No one – not even a doctor – can diagnose endometriosis on the basis of the symptoms alone and cannot rule it out. This is because the disease can also be completely asymptomatic, it can be accompanied by severe pain, but also with mild pain, with permanent pain or with sporadically occurring pain or – depending on the shape, location and severity of the growths – show completely different symptoms.
Therefore, do not let yourself be fobbed off with sentences such as “That-is-normal-cycle pain” or “That-is-psychosomatically”. If your doctor doesn’t seem to be taking you seriously, switch to another doctor.
To find out if you have endometriosis, a thorough diagnosis is required. Diagnosis involves several methods:
- Questioning (anamnesis)
- Gynecological examination/palpation examination
- Transvaginal ultrasound to detect possible other changes, such as cysts, that could cause similar symptoms
- Ultimately, safety is only achieved by a laparoscopy, which is performed under general anesthesia. Among other things, a small tissue sample is taken (biopsy), which is examined under the microscope and can confirm endometriosis.
Which laboratory values are important for endometriosis?
Unfortunately, there are no specific laboratory values that could specifically indicate endometriosis. A blood test alone can therefore not provide information as to whether the disease is present or not.
What degree of endometriosis do I have?
Many women want to know what degree of endometriosis they have. However, the classification of Endo. into degrees and stages is anything but easy, as there are so many different locations and intensity levels.
The four AFS stages
In the past, endometriosis was classified according to the so-called AFS stages of the American Fertility Society (AFS). AFS is now called the American Society for Reproductive Medicine (ASRM), so you can also read about rASRM stages. The lowercase r stands for “revised” (updated). The four AFS stages are:
- Grade I minimum
- Grade II mild
- Grade III Moderate
- Grade IV severe
The ENZIAN Score
However, the AFS stages usually refer only to the superficial issues, not to the infiltrating forms and adhesions. Therefore, there is now the so-called GENTIAN score, which also takes into account these infiltrating forms including retroperitoneal endometriosis. Retroperitoneal endometriosis affects the organs that lie behind (retro) the peritoneum: the kidneys and ureters.
The ENZIAN score is very comprehensive, so its description is beyond the scope of this article.
Classification according to affected organs
The disease is often classified according to the location, i.e. according to the respective organs where the problems occur. There are therefore the following types of endometriosis:
- peritoneal endometriosis – the peritoneum is affected (superficial to deep)
- ovarian Endo. – the ovaries are affected (superficial to deep)
- tubal Endo. – the fallopian tubes are affected (external or internal)
- deeply infiltrating Endo. – endometriosis lesions that proliferate at least 0.5 cm into other tissues
- Adenomyosis uteri or endometriosis interna – here cells of the endometrium proliferate in the muscle wall of the uterus
It is also taken into account whether the growths and adhesions are tender or very dense.
How is surgery performed?
From the point of view of conventional medicine, the endometriosis lesions should be surgically removed as quickly as possible and completely. Surgery for Endo. is performed by laparoscopy, which is also referred to as pelviscopy (pelvis = Latin for pelvis) when the focus is on organs of the pelvis. Surgery with an abdominal incision is rarely necessary. (Whether surgery is actually necessary depends on the woman’s medical history and what alternatives she has already tried).
In addition to laparoscopy, drug treatment is recommended to prevent the disease from returning after surgery for as long as possible. However, affected women often receive medication before the operation. Studies have shown that the risk of the growths returning after surgery then increases.
How quickly can endometriosis come back after surgery?
In many women (6 – 67 percent), the Endo. can come back after the operation – proof of how little causal treatment conventional medicine provides. Whether and when the growths come back varies greatly and depends on various factors. This is why the percentage mentioned has such a wide range. These factors are, for example:
- the place where the Endo. is located (see next section)
- the age of the woman (the younger, the more likely it is to relapse)
- how severe the Endo. was already (the more severe the disease was before the operation, the more likely it was to relapse)
- the period covered by the respective studies (see next section)
- Medication (medication before surgery increases the risk of relapse)
Study: Relapse after surgery
One study, for example, found that endometriosis recurred in 19.1 percent of women within two years of surgery. After five years, it was up to 43.5 percent of women.
Another study showed the relapse rates within four years after surgery depending on different forms of endometriosis:
- 24.6 percent of women with ovarian endometriosis suffered a relapse
- 17.8 percent of women with Endo. on the peritoneum
- 30.6 percent of women with growths not only on the surface of the ovaries but also in the ovaries
- 23.7 percent of women with growths not only on the peritoneum, but also on and in other organs (intestines, bladder)
Do you have to have surgery for endometriosis?
If endometriosis keeps coming back after surgery, the affected women naturally wonder whether surgery is necessary at all for the disease. Here it depends on how severe the disease and its symptoms are and which alternatives have already been tried. Discuss with your doctor whether you can first test naturopathic measures. You can still operate later. Endometriosis does not always require surgery.
But even after the operation, it makes sense to become naturopathically active in order to reduce the risk of relapse after the operation as much as possible.
What medication is prescribed?
The drugs used for endometriosis consist in particular of
- painkillers (ASA, ibuprofen, diclofenac) and
- hormone preparations.
The latter suppress the menstrual cycle or the activity of the ovaries (hormone production), although research is currently being carried out into means that are supposed to contain the disease and at the same time maintain the cycle.
For pain therapy, anti-inflammatory painkillers are chosen in particular, as endometriosis pain is always accompanied by chronic inflammatory processes.
What is hormone therapy for endometriosis?
Since the growth of Endo is driven in particular by the hormone estrogen, attempts are made to lower the estrogen level with medication – for which the following hormone preparations are available:
- Progestins: Progestins are synthetic corpus luteum hormones; the body’s own progestin is called progesterone
- Estrogen-progestin combination preparations: This refers to the contraceptive pills that are taken without a break
- GnRH analogues: GnRH is the abbreviation of gonadotropin-releasing hormones, a hormone that is produced in the hypothalamus in the brain and controls the release of the two hormones FSH and LH. These two, in turn, ensure the formation of estrogen and progesterone in the ovaries. GnRH analogues are a synthetic variant of the natural GnRH – with the difference that the analogues are ineffective. If you take the analogues, the body stops producing its own GnRH, believing that there is enough. However, since the analogues have no effect, hormone production in the ovaries is absent.
What are the consequences of hormone therapy?
All three options mentioned more or less put the woman into artificial menopause, so that the corresponding menopausal symptoms can also occur, e.g. hot flashes, sleep disorders, osteoporosis, etc.
Especially with the GnRH analogues, osteoporosis almost always occurs when taken for a longer period of time, which is why they should not be used for more than 6 months and usually accompanied by low-dose estrogen in order to keep the side effects as low as possible. After discontinuation of the GnRH, the symptoms often return, which is why one should carefully weigh up whether a possible benefit is worth the risks.
What happens if endometriosis is not treated?
The symptoms of many women are so severe that the question of what happens if endometriosis is not treated does not even arise. In many cases, everyday life can no longer be coped with without treatment and the quality of life is poor. So whether you can consider leaving the disease untreated depends on the intensity of the symptoms, age and personal environment.
- Endo. can be asymptomatic. Half of the affected women have no or only very mild symptoms. In this case, of course, treatment is not necessary and nothing happens if the Endo. is not treated.
- If a woman is about to go through menopause – a phase in which the Endo. regresses – the disease may also remain untreated, as there would also be no worsening if the endometriosis is not treated. But of course, it also depends on how the woman in question is doing.
- If a woman has only mild symptoms and a stress-free everyday life (e.g. home office, already independent children, understanding environment, etc.), her endometriosis may not need to be treated because the woman in question may cope very well with an individually effective coping strategy, in which she – depending on the symptoms – combines various naturopathic measures, which we present in our article: Can endometriosis be healed?
Can the disease regress on its own?
By “by itself” we mean a regression without any measures on the part of the woman, i.e. also without naturopathic measures.
It is also possible that endometriosis can regress on its own. This could happen with the less active forms. If there is a rather aggressive form, it is unlikely that it will simply disappear on its own. By the way, whether the growths are aggressive or not cannot be seen from the extent of the growth. For example, a woman with grade I (minimal growths) may have severe symptoms (aggressive form), while a woman with grade III may not notice anything because she has a less active Endo.
Does endometriosis regress during menopause?
During menopause, endometriosis regresses automatically on its own, as hormone production also decreases and the cycle is stopped. But of course that’s no consolation, because if you suffer from severe symptoms at the age of 30, you can’t wait two to three decades for relief to come. This question is therefore about a regression of the disease in the fertile years.
