Endometriosis is a widespread condition, yet there is little awareness about it. As a therapy, the pill is most often recommended. In this article, we explain what endometriosis is, whether there are hormone-free treatment options, and what to consider if you want to have children.

What happens in the body with endometriosis

It is estimated that around 40,000 women are diagnosed with endometriosis each year, and 10 to 15 percent of all women between puberty and menopause develop the disease. Many women have never heard of endometriosis—let alone its symptoms, consequences, or treatment options—although endometriosis is the second most common gynecological disease. Incidentally, trans* men and non-binary people with a uterus can also develop endometriosis.

In endometriosis, cysts and inflammations occur inside the body, called endometriotic lesions. These can settle on the ovaries, uterus, or vagina, but also on the intestines, peritoneum, and bladder.

The tissue of these lesions resembles the uterine lining. With hormonal changes during the menstrual cycle, the inflammations can grow and bleed. Although classified as benign, they can metastasize and cause permanent damage to organs, such as scarring, chronic inflammation, or bleeding. A common consequence of endometriosis is infertility.

Causes, symptoms, and consequences

Although endometriosis is not a new disease and is very widespread, its causes remain unknown.

Endometriosis patients often suffer from severe pain (cycle-dependent and cycle-independent). However, some courses of the disease are pain-free and therefore without the need for therapy, which is why endometriosis often goes undetected.

In some cases, inflammations can be surgically removed without further complications. About half of patients, however, require long-term treatment, as cysts and inflammations can quickly recur after removal.

The most common symptoms are:

• Heavy and irregular menstrual bleeding, often with severe pain

• Abdominal and back pain before and after the period

• Fatigue, exhaustion

• Increased allergies and autoimmune diseases, as well as high susceptibility to infections during menstruation

• Pain during and after sex

• Pain during gynecological examinations

• Painful bowel movements or urination

• Cyclical bleeding from the bladder or intestines

• Infertility and unwanted childlessness

• Psychological stress due to physical and daily limitations

First self-diagnosis: cycle tracking

By observing your cycle and its signals regularly and closely, you can actively contribute to the final diagnosis by a doctor. With the Ovy app, you can document whether your cycle is irregular, when your period starts, and when ovulation takes place. Pay attention to signals such as intermenstrual bleeding and particularly severe pain, and record them daily in the Ovy app.

For a sound diagnosis, however, consultation with a gynecologist is essential. They will also discuss further diagnostic procedures, such as a physical examination, ultrasound, or colonoscopy. A surgical procedure, in which a tissue sample is taken via laparoscopy, is considered the only definitive diagnostic method. This allows the location, severity, and type of growth of the cysts and lesions to be determined.

Due to the lack of awareness about endometriosis, misdiagnoses occur more often than correct diagnoses. On average, it takes about six years from the onset of first symptoms to a final diagnosis.

Chances of recovery: Is the pill the only option?

Precisely because the causes remain unknown and the disease can manifest so differently—sometimes even without symptoms—treatment is just as difficult as diagnosis. There is still no universal therapy. The Endometriosis Association of Germany recommends a team approach involving gynecology, pain therapy, psychology, and holistic medicine.

In addition to laparoscopy—which serves both for diagnosis and removal of lesions—medication-based pain therapy is also possible. However, pain management alone cannot prevent new lesions from forming.

A common treatment method is taking the pill, as it suppresses the buildup of uterine lining. The administered hormones are intended to target the lesions, which under the influence of estrogens would normally build up mucous tissue during the cycle. The pill prevents this, so that no additional tissue has to be shed at the end of the cycle. In this way, the activity of the lesions is suppressed. The use of the pill as a therapy is, however, a controversial subject and must be assessed individually with medical advice.

It should be noted that the pill can cause additional side effects such as an increased risk of thrombosis. An American study also suggested that taking the pill may increase the risk of developing endometriosis. Women who have taken the pill for five years are 2.4 times more likely to develop the disease. According to the study, those who start taking the pill in early adolescence are at even greater risk.

Those who want to track their cycle can determine their fertile days with the Ovy app and the Ovy Bluetooth basal thermometer.

Alternative, natural treatments for endometriosis include acupuncture, homeopathy, herbal medicine, traditional Chinese medicine (TCM), or dietary changes. Many patients who try these alternatives report positive experiences.

What should I consider when planning a pregnancy?

Endometriosis often affects pregnancy planning. In about 40 to 60 percent of women who remain involuntarily childless, it is the cause of infertility. The more severe the endometriosis, the lower the fertility. The reasons vary: it can, for example, influence hormone production and egg maturation. In addition, inflammatory changes and adhesions can reduce the patency and mobility of the fallopian tubes. In any case, detailed counseling with a gynecologist is recommended.

In general, it can be said: those with endometriosis must expect to live with the disease. The ongoing struggle can be mentally very stressful. In support groups, patients can exchange experiences and find help. The Endometriosis Association of Germany provides an overview of suitable groups on its website.

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