Prognosis for endometriosis

Associated with the location of the endometrial implants:

• The rupture, sudden growth or twisting of an endometrioma may result in acute abdomen (it is characterized by symptoms and signs located in the abdominal cavity, mainly with pain) accompanied by a certain degree of peritoneal irritation and could require emergency surgery.
• Abnormal uterine bleeding (AUB) in the form of heavy menstrual bleeding (HMB) possibly requiring oral or intravenous iron therapy, or even a blood transfusion. This is more common in patients who also present adenomyosis.
• Exacerbations, pain crises requiring hospitalisation for intravenous management.
• Subocclusive intestinal symptoms due to endometrial implants located in the small intestine or ileocaecal valve, or large nodules in the rectum/sigmoid colon.

Associated with immediate intra/postoperative processes:

• Gastric and bladder emptying disorders, dyspareunia, sensory alterations in the lower limbs. These are all basically due to denervation processes/damage to the inferior hypogastric plexus which supplies nerves to the pelvis.
• Visceral damage due to the surgical complexity; ureteral lesions that require the ureter to be reimplanted in another location on the urinary bladder, bowel perforations, suture failure, recto/uretero-/vesico-vaginal fistulas.

Chronic complications essentially relate to the consequences of the chronic pelvic pain:

• In certain patients, intense and sustained pain caused by the endometriosis, although they do not have any active implants triggering it, develops into neuropathic pain which leads to the phenomenon of central sensitisation (an increase in neuronal excitability that not only activates the pain signal more easily but also amplifies it). Therefore, patients with chronic pelvic pain are often treated in conjunction with Pain Management Units.

Endometriosis is associated with a long-term increase in healthcare costs. Patients get used to visiting emergency services to control their pain and, in some cases, may require additional hospital stays to receive intravenous painkillers.