Endometriosis

A chronic condition affecting roughly 1 in 10 women of reproductive age, endometriosis requires a personalised approach combining thorough diagnosis with medical and, when necessary, surgical treatment.

What is endometriosis?

Endometriosis is a condition in which tissue similar to the uterine lining (endometrium) grows outside the uterus. These lesions are most commonly found on the ovaries, fallopian tubes, peritoneum, and the ligaments supporting the uterus. In more advanced cases, they can involve the bladder, bowel, or even the diaphragm.

Like the normal endometrium, these implants respond to hormonal fluctuations during the menstrual cycle, leading to local inflammation, the formation of adhesions, and progressive scarring of surrounding tissues.

Key fact: There is often a significant delay between the onset of symptoms and a confirmed diagnosis — an average of 7 years. Early consultation with a specialist is essential to limit disease progression and preserve quality of life.

Symptoms

The presentation of endometriosis varies widely. Some women experience severe symptoms while others have minimal complaints, regardless of the extent of the disease. The most common signs include:

  • Dysmenorrhoea — intense pelvic pain during menstruation that is not relieved by standard painkillers
  • Chronic pelvic pain — dull or sharp pain that may persist throughout the cycle
  • Dyspareunia — deep pain during or after sexual intercourse
  • Painful bowel movements or urination, particularly during menstruation
  • Heavy or irregular periods
  • Fatigue — often underestimated but a major impact on daily life
  • Subfertility or infertility — endometriosis is found in up to 30–50% of women investigated for difficulty conceiving

Diagnosis

A thorough diagnostic evaluation is essential to map the extent of the disease and guide treatment decisions. The workup typically includes:

  • Detailed clinical history — assessment of pain patterns, menstrual symptoms, and their impact on quality of life
  • Gynaecological examination — palpation may reveal nodules or tenderness, particularly in the uterosacral ligaments
  • Transvaginal ultrasound — the first-line imaging modality, effective for identifying ovarian endometriomas and deep infiltrating endometriosis (DIE)
  • Pelvic MRI — provides a detailed map of deep lesions, particularly those affecting the bowel, bladder, or ureters
Note: Diagnostic laparoscopy, once considered the gold standard, is now reserved for cases where imaging is inconclusive or when surgery is already planned for treatment purposes.

Medical treatment

Medical management aims to control pain, reduce inflammation, and slow the progression of endometriotic lesions. It is often the first-line approach:

  • Hormonal therapy — continuous combined oral contraceptives, progestins (dienogest, desogestrel), or the levonorgestrel intrauterine system (hormonal IUD) suppress ovulation and reduce oestrogen-driven growth of endometrial implants
  • GnRH agonists or antagonists — induce a temporary medical menopause; used for more severe cases, usually with add-back hormone therapy to mitigate side effects
  • Analgesics — NSAIDs and, when necessary, neuropathic pain modulators for symptom relief
  • Complementary approaches — physiotherapy, osteopathy, psychological support, and dietary modifications can be valuable adjuncts

Surgical treatment

Surgery is considered when medical treatment is insufficient, when deep infiltrating endometriosis causes organ dysfunction, or when fertility is compromised. The goal is to excise all visible disease while preserving healthy tissue and reproductive function.

  • Laparoscopic excision — the preferred approach; allows precise removal of superficial and deep lesions with minimal scarring and a faster recovery
  • Treatment of endometriomas — ovarian cysts (chocolate cysts) are carefully excised or drained, with ovarian reserve preservation in mind
  • Bowel or bladder resection — in cases of deep infiltrating disease, a multidisciplinary team including a colorectal or urological surgeon may be involved
  • Adhesiolysis — separation of adhesions to restore normal pelvic anatomy and reduce pain
Dr. Maazouzi’s approach: Each case is discussed within a multidisciplinary framework to tailor the treatment strategy. When surgery is indicated, minimally invasive techniques are prioritised to ensure the best possible functional outcomes.

Endometriosis and fertility

Endometriosis can affect fertility through several mechanisms: distortion of pelvic anatomy, damage to the ovaries and fallopian tubes, impaired egg quality, and an inflammatory pelvic environment hostile to implantation.

Management of endometriosis-related infertility requires close collaboration between gynaecological surgeon and reproductive medicine specialist. Options include surgical optimisation of pelvic anatomy followed by natural conception or assisted reproductive techniques (IUI, IVF) depending on the individual situation.

Book an Appointment

Discuss your specific situation with Dr. Maazouzi.

Book on Doctolib