Endometriosis
Estrogen-dependent inflammatory disorder where endometrial-like tissue grows outside the uterus. Causes painful periods, pelvic pain, deep dyspareunia, and infertility in 30–50% of affected women.
What it is
Endometriosis is a chronic, estrogen-dependent inflammatory condition in which endometrial-like glands and stroma implant on pelvic peritoneum, ovaries, fallopian tubes, bowel, bladder and — rarely — distant sites. Each menstrual cycle the implants bleed locally, triggering inflammation, scarring and adhesions. Prevalence is 6–10% of women of reproductive age; 30–50% of women with infertility have endometriosis. Diagnosis is often delayed 7–10 years because cyclical pelvic pain is normalised; the gold standard is laparoscopic visualisation with histology, though MRI and transvaginal ultrasound detect ovarian endometriomas reliably.
Key lab markers
- CA-125 — modestly raised in moderate-severe disease; not specific (also raised in pregnancy, fibroids, ovarian cancer); useful for monitoring known disease.
- CRP, ESR — non-specific inflammatory markers; mild elevation common.
- Haemoglobin, ferritin — low if heavy menstrual bleeding causes iron deficiency.
- AMH — may be low if ovarian endometriomas have damaged ovarian reserve.
- Pelvic ultrasound or MRI — primary diagnostic imaging.
Symptoms
- Dysmenorrhoea (severe period pain disproportionate to cycle)
- Chronic pelvic pain outside of menses
- Deep dyspareunia (pain with intercourse)
- Dyschezia (pain with defecation, especially during menses)
- Cyclical bowel / urinary symptoms (bloating, diarrhoea, urgency)
- Infertility (often the presenting complaint)
- Heavy menstrual bleeding (menorrhagia)
When to discuss with a doctor
Cyclical pelvic pain that disrupts work, school or relationships warrants gynaecology referral — endometriosis is grossly underdiagnosed because the pain is often dismissed as 'normal'. First-line treatment is hormonal suppression (continuous COCP, progestins, GnRH agonists) ± NSAIDs; surgery (laparoscopic excision) is reserved for refractory pain or fertility goals. Mediora.AI flags the (low ferritin + low haemoglobin + raised CA-125) pattern; the diagnosis itself requires imaging + specialist.