Endometriosis: everything you need to know

Advanced diagnosis and personalized treatment of endometriosis. International expertise, minimally invasive surgery and Da Vinci robotic surgery for optimal outcomes and fast recovery.

10%
of women
are affected
7-10
years to
diagnosis
190M
women affected
worldwide
Vice President European Endometriosis League
Coordinator, Endometriosis Center, Saarland University Medical Center
Advisory Board, German Endometriosis Society
Information

What is endometriosis?

Endometriosis is a chronic gynecologic condition in which tissue similar to the endometrium grows outside the uterine cavity. This tissue can be found on the ovaries, fallopian tubes, pelvic peritoneum, urinary bladder and bowel.

It affects about 10% of women of reproductive age worldwide, and is one of the most common causes of chronic pelvic pain and infertility.

Early diagnosis and treatment are essential. The sooner the condition is identified, the more effective treatment options become and the more your quality of life can improve.

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Dr. Alin Constantin - endometriosis specialist
Symptoms

Symptoms of endometriosis

Endometriosis presents differently from one woman to another. Recognizing the symptoms is the first step toward an accurate diagnosis.

Severe dysmenorrhea

Intense menstrual pain that does not respond to ordinary pain relievers and progressively worsens over time.

Chronic pelvic pain

Persistent pain in the pelvic area that can also appear outside of menstruation.

Dyspareunia

Pain during or after sexual intercourse, especially deep pain, is a common symptom.

Infertility

30–50% of women with endometriosis have difficulty conceiving.

Cyclical digestive symptoms

Bloating, constipation, diarrhea or abdominal pain that worsens during menstruation.

Cyclical urinary symptoms

Frequent urination, painful urination or blood in the urine during menstruation.

Chronic fatigue

Persistent exhaustion that affects your ability to carry out normal daily activities.

Abnormal bleeding

Heavy bleeding, prolonged periods or spotting between menstrual cycles.

Severe menstrual pain is NOT normal. If menstrual pain affects your quality of life, do not ignore it. An early diagnosis can make the difference.

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Causes

Causes and risk factors

The exact cause of endometriosis is not fully understood, but several factors contribute to the development of the condition.

Retrograde menstruation

Menstrual blood flows back through the fallopian tubes into the peritoneal cavity, where endometrial cells implant and grow. This is the most widely accepted theory.

Genetic factors

Women with first-degree relatives affected have a 5–7 times higher risk of developing endometriosis. Studies have identified multiple associated genetic variants.

Immunological factors

Dysfunctions of the immune system may allow endometrial tissue to survive and grow in abnormal locations without being cleared by the body.

Hormonal factors

Estrogen plays a central role in the development of endometriosis. Hormonal imbalances can stimulate the growth of ectopic endometrial tissue.

Known risk factors

  • Family history of endometriosis (mother, sister)
  • Early menarche (first period before age 12)
  • Short menstrual cycles (under 27 days)
  • Heavy, prolonged periods (over 7 days)
  • Nulliparity (no prior pregnancies)
  • Anomalies of the reproductive tract
Diagnosis

Diagnostic methods

An accurate diagnosis is fundamental to building the right treatment plan. We use the most advanced diagnostic methods available.

Specialized transvaginal ultrasound

Transvaginal ultrasound performed by an experienced specialist can identify ovarian endometriomas, deep endometriosis nodules and adhesions. The technique requires dedicated expertise.

Magnetic resonance imaging (MRI)

Pelvic MRI provides detailed images of the pelvic structures and can identify deep endometriosis lesions, especially those affecting the bowel, bladder or ureters.

Diagnostic laparoscopy

Laparoscopy allows direct visualization of endometriosis lesions and biopsy sampling for histological confirmation. It also allows treatment in the same session.

Gold standard
Treatment

Treatment options

The treatment plan is personalized based on symptom severity, extent of disease, fertility goals and your preferences.

Medical treatment

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) — for pain control and inflammation reduction in mild forms
  • Combined hormonal contraceptives — suppress ovulation and reduce the growth of ectopic endometrial tissue
  • Progestins — dienogest and other progestins reduce endometriosis lesions and improve symptoms
  • GnRH agonists — create a temporary medically induced menopause to shrink lesions
  • Combined therapy — a multidisciplinary approach for complex cases, including pain management

Surgical treatment

  • Complete laparoscopic excision — removal of all endometriosis lesions while preserving reproductive organs
  • Da Vinci robotic surgery — maximum precision in complex cases, with accelerated recovery
  • Deep endometriosis surgery — specialized procedures for lesions affecting the bowel, bladder or ureters
  • Reproductive surgery — restoration of pelvic anatomy and improvement of fertility
  • Multidisciplinary approach — collaboration with colorectal and urologic surgeons for extensive cases
Technology

Da Vinci robotic surgery

The Da Vinci robotic system is the most advanced surgical technology available, offering significant advantages in the treatment of complex endometriosis.

3D visualization

High-definition three-dimensional imaging with up to 10x magnification for precise identification of all lesions.

7 degrees of freedom

Articulated instruments exceed the dexterity of the human hand, allowing precise maneuvers in narrow anatomical spaces.

Tremor elimination

The system fully filters the natural tremor of the surgeon's hands, ensuring precise movements.

Superior precision

The precision of the robotic instruments allows meticulous tissue dissection while protecting healthy structures.

Minimal blood loss

Precise hemostasis and careful tissue handling significantly reduce intraoperative blood loss.

Accelerated recovery

Minimal incisions, reduced postoperative pain and fast return to normal daily activities.

Dr. Alin Constantin - endometriosis specialist
Your specialist
Endometriosis is not just about pain. It is about years of unanswered questions, of misunderstanding, of a life put on hold. My mission is to offer every patient a clear diagnosis and a treatment plan that gives back their quality of life.
Dr. Alin Constantin Obstetrics and gynecology specialist
Vice President, European Endometriosis League
Coordinator, Endometriosis Center, Saarland University
Da Vinci robotic surgery — Monza Hospital, Bucharest
Surgical training in Germany (Frankfurt, Hamburg)
After treatment

Post-treatment recommendations

Recovery after endometriosis treatment requires attention and adherence to medical recommendations for optimal long-term results.

1

Rest and gradual recovery

Follow the rest period recommended by your doctor. Return to daily activities should be gradual, depending on the type of procedure.

2

Maintenance hormonal therapy

If postoperative hormonal therapy is prescribed, follow the schedule to help prevent recurrence and maintain surgical results.

3

Regular follow-up visits

Schedule the recommended follow-up appointments. Periodic monitoring allows early detection of any recurrence.

4

Balanced lifestyle

An anti-inflammatory diet, regular moderate exercise and stress management help reduce symptoms and prevent recurrence.

5

Psychological support

Endometriosis can affect emotional health. Do not hesitate to seek psychological support if you feel the need. Support groups can help.

6

Open communication with your doctor

Report any new or persistent symptoms. Open communication allows the treatment plan to be adjusted for the best results.

Frequently asked questions

Questions and answers about endometriosis

Answers to the most common questions patients ask about endometriosis.

Endometriosis is a chronic condition that cannot be fully cured, but it can be effectively managed. Complete excision surgery can remove existing lesions and provide significant long-term relief. Maintenance hormonal therapy can help prevent recurrence. A multidisciplinary approach — combining surgery with medical therapy and lifestyle changes — offers the best results.
Recovery after laparoscopic surgery for endometriosis generally takes 1–2 weeks for light activities and 4–6 weeks for full return to normal activities. With Da Vinci robotic surgery, recovery can be even faster thanks to superior precision and minimal blood loss. Every case is individual, and your doctor will provide personalized recommendations based on the complexity of the procedure.
Yes, endometriosis is one of the most common causes of female infertility, affecting 30–50% of women with the condition. Endometriosis can affect fertility through adhesions that distort pelvic anatomy, ovarian involvement (endometriomas), changes in the pelvic environment and fallopian tube dysfunction. The good news is that surgical excision treatment can significantly improve the chances of natural conception or of conception through assisted reproductive techniques.
Endometriosis pain differs in several important ways: it is progressive (worsening over time, from one cycle to the next), does not respond adequately to ordinary pain relievers, may occur outside of menstruation, is frequently associated with other symptoms (pain during intercourse, cyclical digestive symptoms, fatigue) and significantly affects quality of life. Ordinary dysmenorrhea is usually constant in intensity and responds well to anti-inflammatories. If you feel the pain is worsening, it is important to see a specialist.
Endometriosis can appear at any age after puberty, but it is most commonly diagnosed between 25 and 40 years old. Symptoms can start in adolescence, and a delayed diagnosis of 7–10 years is unfortunately common. That is why early evaluation of severe menstrual pain is essential, even in young patients. Menopause does not necessarily mean the disease disappears, although symptoms usually improve.
Dr. Alin Constantin at Healing Mama Africa - endometriosis advocacy event
International advocacy

Endometriosis has no borders. Neither does our expertise.

Dr. Alin Constantin is co-founder of EndoScanAfrica and the Pan African Society of Endometriosis. He brings European expertise in the diagnosis and treatment of endometriosis to communities across Africa.

This global perspective and commitment to advocacy translate into more empathetic consultations and more personalized treatment for every patient in Romania.

"Endometriosis does not mean infertility. With an accurate diagnosis and personalized treatment, most patients can conceive and live without pain."
— Dr. Alin Constantin
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Complete guide

Want to learn EVERYTHING about endometriosis?

We have written a comprehensive guide (over 4,000 words) that covers everything: 2026 definition, causes, the four types of endometriosis, symptoms, modern diagnosis (IDEA protocol), all treatment options, pregnancy and 10 myths debunked.

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