Endometriosis is the term used to describe the appearance of endometrial tissue (i.e., tissue of the uterine lining) in locations outside of the uterus. This benign endometrial tissue settles on the peritoneum, the fallopian tubes, the ovaries, or other organs such as the bladder or the intestines. Under the influence of the female sex hormones, the endometriosis lesions can grow, bleed, become inflamed or scarred and cause symptoms, such as pain and infertility.

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The presence of endometriosis is generally known to be frequent and affects only adolescents and women in their reproductive age. It is estimated that approximately 10% of all women in their reproductive age are affected. Nevertheless, establishment of a diagnosis is often delayed (i.e. several years). Advanced diagnostic skills using transvaginal ultrasound can increase the rate of correct diagnosis. In about half of affected women, existing endometriosis leads to complaints that usually requires treatment. Endometriosis can also lead to a reduction of fertility. Thus, it is often only discovered in the context of infertility treatment.


The symptoms of endometriosis are particularly heterogeneous and vary considerably. The presence of intraabdominal endometriosis lesions, and the resulting bleeding from the lesion and local inflammation can lead to pain, adhesions and reduced fertility. Interestingly however, the severity of endometriosis does not correlate with the intensity of the symptoms.

  • Classic endometriosis complaints include:

  • Severe menstrual pain (dysmenorrhoea)

  • Pain during sexual intercourse (dyspareunia)

  • Infertility

  • Menstrual bleeding abnormalities

  • Chronic pelvic pain

  • Pain during bowel movement (dyschezia)

  • Pain when urinating (dysuria)


Due to the variety and low specificity of the symptoms, endometriosis is often diagnosed very late; on average it takes several years from the onset of symptoms to the final diagnosis.

The mainstay of endometriosis diagnosis is the consultation with a doctor and a thorough gynaecological examination including transvaginal ultrasound. Further imaging procedures such as a special MRI and sometimes a colonoscopy or cystoscopy can provide valuable additional information. However, the final diagnosis of endometriosis is often only possible by means of a laparoscopy with direct visualization of endometriosis lesions and histological examination.


A treatment plan should be established taking into account the patients symptoms, age, fertility planning and imaging results. Any pain symptoms should be quickly addressed in order to avoid chronification.  As stated above, the desire to have children plays a decisive role regarding the type of treatment that can be offered.


Laparoscopy represents the gold standard for the diagnosis of endometriosis. A laparoscopy not only provides definitive diagnosis, but also offers the opportunity of surgical removal of all endometriosis lesions or existing adhesions. The removal of all endometriosis lesions usually leads to a significant reduction in pain and a significant improvement of fertility (pregnancy rate). 

Hormonal treatment options (e.g., pill, minipill, hormone intrauterine device, etc.) are available as a conservative therapeutic approach.  These are able to decrease the activity or even inactivate endometriosis lesions and thus reduce pain. If the patient wishes to become pregnant, this type of medication is not recommended, as they have a contraceptive effect. 

Another important focus of any treatment approach to endometriosis-related pain are the pelvic floor muscles. Longer episodes of any type of lower abdominal pain can activate an involuntary contraction of the pelvic floor muscles and significantly contribute or even become the main source of pain (including pain during intercourse, pain while emptying the bladder or defecation). By achieving a relaxation of these muscles, a significant alleviation of the pain can often be achieved. The use of complementary measures (e.g., cognitive behavioral therapy, stress management, nutrition), can additionally support treatment approaches.

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