What is an Endometriosis? An interview with Dr.med Michaela Fischbach

Endometriosis is a chronic and often painful condition affecting millions of women worldwide. Despite its prevalence, it is frequently misunderstood and misdiagnosed. This article explores what endometriosis is, its causes, symptoms, and available treatment options.

What is Endometriosis?

Endometriosis is a condition in which tissue similar to the endometrium (the lining of the uterus) grows outside the uterus. This misplaced tissue can be found on the ovaries, fallopian tubes, the outer surface of the uterus, and other pelvic organs. In rare cases, it can spread beyond the pelvic region.

During a menstrual cycle, the endometrial tissue inside the uterus thickens, breaks down, and sheds through menstruation. However, with endometriosis, the displaced tissue also thickens and breaks down, but it has no way to exit the body, leading to inflammation, scarring, and the formation of adhesions (bands of fibrous tissue that cause organs to stick together).

Endometriosis symptoms vary from person to person, and some may experience severe symptoms while others have mild or no symptoms. Common symptoms include: Pelvic pain, heavy menstrual bleeding (Including prolonged periods or bleeding between cycles), pain during intercourse, painful urination or bowel movements (particularly during menstruation), infertility, fatigue, bloating, nausea, or digestive issues 

What are the causes?

Scientific research indicates that endometriosis is not just a gynecological disorder but a systemic condition. Studies suggest links between endometriosis and immune system dysfunction, chronic inflammation, and genetic predisposition. Despite ongoing research, the exact cause of endometriosis remains unknown. However, several theories exist:

• Retrograde Menstruation – Menstrual blood containing endometrial cells flows back through the fallopian tubes into the pelvic cavity instead of leaving the body.¹
• Genetic Factors – A family history of endometriosis increases the likelihood of developing the condition.²
• Immune System Disorders – An impaired immune system may fail to eliminate endometrial-like tissue growing outside the uterus.³
• Cellular Metaplasia – Certain cells may transform into endometrial-like tissue due to hormonal or environmental factors.⁵

Diagnosis and Treatment Options

Diagnosing endometriosis can be challenging, as its symptoms overlap with other conditions like irritable bowel syndrome (IBS) and pelvic inflammatory disease (PID). Diagnosis typically involves:

• Pelvic exams – To check for abnormalities or cysts.
• Imaging tests – Ultrasound or MRI can help identify endometrial growths.
• Laparoscopy – A minimally invasive surgical procedure that allows doctors to confirm and assess the extent of endometriosis.

Treatment Approaches – Although there is no cure for endometriosis, several treatments can help manage symptoms:

• Pain Management – Over-the-counter pain relievers (e.g., ibuprofen) can reduce discomfort.
• Hormonal Therapy – Birth control pills, hormonal IUDs, or GnRH agonists help regulate or suppress menstruation, slowing the growth of endometrial tissue.
• Surgical Intervention – Laparoscopic surgery can remove endometrial implants, improving pain and fertility outcomes.
• Lifestyle Changes – Regular exercise, a healthy diet, and stress management techniques may alleviate symptoms.
• Fertility Treatments – In cases of infertility, assisted reproductive technologies like in vitro fertilization (IVF) may be an option.

The stigmas around endometriosis

Women with endometriosis frequently encounter societal stigma, beginning in their school years and extending into adulthood, where their symptoms are often dismissed or invalidated by teachers, employers, and even family members. The normalization of menstrual pain contributes to this dismissal, making it difficult for women to seek validation and support. This stigmatization has profound effects on mental health, leading to increased stress, social isolation, low self-esteem, and, in severe cases, suicidal thoughts. The comparison between endometriosis stigma and mental health stigma highlights how both conditions are widely misunderstood and often trivialized. Additionally, the fear of judgment and disbelief leads many women to conceal their symptoms, contributing to significant diagnostic delays, often spanning 4 to 11 years. Healthcare professionals and society at large play a role in reinforcing this delay by perpetuating the idea that menstrual pain is a normal and expected part of life. 

The stigma surrounding endometriosis also leads to major disruptions in social, academic, and professional settings, making it difficult for women to maintain relationships, succeed in their studies, and meet workplace responsibilities. These challenges are further compounded for minority groups, such as POCs and LGBTQ+ individuals, who experience heightened levels of anticipated stigma, making it even more difficult to access support and medical care.⁴

Statistics

• Endometriosis affects approximately 1 in 10 women of reproductive age worldwide.
• It takes an average of 7-10 years to receive a proper diagnosis.
• 30-50% of individuals with endometriosis experience infertility.
• Endometriosis costs the global economy billions annually in lost productivity and medical expenses.

Living with Endometriosis

Endometriosis can significantly impact physical and emotional well-being. Seeking medical advice, joining support groups, and advocating for better healthcare can help individuals manage the condition effectively. Raising awareness is essential to improving diagnosis, treatment, and quality of life for those affected by this chronic illness.

If you suspect you have endometriosis, consult a healthcare professional for an accurate diagnosis and personalized treatment plan.

Endometriosis & Menopause

Many women hope that endometriosis will disappear with menopause. Unfortunately, this is not always the case.

What happens during menopause?

• Estrogen levels decrease. Since endometriosis tissue is estrogen-dependent, the decrease in hormones can slow the growth of endometriosis and relieve symptoms.
• Many women feel better after menopause and have fewer symptoms.

Does this mean that endometriosis has disappeared?

No, not necessarily. Even if the symptoms subside, endometriosis may still be present. Studies show that a small percentage of women still suffer from endometriosis after menopause. For example, a study of around 42,000 women showed that about 2.55% were still affected by endometriosis after their last menstruation. ⁷ Another study describes that endometriosis tends to regress after the last menstruation, but still affects up to 2.2% of women. ⁸

Why is this the case?

• There are various factors that influence endometriosis, e.g., the type of endometriosis, the location of the lesions, and the individual hormonal situation.
• Even after menopause, the body can still produce small amounts of estrogen, which can promote the growth of endometriosis.

What does this mean for you?

• Even after menopause, it is important to pay attention to your health and consult a doctor if you have any symptoms.
• Hormone replacement therapy (HRT) can help relieve the symptoms of endometriosis during menopause, but it can also increase the risk of the disease recurring. Talk to your doctor about the advantages and disadvantages of HRT.

How hermaid can help you

From contraception to menopause - Dr. Michaela Fischbach is your expert in women's health in Koblenz and online at hermaid. With her many years of experience and comprehensive knowledge, she offers you the latest treatment methods and individual advice. Book your online consultation now and get advice on treatment options.

Author:Tsion Basazinew

Author: Tsion Basazinew & Susanne Feldt, Medical Review: Dr.med. Michaela Fischbach