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Endometriosis is a chronic condition that may cause severe period pain, persistent pelvic pain, pain during sexual intercourse and difficulties becoming pregnant. Symptoms vary considerably, and their severity does not always reflect the extent of the disease.
At Tartaczna 2 Medical Centre in Gdańsk, we provide consultations, diagnosis and treatment for patients with suspected or confirmed endometriosis. Patients are seen by Dr Marek Korożan and Dr Dominika Kozikowska.
Depending on the symptoms and previous results, the diagnostic process may include a gynaecological consultation, an expert endometriosis ultrasound scan in Gdańsk, pelvic magnetic resonance imaging (MRI) or additional diagnostic tests.
The endometrium is the lining of the uterine cavity, which changes throughout the menstrual cycle. Endometriosis is a condition in which tissue similar to the endometrium is found outside the uterine cavity.
Endometriotic lesions may cause chronic inflammation, fibrosis and adhesions. Endometriosis may affect:
The exact cause of endometriosis remains unknown. Hormonal, immunological, inflammatory, genetic and environmental factors are thought to contribute to its development.
Endometriosis and adenomyosis are related conditions, but they are not the same disease. In endometriosis, tissue similar to the endometrium is present outside the uterine cavity. In adenomyosis, similar tissue is found within the muscular wall of the uterus, known as the myometrium.
Both conditions may occur together and may cause painful or heavy periods. Features of adenomyosis can be assessed during a specialist ultrasound examination.
Endometriosis most commonly affects women of reproductive age, although symptoms may begin during adolescence. Symptoms may also persist after the menopause, particularly in patients with previously diagnosed endometriosis.
Endometriosis is estimated to affect approximately 10% of women of reproductive age. Some patients have no characteristic symptoms, and the condition may be identified during fertility investigations or imaging performed for another reason.
Symptoms that may suggest endometriosis include:
The severity of pain does not necessarily correspond to the extent of the disease. Small lesions may cause severe symptoms, while extensive endometriosis may sometimes cause relatively few symptoms.
A consultation is recommended if period pain interferes with everyday activities, causes absence from work or education, or requires the regular use of painkillers.
Diagnostic assessment should also be considered if you experience pain during intercourse, bowel movements or urination, bowel symptoms that become worse during menstruation, or difficulty becoming pregnant.
Severe period pain should not automatically be considered a normal part of the menstrual cycle. An early consultation allows the doctor to plan appropriate investigations and treatment.
The diagnostic pathway should be tailored to the individual patient. It may include:
Laparoscopy is no longer required in every patient before endometriosis can be diagnosed or treated. In many cases, clinical decisions can be based on the patient’s symptoms, examination and appropriately performed ultrasound or MRI.
A normal ultrasound result does not exclude every form of endometriosis. Small superficial peritoneal lesions may not be visible on imaging. The result must always be considered together with the patient’s symptoms and clinical findings.
An expert endometriosis ultrasound scan is more comprehensive than a standard gynaecological ultrasound examination. Its purpose is not only to assess the uterus and ovaries but also to systematically search for and map endometriotic lesions in different areas of the pelvis.
During the examination, the doctor may assess:
At Tartaczna 2 Medical Centre, expert endometriosis ultrasound scans are performed by Dr Dominika Kozikowska. The examination is specifically focused on endometriosis, and identified lesions may be mapped and described using the #Enzian classification.
Dr Marek Korożan provides consultations, diagnosis and treatment for patients with endometriosis. The dedicated expert endometriosis ultrasound scan with #Enzian mapping is a separate examination performed by Dr Dominika Kozikowska.
#Enzian is a system used to describe the location and extent of endometriosis in a structured manner. It can be applied to diagnostic imaging as well as surgical findings.
A #Enzian description helps identify the pelvic areas affected by endometriosis, estimate the size of the lesions and improve communication between the gynaecologist, radiologist and surgical team. It is particularly useful in deep endometriosis and when planning possible surgical treatment.
Pelvic magnetic resonance imaging can complement an endometriosis ultrasound scan, particularly when ultrasound findings are inconclusive, the disease appears extensive or more detailed mapping is required before planned surgery.
MRI may be useful when deep endometriosis involving the bowel, urinary bladder, ureters or other areas that are difficult to assess is suspected. It may also be recommended when a complete transvaginal ultrasound examination cannot be performed or its scope is limited.
The scan should be performed using an MRI protocol designed for endometriosis and assessed by a radiologist experienced in imaging this condition.
The choice between expert ultrasound and MRI is made by the doctor based on the symptoms, previous results and planned treatment. The two examinations may complement one another.
A normal ultrasound or MRI result does not exclude superficial peritoneal endometriosis, as small lesions may remain invisible on imaging.
CA-125 may be elevated in some patients with endometriosis, but it is a non-specific marker. A normal result does not exclude the condition, while an elevated result may occur for many other reasons. CA-125 should therefore not be used on its own to confirm or exclude endometriosis.
In selected situations, the doctor may discuss an additional test such as the EndoRNA test for endometriosis. This is an adjunctive test, and its result should be interpreted together with the patient’s symptoms, clinical examination and imaging findings.
The EndoRNA test does not replace expert ultrasound or MRI and cannot determine the location, extent or stage of endometriotic lesions. The decision to perform this test should be made by a doctor after reviewing the complete clinical picture.
Endometriosis treatment is individually tailored according to the severity of symptoms, location of the lesions, the patient’s age, previous treatment and plans for pregnancy.
Painkillers and anti-inflammatory medicines may be used to relieve symptoms. The type of medicine and the way it is taken should be adjusted to the patient’s medical history and individual needs.
Hormonal treatment may reduce disease activity and relieve pain. Depending on the clinical indications, the doctor may consider combined hormonal contraceptives, progestogens, a levonorgestrel-releasing intrauterine system, or medicines affecting the gonadotrophin-releasing hormone pathway.
Hormonal treatment is not used to improve the chances of natural conception while the medication is being taken. Treatment selection should take account of the patient’s reproductive plans, contraindications and possible adverse effects.
Surgery may involve removing endometriotic lesions, endometriomas and adhesions. The extent of surgery depends on the location of the disease, the severity of the symptoms and the patient’s fertility plans.
When deep endometriosis involving the bowel, urinary bladder or ureters is suspected, accurate pre-operative mapping and treatment planning by an appropriately experienced team are particularly important.
Removal of the uterus is not a routine treatment for endometriosis and does not always resolve all symptoms, as endometriotic lesions may be present outside the uterus.
Endometriosis may affect fertility through adhesions, changes in pelvic anatomy, ovarian involvement or inflammation. However, a diagnosis of endometriosis does not mean that pregnancy is impossible.
Management depends on the patient’s age, ovarian reserve, tubal patency, extent of the disease, semen analysis results and the length of time the couple has been trying to conceive. Depending on the individual situation, the doctor may recommend further attempts at natural conception, surgical treatment or referral to a fertility clinic.
Endometriosis is a chronic condition. Treatment can effectively reduce symptoms, improve quality of life and limit the effect of the disease on fertility. However, symptoms may return in some patients after hormonal treatment is stopped or following surgery.
An individual management plan, appropriate follow-up and adjustment of treatment to the patient’s current symptoms and plans are therefore important.
If you have symptoms suggesting endometriosis, have already been diagnosed with the condition or need to discuss further treatment, you can book a consultation with Dr Marek Korożan or Dr Dominika Kozikowska.
Expert endometriosis ultrasound scans with #Enzian mapping are performed by Dr Dominika Kozikowska. Due to the specialist nature of the examination and high demand, we recommend booking in advance. Our reception team can provide information about the earliest available appointment and the possibility of joining the waiting list.
Book an appointment through our contact form or telephone reception service, or call +48 58 719 10 25.
Online booking through ZnanyLekarz:
See also: gynaecologist in Gdańsk – gynaecology and obstetrics.
