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What is Endometriosis? Symptoms, Diagnosis, and Treatment

Endometriosis is a common condition affecting women of reproductive age, often disrupting daily life. If you’re wondering, “What is endometriosis?”, it’s a condition where tissue similar to the uterine lining (endometrium) grows outside the uterus, such as on the ovaries, intestines, or abdominal wall. This tissue becomes inflamed during menstrual cycles, causing pain, infertility, inflammation, or digestive issues. In Iran, approximately 2 million women may be affected by endometriosis. Advanced cases, such as bowel or urinary tract endometriosis, require highly specialized treatment by a multidisciplinary team (MDT) consisting of gynecologists, colorectal surgeons, and urologists. This article provides comprehensive information on the causes, symptoms, diagnosis, treatment, and the role of colorectal surgeons and MDTs in managing this condition, particularly when the large intestine is involved. The information is updated with the latest medical advancements as of 2025.

What is Endometriosis and Why Does It Occur?

To answer “What is endometriosis?”, it occurs when tissue resembling the endometrium grows in areas outside the uterus, such as the intestines or ovaries. This tissue bleeds during menstruation but, with no exit, causes inflammation, adhesions, and pain. The exact cause remains unclear, but several scientific theories explain its development.

Possible Causes of Endometriosis

• Retrograde Menstruation: Menstrual blood containing endometrial cells flows backward through the fallopian tubes into the pelvic cavity, implanting on areas like the intestines or ovaries. This is the most common explanation and is observed in 80% of patients.
• Immune System Disorders: In some women, the immune system fails to eliminate misplaced endometrial cells, allowing them to grow. This issue may be linked to other autoimmune conditions.
• Genetic Factors: If your mother or sister has endometriosis, your risk is 5-7 times higher. Specific genes may trigger the condition.
• Surgical Transfer: During procedures like cesarean sections, endometrial cells may transfer to the abdominal wall, leading to abdominal wall endometriosis. This occurs in 1-2% of women post-cesarean.
• Hormonal Imbalances: Excess estrogen can stimulate the growth of endometrial tissue in abnormal locations. This is more common in women with early menstruation.
• Dioxins and Environmental Factors: Dioxins, persistent chemical toxins from waste burning, chemical industries, or contaminated foods (e.g., fatty fish), can mimic estrogen, increasing inflammation and potentially raising endometriosis risk. In Iran, improper waste incineration and consumption of high-fat dairy from contaminated sources may increase exposure. Reducing high-fat foods and supporting proper waste management can mitigate this risk.

These factors—genetics, hormones, and environment—combine to make endometriosis a complex condition. Understanding them aids in diagnosis and treatment.

Areas Affected by Endometriosis

Endometriosis can affect various parts of the body, clarifying the question, “What is endometriosis and what are its symptoms?” Each affected area produces distinct symptoms.

Common Affected Areas

• Ovarian Endometriosis: About 40% of patients develop chocolate cysts (endometriomas) in the ovaries, filled with old blood, causing severe pain or infertility.
• Fallopian Tubes and Ligaments: Adhesions in these areas impair egg movement, leading to infertility and pelvic pain.
• Uterine Endometriosis (Adenomyosis): Endometrial tissue grows into the uterine muscle wall, causing heavy, painful periods.
• Bowel Endometriosis: In 5-12% of cases, the rectum or sigmoid colon is affected, causing digestive symptoms like constipation or rectal bleeding. Even the small intestine can occasionally be involved.
• Abdominal Wall Endometriosis: Tissue growth in the abdominal wall layers, often post-cesarean, causing painful masses.
• Subcutaneous Endometriosis: Lesions in the skin or subcutaneous tissue, often at surgical scars, which become painful during menstruation. It can even occur in the navel.
• Bladder and Ureters: Causes pain during urination or kidney issues, potentially leading to chronic urinary obstruction or even loss of kidney function.

Bowel-Associated Endometriosis

Bowel endometriosis occurs when endometrial tissue grows on or within the bowel’s deep layers (Deep Infiltrating Endometriosis, DIE). It can:

• Cause bowel narrowing or obstruction.
• Create adhesions between the bowel and pelvic organs.
• Lead to rectal bleeding during menstruation.
• Cause severe pelvic pain.

In Tehran, this condition is treated by colorectal surgeons (such as Dr. Yousef Fam and his endometriosis surgery team) alongside gynecologists using laparoscopic surgery in a single session.

What Are the Symptoms of Endometriosis?

To address “What is endometriosis and what are its symptoms?”, symptoms vary depending on the affected area. About 25% of patients are asymptomatic, but bowel involvement causes distinct digestive symptoms.

General Symptoms of Endometriosis

• Chronic Pelvic Pain: Especially during menstruation (dysmenorrhea), which may radiate to the back or legs.
• Pain During Intercourse: Dyspareunia, which can disrupt intimate relationships.
• Infertility: 30-50% of women with endometriosis face fertility challenges.
• Fatigue and Depression: Due to chronic pain and disease-related stress.

Symptoms of Bowel Endometriosis

Bowel involvement mimics other gastrointestinal disorders:

• Pain During Bowel Movements: Severe pressure or pain (tenesmus) during menstruation.
• Bowel Habit Changes: Alternating diarrhea or constipation, especially during periods.
• Rectal Bleeding: Blood in stool or bleeding during menstruation.
• Chronic Bloating: A feeling of fullness or abdominal swelling.
• Bowel Obstruction: Rare but severe cases.

Specific Symptoms

• Abdominal Wall: Painful or sensitive masses at cesarean scar sites, worsening during menstruation.
• Subcutaneous Endometriosis: Small, painful lumps under the skin, often at surgical sites.
• Ovarian Endometriosis: Severe pelvic pain, painful cysts, or irregular periods.

These symptoms may be mistaken for conditions like irritable bowel syndrome (IBS), so consulting a gynecologist or gastroenterologist is essential.

Is Endometriosis Cancer?

Many ask, “Is endometriosis cancer?” No, endometriosis is a benign condition, not cancer. However, 2025 studies indicate that women with ovarian endometriosis may have a slight (1-2%) increased risk of specific ovarian cancers, such as clear cell carcinoma. Endometriosis itself is not a benign tumor but a chronic inflammatory condition manageable with proper treatment. Regular follow-ups with a gynecologist reduce the risk of complications.

Can Endometriosis Cause Death?

Another common question is, “Can endometriosis cause death?” No, endometriosis alone is not fatal. However, rare complications like complete bowel obstruction or kidney damage (hydronephrosis) from ureteral involvement can be serious if untreated. Early treatment by a specialized team, particularly in advanced hospitals like Erfan Niayesh, minimizes these risks.

Methods of Diagnosing Endometriosis

Accurate diagnosis is crucial for identifying the location and severity of endometriosis, enabling effective treatment.

• Pelvic Exam: A doctor may detect masses or nodules in the pelvis or behind the uterus. This is useful for initial assessment.
• Transvaginal or Transrectal Ultrasound: Used to identify ovarian cysts (endometriomas) or bowel lesions. Doppler ultrasound in Tehran offers high accuracy and is available at reputable centers like Asa Radiology or Avicenna Infertility Center.
• MRI: Detailed imaging to assess lesion depth, especially in bowel endometriosis, revealing adhesions.
• Colonoscopy: Used to rule out other conditions like colon cancer or colitis, though it’s less precise for diagnosing endometriosis.
• Diagnostic Laparoscopy: The gold standard for diagnosis, where a surgeon uses a small camera to view and biopsy lesions.

Endometriosis Treatment: Management Options

Treatment includes medications, surgery, and complementary approaches, depending on symptom severity, age, and fertility goals.

Medical Treatments

Medications aim to reduce pain and control endometrial tissue growth:

• Pain Relievers: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or mefenamic acid alleviate mild pain and reduce inflammation but do not treat the disease.
• Hormonal Therapy:
  • Contraceptive Pills: Containing estrogen and progesterone, they regulate menstruation and reduce pain.
  • Progestins: Such as dienogest or the Mirena IUD, which inhibit endometrial tissue growth.
  • GnRH Agonists: Like leuprolide, inducing temporary menopause to halt symptoms.
  • Aromatase Inhibitors: Such as letrozole, used for treatment-resistant cases.
• New Treatments (2025): Targeted drugs inhibiting inflammatory pathways are under trial, showing promising results.

Surgical Treatments

Surgery is recommended for severe endometriosis, such as bowel involvement, or when medications are ineffective:

• Laparoscopy: A minimally invasive procedure with small incisions to remove lesions, offering a short recovery (1-2 weeks) and minimal complications.
• Open Surgery: For complex cases with extensive adhesions or bowel obstruction, requiring larger incisions.
• Shaving: Removal of superficial bowel lesions without deep cutting, suitable for mild lesions with low risk of bowel damage.
• Disc Excision: Removal of localized deep lesions using a stapler, ideal for smaller rectal lesions.
• Bowel Resection: Removal of the affected bowel segment (e.g., rectum) with reconnection (anastomosis). This is necessary for deep infiltrating lesions but may require a temporary ostomy. Notably, Dr. Yousef Fam’s surgical team at Erfan Niayesh Hospital achieves this with complications below 0.5%.

Laparoscopic surgery by the best endometriosis surgeons in Tehran can improve fertility and reduce symptoms by up to 70% with minimal complications.

Complementary Treatments

To support primary treatments:

• Diet: An anti-inflammatory, high-fiber diet (fruits, vegetables) with reduced red meat eases bowel symptoms.
• Pelvic Physiotherapy: Exercises to reduce pain and improve pelvic mobility.
• Psychological Counseling: Managing stress and depression from chronic pain.

Indications for Surgery in Endometriosis

Surgery, particularly for bowel endometriosis, is recommended in the following cases:

• Severe Pain: When medications fail to control pelvic or digestive pain.
• Bowel Obstruction: Narrowing or blockage due to deep lesions.
• Rectal Bleeding: Persistent bleeding during menstruation.
• Infertility: Adhesions or cysts impairing fertility.
• Deep Infiltrating Endometriosis (DIE): Lesions penetrating the bowel or ovarian layers.

Our center’s MDT and colorectal surgeon evaluate risks (up to 40% recurrence) and benefits (improved quality of life) to make the best decision for the patient.

Role of the Multidisciplinary Team (MDT) in Endometriosis Treatment

The multidisciplinary team (MDT) consists of specialists collaborating to manage the complexities of endometriosis, especially bowel involvement.

MDT Members

• Gynecologist: Initial diagnosis, hormonal therapy, and surgical planning.
• Colorectal Surgeon: Removal of bowel lesions using minimally invasive techniques.
• Urologist: Treats ureter or bladder involvement alongside the endometriosis team.
• Gastroenterologist: Evaluates bowel symptoms and rules out similar conditions.
• Radiologist: Interprets ultrasounds and MRIs for lesion mapping.
• Fertility Specialist: Advises on fertility preservation or IVF.
• Psychologist and Physiotherapist: Supports mental and physical health.

Benefits of MDT

The MDT approach delivers better outcomes:

• Accurate Diagnosis: Combining MRI and colonoscopy with radiology and gastroenterology expertise.
• Personalized Treatment: Tailored combinations of medication, surgery, or IVF for each patient.
• Reduced Complications: Coordination between gynecologists, colorectal surgeons, and urologists minimizes risks like bowel or urinary leakage.
• Regular Follow-Up: Annual check-ups to prevent recurrence.

In Tehran, Erfan Niayesh Hospital and Dr. Yousef Fam’s specialized team use MDT for endometriosis treatment.

Role of the Colorectal Surgeon in Bowel Endometriosis Surgery

With the increasing prevalence and diagnosis of endometriosis in Iran and the complexity of bowel involvement, the colorectal surgeon plays a pivotal role, requiring specialized skills to preserve bowel function.

Colorectal Surgeon’s Responsibilities

• Pre-Surgical Assessment: Reviewing MRI and ultrasound to determine lesion location and depth, e.g., whether the lesion affects only the rectal surface or penetrates the muscle.
• Laparoscopy: Minimally invasive surgery with a camera and fine instruments to remove lesions while maintaining natural bowel function with minimal complications.
  • Shaving: Removing superficial lesions without cutting the bowel, suitable for small lesions with low risk (complications <2%) and quick recovery.
  • Disc Excision: Removing localized deep lesions with a stapler, used for smaller rectal lesions while preserving bowel function. Dr. Yousef Fam introduced a unique disc excision technique, presented for the first time globally at the 2019 Swiss Colorectal Congress.
  • Anterior Rectal Resection: Removing the affected bowel segment and reconnecting it with sutures or a stapler, necessary for deep infiltrating lesions, requiring 4-6 weeks of recovery.
  • Temporary Ostomy: In complex cases, a temporary ostomy protects the bowel and is removed after 3-6 months. At our center, this is needed in less than 1% of cases.
• Complication Management: Preventing anastomotic leaks, fistulas, or infections with precise techniques.
• Follow-Up: Post-surgical check-ups to monitor recurrence or digestive issues.

Why is a Colorectal Surgeon Important?

The best endometriosis surgeons in Tehran with colorectal expertise:

• Have thorough knowledge of bowel anatomy, reducing the risk of damage.
• Use advanced technologies like laparoscopic surgery for higher precision.
• Collaborate with gynecologists to preserve fertility.
• Reduce surgical complications (e.g., infections or leaks) to below 1%.

What is Abdominal Wall Endometriosis?

Abdominal wall endometriosis refers to endometrial tissue growth in the abdominal wall, typically following cesarean sections or laparotomy. Symptoms include a painful mass at the scar site that worsens during menstruation. Treatment often involves surgical removal of the mass by a general or gynecologic surgeon. This condition affects 1-2% of women post-cesarean.

What is Endometriosis?

Endometriosis, sometimes searched as “endometriozis,” is an inflammatory condition that may affect the ovaries, bowels, or abdominal wall and is manageable with appropriate treatment.

Long-Term Management and Prevention

Endometriosis is a chronic condition requiring ongoing care:

• Hormonal Therapy: Progestins or GnRH agonists post-surgery to prevent recurrence.
• Lifestyle Changes: An anti-inflammatory diet (vegetables, omega-3), regular exercise, and stress reduction.
• Follow-Up: Annual check-ups with gynecologists and gastroenterologists.
• Fertility: Early consultation for pregnancy planning or IVF.

Reducing exposure to toxins like dioxins (via organic foods) can also help.

Why Treat Endometriosis in Tehran?

Tehran, with advanced hospitals like Erfan Niayesh and top endometriosis surgeons and MDTs, is an ideal destination for treatment. Laparoscopic technologies in these centers yield excellent outcomes. For consultation or appointment booking, contact us.

Contact or Book an Appointment with Dr. Yousef Fam

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