Endometriose – Ursachen, Symptome, Behandlungsmethoden

Endometriosis is a condition where cells from the uterine lining (endometrium) grow outside the uterus. Despite their abnormal location, these cells remain functional. Hormonal fluctuations, particularly during the menstrual cycle, lead to the formation of inflammatory lesions at the sites where these cells have settled. The condition most commonly affects the peritoneum and reproductive organs, such as the uterine muscles, fallopian tubes, and ovaries. However, endometriosis can also impact other organs, including the digestive tract (particularly the rectum), lungs, or even bones. It is most frequently diagnosed in women aged 25–35, though it can also occur in adolescents and postmenopausal women.

While the exact mechanisms underlying endometriosis remain unclear, several theories explain the development of pro-inflammatory endometrial lesions. – According to Meyer's theory, endometrium cells enter the peritoneal cavity due to metaplastic reactions. Factors that may amplify this process include infections, aging, and hormonal imbalances. – Levander's theory, also known as the inductive theory, suggests that cells within the peritoneal cavity transform into endometrial cells under the influence of biochemical or immunological factors. – Sampson's theory, often referred to as retrograde menstruation or the regurgitation theory, posits that endometrium cells migrate into the peritoneal cavity via the fallopian tubes, where they adhere to peritoneal cells, undergo implantation, and proliferate, forming endometriotic lesions. – Recklinghausen's theory proposes that cells of the uterine lining outside the cavity are remnants of embryonic cells. – The theory of disseminated endometriosis suggests that endometrial cells spread throughout the body via the circulatory and lymphatic systems. – The implantation theory indicates that uterine lining cells may be displaced during surgical procedures such as cesarean sections or laparoscopies. Additionally, there is substantial evidence linking endometriosis to estrogen level dysregulation and suggesting a hereditary component.

Pain arises as a consequence of the previously mentioned inflammatory changes. Pain symptoms become increasingly severe over time and are typically localized in the pubic symphysis, sacrum, and pelvis. An initial indication that may suggest the presence of endometriosis is pain during intercourse (so-called dyspareunia). Pain results from the aforementioned inflammatory alterations. Over time, discomfort intensifies significantly and is usually concentrated in the pubic symphysis, sacrum, and pelvic region. The inflammatory process caused by endometrial cells leads to tissue damage in affected areas, resulting in scarring and adhesions, which further exacerbate pain. Typical symptoms of endometriosis also include painful and heavy menstrual bleeding. Bleeding may occur outside the menstrual cycle, such as hematuria or contact bleeding in cases of cervical endometriosis. Other symptoms include sleep disturbances, pain during defecation, ovarian cysts, bacterial flora imbalances, increased pelvic floor muscle tension, urinary difficulties (e.g., frequent urination), and gastrointestinal issues (e.g., diarrhea, bloating, constipation, digestion problems). Untreated endometriosis can lead to serious complications. Firstly, it increases the risk of reduced fertility or even infertility, making conception more difficult. This is typically due to the accumulation of endometrial cells that impair normal fallopian tube patency. Secondly, women with endometriosis often experience mood deterioration. Persistent pain and difficulties in intimate and daily life can negatively impact quality of life, including professional aspects. Reduced efficiency and worsened well-being may contribute to declining mental health, including the development of depression.

The diagnosis of endometriosis primarily relies on imaging studies that confirm the presence of cellular clusters or endometrial cysts outside the uterine cavity. Diagnostic methods include laparoscopy, computed tomography, and transabdominal or transvaginal ultrasound. The surgical removal of endometriotic lesions via laparoscopy or laparotomy is considered the most effective approach to eliminate changes caused by endometriosis. However, surgery does not prevent the formation of new cellular clusters, which trigger inflammatory processes. Therefore, surgical treatment focuses on removing adhesions to alleviate pain and restore normal organ mobility. Laparoscopy is particularly recommended in cases where hormone therapy is not feasible, endometrial cysts are present, pharmacotherapy is ineffective, or the disease affects internal organs. Endometriosis treatment aims to manage chronic pain. The use of nonsteroidal anti-inflammatory drugs (NSAIDs) rarely provides long-term relief. Instead, combined estrogen-progestogen therapy is more commonly employed. In pharmacotherapy, aromatase inhibitors, denogest, danazol, and GnRH agonists are also utilized.

Manual therapy is becoming an increasingly vital component in endometriosis treatment. Its primary objectives include: alleviating pain, regulating muscle tension, accelerating tissue repair, enhancing scar and adhesion flexibility, and optimizing blood flow, nutrition, and oxygenation of soft tissues. Therapeutic approaches encompass visceral therapy, dry needling, manual scar mobilization, pinopressure, and urogynaecological physiotherapy. Additionally, medical health training is incorporated to correct movement patterns, improve posture, and implement breathing exercises.