Endometriosis is a chronic benign condition in which tissue similar to the endometrium, the lining of the uterus, is found outside the uterus. It most often affects the ovaries, fallopian tubes, pelvic ligaments and the peritoneum that covers the inside of the pelvis.
Endometriosis is common in women of reproductive age. It can cause pelvic pain, painful periods, pain during sexual intercourse and, in some women, difficulty getting pregnant.
In Lisbon, Dra. Joana Faria offers consultations for endometriosis in Portuguese, English, French, and Spanish. The aim is to listen to your symptoms, confirm the diagnosis and build a realistic plan for long term care.
This page focuses on endometriosis. For related topics you can also read the pages on reproductive tract diseases, adenomyosis, myomas and uterine polyps.
What it is
In a normal cycle, the endometrium grows inside the uterus and is shed during menstruation. In endometriosis, tissue similar to endometrium is found in places where it should not be, for example:
- On the ovaries, where it can form endometriotic cysts, often called chocolate cysts.
- On the pelvic ligaments and peritoneum, forming small implants or nodules.
- Between the uterus and the rectum, in the rectovaginal septum.
- More rarely, on other organs such as the bladder or bowel.
This tissue reacts to hormones during the cycle. It can bleed and cause inflammation in the surrounding area. Over time, this leads to irritation of nerves, formation of adhesions and, in some women, distortion of pelvic anatomy.
Endometriosis is benign. It is not a cancer. However, it is often painful and can have a strong impact on quality of life, sexuality and fertility.
Main symptoms and when to worry
Symptoms of endometriosis are very variable. Some women have important lesions and almost no pain. Others have severe pain with only subtle changes on imaging. The most frequent complaints are:
- Painful periods that require strong painkillers, limit daily activities or cause missed work or school.
- Pelvic pain that starts a few days before menstruation and improves after it ends.
- Pain during sexual intercourse, especially with deep penetration.
- Pain when passing stool or urinating during menstruation.
- Chronic pelvic pain, even outside the period.
- Difficulty getting pregnant or infertility that has no other clear explanation.
You should consider booking a consultation if:
- You need to plan your month around pain and bleeding.
- Simple painkillers taken correctly are not enough most cycles.
- You avoid or fear sexual intercourse because of pain.
- You have been trying to conceive for more than a year without success, or for six months if you are older than 35.
You should seek urgent care if you have sudden intense pelvic pain, pain with fever and strong malaise, or very heavy bleeding with dizziness or fainting. These signs can indicate an emergency such as a ruptured cyst or infection and should be evaluated quickly.
Diagnosis: exams and what to expect
There is no single blood test that confirms endometriosis. The diagnosis is based on your symptoms, a careful clinical examination and high quality imaging. In some cases, laparoscopy confirms the diagnosis and allows treatment at the same time.
During the evaluation, you can expect:
- Clinical history
Detailed discussion of your menstrual cycle, pain, digestion, urinary symptoms, sexual life, previous surgeries and fertility plans. - Gynecologic examination
Assessment of the vulva, vagina and cervix and bimanual palpation of the uterus and ovaries. The doctor also palpates the pelvic ligaments and the space between the vagina and the rectum to look for tender areas or nodules. - Transvaginal pelvic ultrasound
Key exam to detect ovarian endometriotic cysts and to look for deep lesions in the pelvis. When performed by an experienced examiner, ultrasound provides important information to guide treatment. - Pelvic MRI
In selected cases, MRI adds detail about the location and extent of deep endometriosis, especially when bowel or bladder involvement is suspected. - Laparoscopy
Minimally invasive surgery that allows direct visualisation of endometriotic lesions inside the abdomen. It is usually reserved for women who need surgical treatment or when the diagnosis is uncertain after non invasive exams.
Endometriosis often coexists with other conditions such as adenomyosis and fibroids. Dra. Joana Faria will explain which findings are most likely to be linked to your symptoms and how this influences your treatment options.
Treatment options and realistic expectations
Endometriosis is usually a long term condition. The goal of treatment is not only to correct lesions but to improve quality of life, protect fertility when possible and allow you to live in a way that is compatible with your plans.
Main strategies include:
- Hormonal treatment
Continuous or cyclical hormonal contraception, progestins and other hormonal medicines reduce or stop menstruation. This often decreases pain and slows the progression of lesions. These treatments are less invasive than surgery, but they can have side effects and may not be suitable for all women. - Non hormonal pain management
Painkillers, anti inflammatory medicines and other supportive strategies remain important, even when hormonal or surgical treatments are used. - Surgical treatment
Laparoscopic surgery can remove or destroy endometriotic implants and release adhesions. It may improve pain and fertility in selected women. Surgery is more invasive and has risks, so it is planned carefully and usually performed in specialised centres. - Combined approach
Many women benefit from a combination of treatments over time. For example, surgery followed by hormonal therapy to keep symptoms under control and reduce the risk of recurrence.
Realistic expectations are essential. There is no single cure that works forever. Symptoms may improve a lot but they can come back, especially if hormonal treatment is stopped. The aim is to find a plan that gives you the best possible balance between relief of symptoms, protection of fertility and side effects.
How Dra. Joana Faria approaches endometriosis in practice
Dra. Joana Faria knows that endometriosis is much more than a painful period. It can influence studies, work, relationships, sexuality and future family plans. Her approach is centred on your story and your priorities.
In daily practice she:
- Listens without minimising your pain or attributing it automatically to stress.
- Reviews previous ultrasounds, MRI images and surgical reports with you whenever possible.
- Explains clearly the benefits and limits of hormonal treatment and surgery in your situation.
- Works in close collaboration with pelvic pain, fertility and surgery teams when needed.
- Builds a step by step plan that can be adjusted if your symptoms or life projects change.
The aim is for you to feel understood and supported, with a clear strategy instead of feeling alone with a chronic disease that no one takes seriously.
