstruation a little menstrual blood can flow back into the abdominal cavity, taking endometrial cells with it” explains Fabio Parazzini, associate professor of gynecology at the University of Milan, former coordinator of a national study group on endometriosis . “In the presence of particular favorable conditions, these cells can implant themselves in abnormal sites, giving rise to small foci of endometriosis”.

It is still not entirely clear what these favorable conditions are: probably several are involved

  • immune factors,
  • inflammatory
  • and vascular.

4 How common is endometriosis?

There are no definitive data on the disease in the Italian population, but it is estimated that it affects 10-20% of women of reproductive age and is therefore a rather common disease. “Indeed, it is an emerging disease that is becoming more frequent than in the past, because women arrive at their first pregnancy later and later and this represents a risk factor” adds Zannoni.

Many of the women affected, however, do not even know they have it : perhaps the condition is discovered by chance, in the course of investigations made for other reasons.


endometriosis, the point about the disease

5 Are there any particular risk factors?

Significant risk factors for endometriosis are:

  • the absence of pregnancies. “This happens because, by stopping menstruation, pregnancy shuts down the factors that stimulate the onset or progression of the disease” explains Parazzini. “The later a pregnancy arrives, the longer and more opportunities are given for the disease to establish itself”;
  • very short menstrual cycles and very heavy menstruation.

Some studies have highlighted other weaker risk factors, linked to lifestyle and the environment . “This is in particular the consumption of alcohol, a diet very rich in fat and low in fruit and vegetables, exposure to toxic substances such as dioxin”, Parazzini specifies. “But be careful: they are weak associations, which need to be investigated better. And which account for only a small part of the risk, in a limited number of cases”.

6 How is endometriosis recognized? What are the symptoms?

When present, the most characteristic symptoms are of two types:

  • d olore
  • and infertility.


Approximately 70 to 80% of women with endometriosis have characteristic chronic pain . These are in particular menstrual pain – which generally accompany irregular and abundant flows, especially in the case of adenomyosis – pain during sexual intercourse, general pelvic pain, especially in the days just before or just after menstruation.

These can be associated with others, which vary according to the organs involved, such as pain in the rectum during defecation or in the bladder during urination, diarrhea and / or constipation. Often these symptoms also occur in conjunction with the days of menstruation.

“Unfortunately, sometimes these pains are so intense that they are debilitating and alter the quality of life,” Bardi points out. This translates into a concrete impact on daily life, as Jacqueline Veit, founder and president of the Italian Endometriosis Association tells us : “The chronic pains of endometriosis can compromise the constancy in study or work, prevent the normal performance of domestic activities, hinder social life “.


Another possible symptom is infertility : it is estimated that 30-40% of infertile women suffer from endometriosis .

7 What is the relationship between endometriosis and infertility ?

In some cases there is a direct relationship, because the disease can determine the formation of adhesions, obstructions and anatomical alterations that physically prevent the meeting between the egg and the spermatozoa or the implantation of the embryo.

“In other cases, the association between endometriosis and infertility is not so clear” Zannoni specifies. “It may be that immune or vascular factors are involved, which in some way hinder ovarian function or the onset of pregnancy.”

8 If pregnancy starts, can endometriosis cause complications?

The effect of endometriosis on pregnancy is an emerging field of research. Some recent studies seem to suggest an association between this condition and an increased risk of miscarriage or complications such as preterm birth , but in reality it is still unclear whether these effects depend on endometriosis itself or on whether it is pregnancy. who arrive at an older age or thanks to assisted fertilization .

“Probably some localizations of endometriosis, such as those in the wall of the uterus, involve some more complications, but in general the message must be reassuring: if the pregnancy starts, it also manages to arrive well to term ” comments Zannoni. “Obviously, however, it is important that women who find themselves in this condition are followed a little more carefully, with a few more visits and checks”.

Read the stories on endometriosis and pregnancy

9 How can endometriosis be diagnosed?

“The diagnosis of endometriosis is made first of all on a clinical basis, that is, starting from the symptoms that the woman reports”, says Bardi. The doctor will ask in particular how your menstrual cycles are, if sexual intercourse is painful, if you are looking for children and they do not arrive.

The second step is the gynecological examination , which can give indications on a possible endometriosis with localizations in the vaginal, recto-vaginal or cervix.

On the other hand, transvaginal ultrasound makes it possible to clearly identify any cysts affecting the ovaries. Sometimes, these tools are not enough for a definitive diagnosis: in these cases, certainty can be obtained with laparoscopy , a minimally invasive surgical technique that allows you to examine the inside of the abdomen.

“Unfortunately, the path is not always straightforward and it can take years to reach a definitive diagnosis,” Veit points out. “This is partly due to the fact that women tend to overlook their painful symptoms as normal, partly because some doctors also underestimate the symptoms and the disease.”

10 In the case of endometriosis, is it always necessary to intervene or can nothing be done?

“You can also do nothing, but it depends on the situation ” Zannoni replies. “If there are no symptoms, the woman is not looking for children and the controls say that the situation is stable, you can easily do nothing”.

“However, if the conditions change, the visits say that the disease is progressing, the pain becomes important or the woman wants a pregnancy , or even has begun to look for one and sees that it does not arrive, it is better to intervene”.

11 How is it done? Is there a cure?

There is no cure. You can only cure the symptoms. Generally, first we intervene with a drug therapy , for example based on contraceptive pills which, significantly reducing menstrual bleeding, also slows down endometriosis a lot. “More recently , progestogen-based drugs have been introduced specifically for this disease, which inhibit endometrial changes without altering normal ovarian hormonal function,” adds Bardi.

These drugs are the responsibility of the patient. ” There are no exemptions for this disease” explains Veit, who underlines how the Italian Endometriosis Association is currently engaged in campaigns and activities for the recognition of endometriosis as a chronic disease.

If the therapies are not sufficient or if the symptoms are very severe at the start or important cysts and nodules are immediately identified, a surgical strategy is preferred . The operation takes place in laparoscopy and allows to remove the abnormal tissues. “But be careful, especially in the case of ovarian localizations, today we tend to intervene with great caution ” underlines Zannoni. “This is because there is always the risk that, by intervening on the ovaries, some follicles will also be damaged, thus reducing the ovarian reserve “.

It’s not all. Bardi adds: “Since this is a disease that can alter the perception of body image and female identity, psychological support is also important for women affected by endometriosis”. Support that can also be achieved between “peers”, ie between groups of patients, in so-called self-help groups .

And yet, beyond the more radical strategies, other “alternative” pain control strategies can also be useful . Some studies suggest the efficacy, in this sense, of mindfuless paths or cognitive-behavioral therapy. Read also: endometriosis and impact on quality of life and 9 tips to improve quality of life.

2 Are there effective diets to slow the disease and reduce the symptoms of endometriosis?

“Also in this regard there are no definitive conclusions” replies Parazzini. Some studies seem to suggest that a diet rich in fruit, vegetables, legumes and low in animal fats and sugars can help. “We have no data to say it really works, but on an individual level it may be worth a try.”

13 Who to contact?

Generally, for an initial diagnosis it is enough to go to your gynecologist, but if the diagnostic picture is unclear, it is advisable to go to dedicated centers, which follow precise protocols where various specialists in teams identify the most appropriate tests depending on the site involved. After the correct diagnosis, it will be decided which path to follow: whether to do nothing and continue with the checks, or to follow medical or surgical therapy. In Italy there are various centers dedicated to the diagnosis and treatment of endometriosis, even if they often do not have a specific name. If you do not find a center dedicated specifically to this disease, you can go to centers that deal with infertility or gynecological surgery.

14 Mom with endometriosis? It can. Your stories

Stories of women with endometriosis who managed to fulfill their dream of becoming moms. There are those who have been looking for a child for years and had already lost hope, those who have resorted to medically assisted procreation. Here are your stories of women who became moms despite endometriosis.


by Abdullah Sam
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