Endometriosis: Overview and Management Options: A Review Article
Endometriosis is a chronic disease that is basically benign but can cause innumerable symptoms including infertility. The reason is the lining of the uterus (endometrium), which grows outside the uterus and there also behaves in a cycle-dependent manner. Severe pain before and during the period (dysmenorrhea), especially with adenomyosis, is suspect. This form of endometriosis also often causes pain during sex. If the intestine is affected, it can lead to cycle-dependent digestive difficulties or chronic abdominal pain outside of menstruation, problems with urination can indicate endometriosis of the bladder. The diagnosis is initially made according to the principle of exclusion: If neither cysts, fibroids nor hormonal causes are possible triggers for the symptoms mentioned above, it could be endometriosis. In some cases, foci of endometriosis can already be seen on the ultrasound, for example if they affect the fallopian tubes or ovaries. Often, however, the disease cannot be diagnosed in this way, but above all it cannot be ruled out. Just a laparoscopy (laparoscopy) or a hysteroscopy gives certainty. The chance of discovering endometriosis foci and successfully removing them is many times higher. However, just as important as the medical equipment in the operating room is a surgeon who knows how to use it. In the case of severe infestation, especially of the intestines and bladder, a separate, interdisciplinary intervention is sometimes necessary. For this purpose, surgical colleagues, for example from urology, can be called in. If the endometriosis infestation and the associated psychological stress is very strong and family planning has already been completed, removal of the uterus (hysterectomy) can also be considered. Even these more complex operations are now mostly minimally invasive and can be performed with the laparoscopic keyhole technique.