{"id":5248,"date":"2024-12-11T17:22:31","date_gmt":"2024-12-11T16:22:31","guid":{"rendered":"https:\/\/irccs.com\/patologie\/endometriosis\/"},"modified":"2026-03-25T16:11:10","modified_gmt":"2026-03-25T15:11:10","slug":"endometriosis","status":"publish","type":"pathology","link":"https:\/\/irccs.com\/en\/patologie\/endometriosis\/","title":{"rendered":"Endometriosis"},"content":{"rendered":"\n<h2 class=\"wp-block-heading\"><span  id=\"pathology\" class=\"h2_anchor\"><\/span>Pathology<\/h2>\n\n\n\n<p>Endometriosis is a <strong>widespread<\/strong> condition (affecting about <strong>one in 10 women<\/strong>), characterized by the presence of the tissue that normally lines the inside of the uterus (endometrium) outside the uterine cavity itself.<\/p>\n\n\n\n<p>Endometriosis is a <strong>multifactorial<\/strong> and <strong>hormone-dependent<\/strong> condition typical of childbearing age. It generally has a <strong>chronic, progressive<\/strong> course <strong>with possible recurrence<\/strong>, and manifests mainly with <strong>pelvic pain<\/strong> and difficulty in conception<strong>(infertility<\/strong>).<\/p>\n\n\n\n<p>The most common sites where <strong>endometriosis implants<\/strong> develop are the <strong>ovaries<\/strong>, the <strong>pelvic peritoneum<\/strong> (the membrane that lines the pelvis internally), and the <strong>recto-vaginal septum<\/strong> (the space between the rectum and vagina). However, this disease can also affect other organs and tissues of the body, with the exception of the <strong>spleen<\/strong>.<\/p>\n\n\n\n<p>Endometriosis is also associated with an <strong>increased risk of some gynecologic cancers<\/strong>, including ovarian carcinoma, endometrial carcinoma, and sarcomas of the endometrial stroma. Indeed, studies have shown that women with endometriosis have a <strong>3- to 5-fold higher<\/strong> risk of developing ovarian cancer than the general population. In numbers,<a href=\"https:\/\/irccs.com\/en\/divisioni-cliniche\/ovarian-cancer-center\/\" type=\"medical-area\" id=\"5148\"> ovarian cancer<\/a> is observed in <strong>1.5 percent of women with endometriosis<\/strong>, compared with <strong>0.04 percent in the general population<\/strong>. At the same time, endometriosis is more common among women with ovarian cancer, with an incidence of 8% to 30%.<\/p>\n\n\n\n<p>At the Candiolo Institute, we treat this disease with a specific approach that allows us to <strong>accurately recognize precancerous forms <\/strong>and intervene early on those that could develop into cancer.<br>The goal is to offer patients a <strong>safe and effective course of care<\/strong>, thanks to advanced expertise that allows for gentle and targeted treatments similar to gynecologic oncology surgery, but with a less invasive approach.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Clinical divisions involved<\/h3>\n\n\n\n<p>The diagnostic and therapeutic pathway of endometriosis at Candiolo involves several clinical divisions, including the <strong><a href=\"https:\/\/irccs.com\/en\/divisioni-cliniche\/gynecologic-oncology-and-hereditary-tumors\/\" type=\"medical-area\" id=\"5119\">Gynecologic Oncology<\/a><\/strong> and the <strong><a href=\"https:\/\/irccs.com\/en\/divisioni-cliniche\/ovarian-cancer-center\/\" type=\"medical-area\" id=\"5148\">Ovarian Cancer Center<\/a><\/strong>.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"symptoms\" class=\"h2_anchor\"><\/span><strong>Symptoms<\/strong><\/h2>\n\n\n\n<p>The most common symptoms are:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Dysmenorrhea<\/strong> (pain during menstruation);<\/li>\n\n\n\n<li><strong>chronic pelvic pain<\/strong>;<\/li>\n\n\n\n<li><strong>periovulatory pain<\/strong>;<\/li>\n\n\n\n<li><strong>Dyspareunia<\/strong> (pain during sexual intercourse);<\/li>\n\n\n\n<li><strong>Dyschezia<\/strong> (pain in defecation);<\/li>\n\n\n\n<li><strong>Dysuria<\/strong> (pain to urinate).  <\/li>\n<\/ul>\n\n\n\n<p>Endometriosis-related pain can be <strong>very intense and disabling<\/strong>, significantly affecting the quality of life and psychological well-being of affected women.<\/p>\n\n\n\n<p>In addition to pain, endometriosis can cause <strong>anatomical changes<\/strong> in several pelvic organs: bowel, bladder, and ureters. In some cases, these changes can lead to <strong>intestinal or urinary stenosis<\/strong> and even <strong>organ damage<\/strong>, or result in <strong>pelvic dysfunction<\/strong> of various kinds:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>sexual<\/strong>: pain during intercourse (dyspareunia), vulvar pain (vulvodynia);<\/li>\n\n\n\n<li><strong>Urinary<\/strong>: bladder hypersensitivity or overactivity;<\/li>\n\n\n\n<li><strong>rectal<\/strong>: constipation, diarrhea, irregular alvus, intermittent alvus, rectal tenesmus;<\/li>\n\n\n\n<li><strong>Perineal<\/strong>: pelvic floor hypertone.<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"risk-factors\" class=\"h2_anchor\"><\/span>Risk factors<\/h2>\n\n\n\n<p>Factors that may increase the risk of developing endometriosis include:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Age and menstrual cycle<\/strong>: it is more common in women of childbearing age, with early menarche or short menstrual cycles (&lt;28 days);<\/li>\n\n\n\n<li><strong>Family history<\/strong>: having a mother, sister, or relative with endometriosis increases the risk;<\/li>\n\n\n\n<li><strong>Menstrual flow abnormalities<\/strong>: heavy, prolonged menstruation or difficulty with uterine drainage;<\/li>\n\n\n\n<li><strong>Pre-existing infertility<\/strong>: women with fertility problems are more likely to have endometriosis;<\/li>\n\n\n\n<li><strong>Hormonal factors<\/strong>: high estrogen levels or prolonged exposure to estrogen can promote the development of the disease;<\/li>\n\n\n\n<li><strong>lifestyle and environment<\/strong>: obesity, sedentary lifestyle and some environmental exposures could influence risk, although the data are less definitive;<\/li>\n\n\n\n<li><strong>previous uterine surgery or trauma<\/strong>: such as cesarean section or surgery on the uterus, which in some cases can facilitate implantation of endometrial tissue in abnormal locations.<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"diagnosis-and-examination\" class=\"h2_anchor\"><\/span>Diagnosis and examination<\/h2>\n\n\n\n<p>The <strong>symptomatology of endometriosis<\/strong> is highly variable and similar to other diseases, such as irritable bowel syndrome or pelvic inflammatory disease, often causing a <strong>delay in diagnosis.<\/strong><\/p>\n\n\n\n<p>Diagnosis of endometriosis is based on history and assessment of pelvic pain, physical examination, and instrumental investigations, particularly<strong>transvaginal or transabdominal pelvic ultrasound<\/strong>, which allows accurate <strong>&#8220;pain mapping<\/strong>.&#8221; Since it is operator-dependent, it should be performed in experienced centers.<\/p>\n\n\n\n<p><strong>Candiolo IRCCS Institute<\/strong> has outpatient clinics dedicated to the study of endometriosis, with <strong>level II<\/strong> ultrasound scans performed by experienced sonographers who can distinguish benign endometriotic ovarian masses from lesions with suspicious features of cancer. Given the<strong>extreme clinical variability and different localizations<\/strong>, an accurate assessment of the disease is essential to define the extent and choose the<strong>most appropriate therapeutic approach<\/strong>.<\/p>\n\n\n\n<p>When necessary, <strong>complementary investigations<\/strong> can be used to plan the best course of treatment:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Level II transvaginal pelvic ultrasonography<\/strong><\/li>\n\n\n\n<li><strong>Magnetic Resonance Imaging (MRI)<\/strong><\/li>\n\n\n\n<li><strong>Uro-TAC<\/strong><\/li>\n\n\n\n<li><strong>Cystoscopy<\/strong><\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"therapies\" class=\"h2_anchor\"><\/span>Therapies<\/h2>\n\n\n\t<div id=\"block_69c3fb0d72bc1\" class=\"accordion-block acf-block\">\n\t\t<div class=\"my-4 lg:my-6\">\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Medical therapy<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p><span style=\"font-weight: 400;\">Excluding the possible evolution in a cancerous direction, <strong data-start=\"100\" data-end=\"136\">medical therapy of endometriosis<\/strong> mainly serves to <strong data-start=\"160\" data-end=\"181\">reduce symptoms<\/strong>, such as pain and pelvic discomfort, but <strong data-start=\"223\" data-end=\"265\">does not change the course of the disease<\/strong> or achieve a <strong data-start=\"294\" data-end=\"317\">complete cure<\/strong>.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Medical treatment of endometriosis aims to <\/span><b>maintain the pathology in a state of stand-by <\/b><span style=\"font-weight: 400;\">as a function of the woman&#8217;s reproductive life. <\/span> <\/p>\n<p><span style=\"font-weight: 400;\">Medical therapy is based on the use of <\/span><b>anti-inflammatories and painkillers<\/b><span style=\"font-weight: 400;\"> (NSAIDs), the <\/span><b>combined hormonal contraceptives <\/b><span style=\"font-weight: 400;\">(COCs) and <\/span><b>progestins<\/b><span style=\"font-weight: 400;\"> which are considered the medical therapy of first and second choice in the treatment of endometriosis, GnRH analogs.<\/span><\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Surgical Therapy<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p><span style=\"font-weight: 400;\">Surgical therapy may be necessary within the fertile life span of affected women to <\/span><b>reestablish the anatomy of the abdomen<\/b><span style=\"font-weight: 400;\">, resolve symptomatology that does not respond to drug therapy, treat &#8220;complicated&#8221; or atypical or cancerous forms of the disease.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">The surgical approach (depending on the patient&#8217;s age, desire for pregnancy, clinical picture, and specific needs of the patient) involves either <\/span><b>conservative or radical treatment<\/b><span style=\"font-weight: 400;\"> offered in our center.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Conservative surgery with complete removal of disease lesions can lead to resolution of painful symptoms in most cases. The effectiveness of surgical treatment, given the chronic-recurrent nature of the condition, may not be definitive. Therefore, regular postoperative follow-up should be performed to highlight any recurrence of disease.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">The <\/span><b>objectives<\/b><span style=\"font-weight: 400;\"> Of conservative surgical treatment are: <\/span> <\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Complete excision of macroscopic lesions;<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Restoring normal anatomical relationships;<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Preserving or improving fertility;<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Treatment of complicated endometriosis:<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Organ impairment (ureteral compression or significant intestinal stenosis);<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Suspected ovarian cysts (risk of cancerization);<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Pelvic inflammatory picture.<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">The <\/span><b>laparoscopy<\/b><span style=\"font-weight: 400;\"> (minimally invasive surgery performed by making 4 incisions of 5 mm and 12 mm at the level of the abdomen) <\/span><b>is the preferred surgical approach<\/b><span style=\"font-weight: 400;\"> in the treatment of endometriosis because it offers numerous advantages over laparotomy (more invasive surgery that involves opening the abdomen).<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Crucially, the surgery should be performed in specialized centers capable of performing a <\/span><b>nerve-sparing surgery<\/b><span style=\"font-weight: 400;\"> that spares the nerve plexuses.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">At the Candiolo Institute, there is an advanced laparoscopic surgery service performed by extremely qualified staff using state-of-the-art techniques such as <\/span><b>fluorescence-guided surgery with indocyanine green <\/b><span style=\"font-weight: 400;\">(an experimental technique to preserve healthy tissues from those infiltrated by endometriosis).<\/span><\/p>\n<p><span style=\"font-weight: 400;\">The Candiolo Institute IRCCS also offers direct connections with reproductive medicine centers so as to provide fertility preservation support and counseling for medically assisted procreation pathways where needed.  <\/span><\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n\n\t<\/div>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"why-choose-us\" class=\"h2_anchor\"><\/span>Why choose us<\/h2>\n\n\n\n<p>The Candiolo Institute offers <strong>diagnosis, counseling and treatment<\/strong> for this condition that is very common in the female population but often goes unrecognized for a long time, resulting in delays in diagnosis. In this way, each patient can be followed by <strong>experienced professionals<\/strong> at all stages of the treatment pathway.<\/p>\n\n\n\n<p>For <strong>diagnosis<\/strong>, the Institute provides:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>A <strong>Level II ultrasound clinic<\/strong> that specializes in detecting endometriosis;<\/li>\n\n\n\n<li>A <strong><a href=\"https:\/\/irccs.com\/en\/divisioni-cliniche\/gynecologic-oncology-and-hereditary-tumors\/\" type=\"medical-area\" id=\"5119\">gynecological outpatient clinic<\/a> dedicated to deep endometriosis<\/strong>.<\/li>\n<\/ul>\n\n\n\n<p>For <strong>surgical treatment<\/strong>, an <strong>advanced laparoscopic surgery service<\/strong> is available, performed by highly qualified personnel. Innovative techniques, such as <strong>fluorescence-guided surgery with indocyanine green<\/strong>, are used to distinguish healthy tissues from those affected by endometriosis, preserving the function of the organs involved.<\/p>\n\n\n\n<p>The Institute also offers <strong>direct links with reproductive medicine centers<\/strong> to support fertility preservation and provide <strong>counseling on medically assisted procreation pathways<\/strong> when needed.<\/p>\n","protected":false},"featured_media":0,"template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-5248","pathology","type-pathology","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.2 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Endometriosis - Istituto di Candiolo<\/title>\n<meta name=\"description\" content=\"Endometriosis and women&#039;s health: learn about symptoms, diagnostic tools, impact on fertility, and treatments available at the Candiolo Institute.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/irccs.com\/en\/patologie\/endometriosis\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Endometriosis - 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