How common is endometriosis in women

Endometriosis - what is important to you

The illness

Endometriosis is a common condition. It is estimated that around 40,000 women develop it in Germany every year. With them, uterine lining-like tissue grows outside the uterine cavity, for example in the abdomen, ovaries or fallopian tubes, and less often on the bladder or intestine. These endometriosis foci can enlarge and spread. But they are benign. Like the mucous membrane in the uterus, they are subject to monthly hormonal changes: They grow and are rejected again. However, the detached mucous membrane cannot drain through the vagina as it does during menstrual bleeding, but remains in the body. This can lead to inflammation and adhesions. Occasionally, blood-filled cavities form in the ovary (Cysts). Sometimes affected organs can no longer work properly as a result. It has not yet been clarified why endometriosis foci form at all and why some cause severe symptoms and others hardly any.

Signs and complaints

The symptoms usually begin between the ages of 20 and 30, often with the first menstrual period. How endometriosis manifests itself varies from woman to woman. Many of them have little or no complaints. Others are so affected by severe pain that they can hardly go about their work or everyday life.

Examples of signs of endometriosis are:

  • severe pain during menstruation

  • Pain during or after intercourse

  • Pain or bleeding when emptying your bladder or bowel

  • unfulfilled desire to have children

  • heavy or prolonged menstrual bleeding

  • Pain in the lower abdomen that is independent of menstrual bleeding and can be very severe

The signs can indicate other illnesses as well. It takes an average of 10 years until it is clear that endometriosis is present. Some women seek medical advice because they cannot get pregnant. The disease is often discovered by chance.

The treatment

Endometriosis is a permanent disease. It can only be cured in individual cases. The symptoms usually go away on their own after the last menstrual period.

If you have no symptoms, do not want to have children and all organs are working normally, treatment is not necessary.

There are several effective treatment options. Which treatment is suitable for you depends on your complaints and your life situation. Since endometriosis often recurs, repeated treatments are often necessary.

Endometriosis foci can be removed with an operation. This has been shown to reduce pain in most women. As a rule, you will receive a laparoscopy for this: a camera and instruments are inserted into the abdomen through small incisions in order to remove the foci.

Hormones may also be an option for you. For example, corpus luteum hormones are suitable for this. A contraceptive pill can also be used. However, the "pill" is not approved for the treatment of endometriosis in Germany. Hormones can relieve symptoms by weakening menstrual bleeding or suppressing it for a longer period of time. This also immobilizes the endometriosis herds. Inquire about the side effects and the advantages and disadvantages of the hormones before taking them.

There is scientific evidence that treatment with hormones does not improve fertility. If the desire to have children is unfulfilled, surgical removal of the endometriosis focus can increase the prospect of pregnancy. If you still do not become pregnant, fertility treatment, such as artificial insemination, can help. With many sick women, pregnancy can be achieved with it.

Painkillers are often used for endometriosis. However, no meaningful studies have been found showing how effective they are for pain caused by endometriosis. Depending on your needs, you can receive specialist pain treatment as well as emotional and social support. Medical rehabilitation ("rehab") is often recommended after a major endometriosis operation or if the pain persists.

What you can do yourself

  • It is good to speak openly about your symptoms with your doctor. There are also endometriosis centers where specialized gynecologists work. They are very familiar with the disease.

  • You don't have to bravely endure pain. Mild menstrual pains for 1 to 2 days are normal, but if you can hardly stand them without medication or therefore cannot work, you should see a doctor. Painkillers have side effects. Do not take these for long periods of time without talking to your healthcare team.
  • Exercise is good for you. It's best to choose something that you enjoy. For example, some affected women find Nordic walking, pelvic floor training or exercise in warm water to be pleasant.
  • Learn to relax and manage stress. Relaxation exercises like yoga can be supportive in reducing pain, anxiety, and tension.
  • You may also find acupuncture, Chinese herbal medicine, or physical therapy helpful.
  • It is advisable to observe yourself. To help you, you can write down your complaints in a diary. This is how you can find out what works and what doesn't.

  • You are not alone with your illness. It can help to be open about it. You can also share your experiences with other people affected, for example in a self-help group.

November 2018, published by the German Medical Association and the National Association of Statutory Health Insurance Physicians