Endometriosis and adenomyosis: diagnosis and treatment
Endometriosis Basel: assessment and conservative treatment, adenomyosis – gynaecologist
FMH Gynecology
Board certified
SGGG
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Colposcopy diploma
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Spalenvorstadt 3
4051 Basel
In endometriosis, endometrium-like tissue grows outside the uterus – often on the peritoneum, on the ovaries (endometriomas, so-called 'chocolate cysts'), on the supporting ligaments, or deep-infiltrating in the area of the bowel or bladder. This tissue responds to the cycle, bleeds along with it and triggers inflammation, adhesions and pain.
Endometriosis is one of the most common gynaecological conditions and is often overlooked for years. It can cause menstrual pain, chronic pelvic pain, pain during intercourse and unfulfilled desire to have children – but it is well treatable.
Women of any age with a cycle can be affected. Very severe menstrual pain starting from the first period should be investigated early.
Key facts
At a glance.
- We handle assessment and conservative treatment. We do not perform surgery – for that we refer you to an endometriosis centre.
- Effective treatment is often possible without surgery being necessary first.
- Endometriosis often begins in adolescence and often goes unrecognised for years.
- Adenomyosis (growth into the muscular layer of the uterus) may be present in addition to endometriosis.
- A specialised ultrasound detects many – but not all – endometriosis lesions.
- An unremarkable ultrasound does not reliably rule out endometriosis.
- Ryeqo® is established in Switzerland as an approved second-line option for previously treated women.
Causes
Background and risk factors.
The exact cause of endometriosis has not been fully clarified. Retrograde menstruation, immunological and genetic factors, and hormonal influences are discussed. The most common causes of pain are the endometriosis lesions themselves with cyclical bleeding and inflammation, adhesions, deep-infiltrating lesions in the area of the bowel, bladder or supporting ligaments – as well as accompanying adenomyosis.
Adenomyosis
In addition to endometriosis, adenomyosis may also be present. Here, endometrium-like tissue grows into the muscular layer of the uterus. Typical features are heavy and prolonged menstrual bleeding, severe menstrual pain, chronic pelvic pain, a feeling of pressure in the pelvis and occasionally an unfulfilled desire to have children. Adenomyosis can often already be recognised on specialised gynaecological ultrasound – a focus area of our practice.
Risk factors
- Family history (mother, sister)
- Early onset of periods
- Very heavy or prolonged bleeding
- Short cycle lengths
Frequency
Endometriosis affects an estimated 1 in 10 women of reproductive age. Adenomyosis is also common, especially between ages 35 and 50.
Symptoms & findings
How does it present?
Typical symptoms
- Very severe menstrual pain, often starting a few days before the period
- Chronic pelvic pain, cycle-dependent or independent
- Pain during intercourse (dyspareunia)
- Pain on bowel movements or urination, especially during the period
- Heavy and prolonged menstrual bleeding (also typical for adenomyosis)
- Fatigue, reduced resilience
- Unfulfilled desire to have children
Common incidental findings
- Symptoms are normalised from the start as 'just a heavy period'
- Incidental finding on ultrasound (ovarian endometrioma)
When is it detected?
Menstrual pain that limits daily life, does not respond adequately to ibuprofen, or is accompanied by pain outside the period should be investigated. This also applies to adolescents.
Diagnostics
How the diagnosis is made.
The first step is a detailed conversation
when do the symptoms occur, how severe are they, is there pain during intercourse, bowel movements or urination, is there a wish to have children, what is the bleeding pattern like? This is followed by a specialised gynaecological ultrasound – vaginal, and rectal if needed –, which can often clearly show endometriomas, deep-infiltrating lesions and adenomyosis. For complex findings we add an MRI. A laparoscopy is no longer a prerequisite today for effective treatment – it is used specifically when diagnosis or therapy requires it.
Examinations
- Detailed conversation & pain history
- Specialised transvaginal ultrasound
- Examination, if needed with rectal ultrasound
- MRI for deep-infiltrating endometriosis or complex findings
- Laparoscopy specifically when clearly indicated
What do the findings mean?
Many endometriotic lesions and adenomyosis are recognisable on specialised ultrasound; superficial peritoneal lesions, however, often remain invisible. An unremarkable ultrasound does not reliably rule out endometriosis – treatment can already begin for typical symptoms.
Treatment
Possible approach.
Watchful waiting
Treatment is based on your symptoms, findings, age and your wish to have children. The goal is pain reduction, preserving quality of life and, if desired, fertility. Many women manage well with a combination of painkillers and hormonal therapy – surgery is not always necessary.
Medication
Painkillers
NSAIDs such as ibuprofen, mefenamic acid or naproxen work well on cramps and inflammation; take early and at an adequate dose.
Hormonal therapies (first line)
the combined pill (including extended cycle or continuous use), progestin-only preparations (e.g. dienogest) or the hormonal IUD can significantly relieve symptoms. With progestins, oestrogen levels remain in the range of the early follicular phase – a favourable compromise between effectiveness and tolerability.
Ryeqo® (relugolix combination)
Ryeqo® is a tablet taken once daily that combines three active substances. The active ingredient relugolix suppresses hormone production by the ovaries and temporarily puts the body into a menopause-like state. So that typical menopausal symptoms are cushioned and bone health is protected, two low-dose hormones (estradiol and norethisterone acetate) are included in the same tablet. In Switzerland, Ryeqo® is approved for the treatment of endometriosis-related pain – for women who have already been treated with medication or surgery and in whom progestin therapy alone is not sufficiently effective or is not an option. In the approval studies, both pain during menstruation and independent pelvic pain decreased significantly. Because Ryeqo® can be taken over a longer period, we keep an eye on bone density and perform bone density measurement if needed. Whether Ryeqo® is an option for you is discussed individually.
Surgery
Laparoscopy can be useful if medication is not sufficient, a larger endometrioma is present, deep-infiltrating lesions cause symptoms, or there is an unfulfilled desire to have children with advanced findings. The goal is the most complete, tissue-sparing removal of the lesions possible. In complex cases, surgery is performed by an interdisciplinary team.
Prevention
What you can do yourself.
- Have very severe menstrual pain investigated early – even in adolescents
- Use sufficiently high-dose NSAIDs early in the cycle
- With known endometriosis, attend regular check-ups
- If you wish to have children: discuss early, do not lose time
- Consider accompanying pelvic floor therapy / physiotherapy for chronic pain
Complementary
Complementary treatment options
Besides painkillers and hormonal therapies, many patients are interested in complementary measures. The following approaches are not guideline-based; individual studies are promising, but the evidence base is limited. They do not replace effective medical treatment, but can complement it. Talk to us before starting anything.
Diet
Some studies suggest that a predominantly plant-based, anti-inflammatory diet can relieve symptoms. Many women report improvement from less red meat, fewer heavily processed foods, reduced dairy products, and more vegetables, fruit and omega-3 fatty acids. However, scientific evidence remains limited so far.
N-acetylcysteine (NAC)
NAC is an antioxidant. Smaller studies show that it can relieve pain and possibly slow the growth of endometriosis lesions. The data are promising but not yet sufficient to recommend NAC as standard therapy.
GLP-1 receptor agonists
GLP-1 medications (e.g. semaglutide or tirzepatide) are not part of standard endometriosis treatment. In patients with overweight, they can favourably influence inflammatory processes through weight reduction and thereby possibly indirectly improve symptoms. Whether GLP-1 medications have a direct effect on endometriosis or adenomyosis is currently being scientifically investigated.
One appointment. One main concern. So we can give you our full, unhurried attention, we address one main topic per appointment. We're happy to schedule additional or complex questions in a separate appointment. This is what allows consultations to run on time and without long waiting times – thank you for your understanding.
Frequently asked questions
FAQ.
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Medically responsible.
Dr. med. Anna Margareta Wagner is a board-certified FMH specialist in gynecology and obstetrics with her own practice at Spalenvorstadt 3 in Basel. Special focus on surgical gynecology; further focus areas: gynecological check-ups, colposcopy and dysplasia consultations, intimate surgery, pregnancy care, and consultations for girls and adolescents.
- FMH specialist certification in gynecology and obstetrics
- Special focus: surgical gynecology
- SGGG member
- Certified colposcopy diploma
- Languages: German, English
- Service area: Basel-Stadt, Basel-Landschaft, northwestern Switzerland
The content on this page is reviewed regularly against current specialist medical recommendations.
Sources
Scientific references.
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