Welcome to the latest edition of our newsletter, where we shed light on important medical topics. This month, we focus on a prevalent and often misunderstood condition affecting millions of women worldwide - Endometriosis. As an expert in gynecology and reproductive health, Dr. Jose Goncalves aims to raise awareness about this condition, its symptoms, methods of diagnosis, and various management approaches.

Endometriosis is a chronic and often painful disorder where tissue similar to the lining of the uterus (endometrium) grows outside the uterus.

These growths, called endometrial implants, most commonly occur on the ovaries, fallopian tubes, and the tissue lining the pelvis.

However, they can also be found on other organs within the pelvic cavity and, in rare cases, even outside the pelvis.

The symptoms of endometriosis can vary in intensity from mild to severe, and they might include:

• Pelvic Pain: Chronic pelvic pain is the most common symptom, often worsening during menstruation and sometimes throughout the entire menstrual cycle.

• Painful Menstruation (Dysmenorrhea): Severe menstrual cramps that may include lower back and abdominal pain.

• Painful Intercourse (Dyspareunia): Discomfort or pain during sexual intercourse.

• Painful Bowel Movements or Urination: Painful bowel movements or urination, especially during menstruation.

• Excessive Bleeding: Heavy menstrual bleeding or irregular bleeding.

• Infertility: Difficulty getting pregnant or infertility.

Diagnosing endometriosis may require a combination of approaches, including:

• Medical History and Symptom Evaluation: A detailed discussion about your symptoms, menstrual history, and family history can provide crucial clues.

• Physical Examination: A pelvic examination helps identify any abnormalities or masses in the pelvis.

• Ultrasound: Transvaginal ultrasound can help detect larger endometriotic cysts on the ovaries.

• Magnetic Resonance Imaging (MRI): An MRI can provide a clearer image of the pelvis and help identify deeper infiltrating endometriosis.

• Laparoscopy: The definitive diagnosis of endometriosis is made through laparoscopy, a minimally invasive surgical procedure that allows direct visualization and biopsy of endometrial implants. Note that excision of endometriosis is more effective than just cauterization of the implants.

There are several approaches to managing endometriosis, depending on the severity of symptoms and the patient's fertility goals. Some common management strategies include:

• Pain Medication: Over-the-counter pain relievers can help manage mild pain, while prescription medications may be required for more severe cases.

• Hormonal Therapy: Hormonal treatments, such as oral contraceptives, progestins, or GnRH agonists, can help control the growth of endometrial tissue and alleviate symptoms.

• Surgery: Laparoscopic surgery can remove endometrial implants, cysts, and scar tissue. In severe cases, a hysterectomy (removal of the uterus) may be considered, but this decision should be thoroughly discussed with a healthcare professional.

• Fertility Treatments: For women struggling with infertility due to endometriosis, fertility treatments like in vitro fertilization (IVF) may be recommended.