It is a chronic condition in which the uterine lining tissue (endometrium) is located in various locations outside the uterine cavity. In these locations, it causes chronic inflammation, adhesions, which can result in pain and lead to dysfunction of many organs, including the urinary or gastrointestinal tract.

A key warning sign is the cyclic nature of symptoms. If abdominal pain, gastrointestinal discomforts (diarrhea, constipation, bloating), shoulder pain, or an increased need to use the toilet intensify during certain phases of the menstrual cycle (e.g., around ovulation or menstruation), there is a high probability of endometriosis associated with these symptoms.

Severe pain that prevents normal functioning is never normal. Although it can also have causes other than endometriosis, it always requires extended diagnostics and determination of its origin. Then the treatment is personalized and tailored individually to meet the woman’s needs and improve her quality of life.

Endometriosis makes it difficult to get pregnant not only by mechanically blocking the fallopian tubes due to the occurrence of adhesions, but also by chronic inflammation in the lesser pelvis. Moreover, endometriosis shows features of an immune disease and through its effect on the immune system it can prevent the implantation of the embryo in the uterine cavity by initiating the activation of various cytokines. In many cases, precise surgery to remove the disease foci allows for natural conception even after unsuccessful IVF attempts.

The delay is due to the fact that the complaints are non-specific and are often associated with diseases such as irritable bowel syndrome (IBS) or small intestinal bacterial overgrowth syndrome (SIBO). Patients often report bloating, diarrhea, constipation, and even chronic fatigue and so-called brain fog. Unfortunately, it is still common for severe menstrual pain to be unjustly ignored by people around and even the physicians by referring to it as “a natural thing”.

Sources indicate that not every specialist has the right tools and experience. Diagnostics for endometriosis, especially by ultrasound or magnetic resonance, requires specialized training and image interpretation skills. It is recommended to choose physicians and centers that specialize specifically in this disease.

No. Patients with very advanced endometriosis may have normal complete blood count or coagulation tests results. Laboratory tests, such as the CA-125 marker, can be helpful (especially in differentiating from ovarian tumors, but they are sometimes elevated in the case of endometrial cysts). They are not sufficient to establish a final diagnosis without correlation with symptoms and imaging diagnostics.

• New tools are appearing on the market, such as:
• blood tests (e.g., EndomKIT) that analyze marker values (CA-125 and brain-derived neurotrophic factor [BDNF]) and clinical history;
• mRNA tests (endometrial biopsy) that examine gene expression;
• saliva tests, which show high reliability, although they are currently very expensive. However, it is worth remembering that many of these methods are still in the validation phase according to the latest medical standards.

The disease is considered chronic, which means that pharmacological treatment is often symptomatic (elimination of pain or inflammation). Discomforts experienced by patients with endometriosis are complex and may originate not only from the uterus and ovaries, but also from the neighboring organs, where hormonal drugs will not be effective. These include bladder symptoms, bowel symptoms and also any tension-induced and vascular lesions located in the pelvis. Another component unaffected by hormonal drugs are adhesions that form as a result of chronic inflammation that accompanies endometriosis. It is for these reasons, among others, that a holistic approach to the patient’s planned therapy is key to success.  As a result of permanent organ damage in some patients, certain discomforts may remain unresolved despite such a comprehensive approach. In such cases, surgery may be necessary. Moreover, endometriosis leads to permanent tissue lesions, such as fibrosis and adhesions, which remain in the body and can cause pain and discomfort even when hormonal drugs eliminate the activity of the foci

Unfortunately, endometriosis is a chronic disease and cannot be cured in the same way as, for example, infections. However, it can be effectively controlled by reducing symptoms and removing foci, which allow patients to live in comfort. However, treatment requires a long-term management plan and a holistic approach, rather than a one-time intervention.

• Experts highlight the great importance of a holistic approach. Methods of very high efficacy include:

• physiotherapy (especially urogynecological),
• adequate anti-inflammatory diet,
• supplementation adjusted by a specialist,
• maintaining a healthy lifestyle and physical activity.

The length of hospitalization after endometriosis surgery depends primarily on the method of surgery and the extent of lesions. The average length of hospital stay is between 1 and 5 days.

For up to about 4 weeks after the procedure, it is recommended to maintain a calm, non-strenuous lifestyle for daily activities, follow an easy-to-digest diet, take walks, avoid excessive physical exertion and carrying heavy objects, refrain from sexual intercourse (usually for about 4–6 weeks), avoid cycling and swimming pools, and wear loose cotton underwear.

Experts highlight that treating endometriosis is a multi-year management plan, not a one-time procedure. A very important role is attributed to pharmacological treatment, but also to supportive methods such as physiotherapy, diet and appropriate supplementation

There are no precise time frames regarding the timing of initiation of pregnancy attempts. This issue is highly individual, depending on the extent of the surgery performed, the pharmacological treatment administered, the persisting clinical symptoms and the patient’s overall quality of life.

Radical removal of foci (for example, in the case of deeply infiltrating endometriosis) offers a chance to live in complete comfort, even without drugs.

Since the disease is considered chronic and incurable, its foci can be active throughout the reproductive period. Even after periods of inhibition, such as after pregnancy, the disease can recur. Treatment effectiveness depends on the radicality of the procedure and the degree of progression of the lesions

This is one of the most common myths. Although pregnancy suppresses the menstrual cycle and can temporarily reduce inflammation, it does not remove the disease itself. After childbirth, when a woman begins menstruating, discomforts often recur, sometimes with even greater severity.

The common belief that menopause completely solves the problem of endometriosis is only partially true. Although in many women the drop in estrogen levels reduces active inflammation, the disease itself does not always “disappear” in a way that restores full comfort.
Key facts from the document:
• Reduction of symptoms: Indeed, for some patients, entering menopause brings significant relief, as the disease foci are no longer hormonally active.
• Permanent tissue damage: Endometriosis is an inflammatory process that over the years leads to tissue destruction and fibrosis in anatomical structures.
• Other structural lesions: Even when the ovaries stop secreting hormones, lesions that have already appeared (such as adhesions in the colon or rectum) remain in the body and can contribute to discomfort and pain.
• Post-menopausal pain: Due to such “cracks on the glass” (irreversible structural lesions), the pain may not recede, which is sometimes a huge disappointment for patients.
In conclusion, although the inflammatory activity of the disease usually reduces, the effects of its multi-year presence can continue to negatively affect a woman’s quality of life even after menopause.

The risk of ovarian cancer development is four times higher in women with endometriosis compared to healthy women. For severe subtypes of endometriosis, the risk increases almost tenfold (precisely, a 9.66 times greater risk in those with deeply infiltrating endometriosis or ovarian endometriosis). Endometriosis, especially its deep form, is a risk factor for specific types of cancer: endometrioid and clear-cell cancers. Studies have demonstrated that in women with endometriosis, the approximate risk of type I ovarian cancer is 7.5 times higher and of aggressive type II – approximately 2.7 times higher. In light of such relatedness, experts point out that endometriosis patients should benefit from cancer risk and prevention counseling and regular examinations, such as transvaginal ultrasound and ROMA (Risk of Ovarian Malignancy Algorithm) test.