Endometriosis: when the lining of the uterus grows in the wrong place

With endometriosis, "implants" of uterine lining (endometrium) grow outside the uterus. This usually occurs in the abdominal cavity, ovaries, fallopian tubes, or on other organs such as the bladder or intestines. But sometimes these small implants can also appear in the nose. We don't know how the uterine lining gets to that part of the body.

What problems can occur?

The lining of the uterus is sensitive to hormones and normally thickens during the female cycle in preparation for hosting a fertilised egg, or it is released during menstruation when no fertilisation has taken place. The endometrial cells located outside the uterus respond to the hormonal stimulation as well. This can be quite unpleasant, particularly during menstruation, when these cells also break down and bleed. "The remains of the cells and the blood can lead to pain or adhesions in the abdominal cavity, or to monthly nosebleeds. But sometimes that is not the actual problem, but rather that the implants occur in a location where they create a mechanical disturbance or block a passage," explained Silke Schmitt Oggier, Medical Director at santé24. This can for example occur in the fallopian tubes or the wall of the uterus.

Symptoms and diagnosis

Some patients have no complaints at all and first learn that they have endometriosis when they are trying to get pregnant. Others report very intense period pains, abdominal pain independent of periods, or pain during intercourse, urination or bowel movements.

When typical symptoms occur, patients are asked whether any of their family members (such as their mother or sister) have endometriosis. Following an in-depth gynaecological palpation, an ultrasound examination, ideally done vaginally, can provide valuable information. This can often reveal larger endometriosis implants, cysts or adhesions. The ureter and area around the kidneys should also be examined. In most cases keyhole surgery (laparoscopy) is conducted through the belly button in order to view the findings more closely and take tissue samples which make it possible to more accurately diagnose the severity of the condition. Despite all this, endometriosis is considered a benign illness.

Treatment options

Treatment depends on the symptoms. If the patient is experiencing pain, medication is the first line of attack. This consists of a mix of pain relief and hormonally effective medication such as birth control pills or other cycle-regulating drugs. However, medicinal treatment only mitigates the symptoms, and is not a cure for endometriosis.

When the patient is having trouble getting pregnant because of endometriosis, the only way to improve fertility is with an operation. Surgery to remove the offending endometriosis nodules is minimally invasive, and as gentle as possible. This type of procedure can help patients get pregnant naturally and also increases the success rate for artificial insemination.

santé24 – your Swiss telemedicine service

Medical help around the clock: The doctors and medical specialists at santé24 are there to offer you expert advice on all of your questions concerning prevention, illness, accidents and maternity – 365 days a year. Advice is free of charge to SWICA customers.


02.02.2022