Endometriosis from adolescence to adult life

The frequency of endometriosis in the general population reaches 80%. However, only 20% will finally be diagnosed with the disease. The cause of endometriosis development is unknown. The presence of the endometriotic lesions does not necessarily induce pelvic pain. The extent and the severity of the disease is not always accompanied with severe abdominal pain. However few small lesions can occasionally cause very intense cyclic pains. In some cases the symptoms of dyspareunia, dyschesia and dysmenorrhea are so severe that the quality of life is severely compromised. Painkillers usually do not alleviate the cyclic pains. Adolescents suffering from dysmenorrhea have 70% risk to have endometriosis.

It seems that during menstrual cycle, endometrial cells travel through the tubes into the pelvic cavity on the surface of the bowel and the peritoneum. Unfortunately the patients’ symptoms that will deteriorate and will develop even more severe endometriotic lesions cannot be predicted.  Women that stay pregnant below the age of 30 and have normal body weight reduce the risk of endometriosis.

The ultrasound and magnetic resonance image (MRI) provide today the most reliable diagnosis of ovarian endometriomas upto 1.5cm in size. Endometriosis foci on the bowel and peritoneum are difficult to be detected with imaging techniques. Their diagnosis is possible by abdominal or transvaginal laparoscopy.

Excision and ablation of the endometriotic lesions is considered the most efficient way of treatment. In depth knowledge and skills regarding endometriosis surgery are of primary importance in order to achieve satisfactory post-operative results.  The contraceptive pill and the progesterone intrauterine device can help only the low grade of endometriosis. Estrogens usually exacerbate the disease. Extensive endometriosis  and ovarian endometriotic cysts seriously threaten normal ovarian function and ovulation and cause infertility. The development of the chronic pelvic inflammation causes fibrosis and adhesions contributing to severe abdominal pains. The laparoscopic operation must be on time and according to internationally accepted protocols. Laparoscopic surgery is indicated when ovarian cysts of endometriosis are larger than 3-5cm while smaller lesions can be treated by transvaginal laparoscopy. The gonadotrophin releasing hormone analogues (GnRHa) can stop the estrogen secretion, inflammation and edema only temporarily. Usually GnRHa are administrated for 3 -6 months but they cause hot flashes, vaginal dryness and mood swings.