All about endometriosis



What is endometriosis?

Endometriosis occurs when tissue similar to the lining of the uterus grows outside of it.

This tissue behaves like normal uterine tissue during the menstrual cycle – it breaks down and bleeds at the end of the cycle. However, this blood has nowhere to go. Surrounding areas can become inflamed or swollen, leading to scars and lesions.

Endometriosis most commonly affects the ovaries.


Types of endometriosis

  1. Superficial peritoneal endometriosis: The peritoneum is a thin membrane that lines the abdomen and pelvis, covering most organs in these areas. In this type, endometrial tissue attaches to the peritoneum. This is the least severe form of endometriosis.
  2. Endometriomas: These are dark cysts filled with blood-like fluid, also known as chocolate cysts. They vary in size and can appear in different parts of the pelvis or abdomen, but they are most commonly found on the ovaries
  3. Deep infiltrating endometriosis (DIE): In this type, endometrial tissue has affected organs within or outside the pelvic cavity. This can include the ovaries, rectum, bladder, and intestines. Rarely, adhesions may bind these organs together, causing them to become immobile. This condition is known as a “frozen” or “fixed” pelvis, occurring in only 1% to 5% of people with endometriosis.
  4. Endometriosis on the abdominal wall: In some cases, endometrial tissue can grow on the abdominal wall. The cells may attach to a surgical incision site, such as one of a cesarean section.


Symptoms of endometriosis

  • You may not notice any symptoms of endometriosis. When present, they can include:
  • Back pain during menstruation
  • Severe menstrual cramps
  • Pain during bowel movements, especially during menstruation
  • Unusual or heavy bleeding during menstruation
  • Blood in stools or urine
  • Diarrhea or constipation
  • Painful intercourse
  • Persistent fatigue
  • Difficulty getting pregnant

It is important to note that the severity of symptoms does not necessarily reflect the extent of the condition. You may have a significant amount of endometrial tissue with minimal symptoms and vice versa.



There is currently no cure for endometriosis, and modern medicine plays a crucial role in managing the condition.

As of today, treatment typically involves medication therapy or surgery. Different treatments may need to be tried to find the most suitable therapy for the patient.


A gynaecologist may recommend pain relievers or hormonal medications. Hormonal therapy reduces the amount of estrogen produced by the body and may stop the menstrual cycle. This helps reduce bleeding from lesions, thereby reducing inflammation, scars, and the formation of cysts.

If these treatments are not effective, surgery may be necessary to remove the endometrial lesions. This can be done laparoscopically or through open abdominal surgery. Another option for women who do not plan to become pregnant is surgical removal of the uterus, known as hysterectomy, which may be performed concurrently with oophorectomy, the removal of the ovaries.


When you visit your gynecologist, it’s important to ask the following questions:

  • What treatment plan have you chosen for me?
  • How will we know if it’s working?
  • What are the benefits of this treatment plan? And what are the risks?
  • How long will this treatment last?
  • Are there any other treatment options?
  • Will I need additional therapies or procedures in the future?
  • What will happen if I do nothing?
  • What is your approach to managing pain?


If you are still searching for an experienced specialist and excellent equipment, we recommend scheduling an appointment with Dr. Vasil Dimov (works with NHIF) или Dr. Nina Baycheva

Book your appointment by phone: 02 404 8656; 0882 441 433


Online via the Superdocsystem.

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