Deep infiltrating endometriosis (DIE) is a chronic and progressive disease that affects the female reproductive system. It arises when cells similar to the inner lining of the uterus settle outside the uterus, especially in deep pelvic structures such as the bladder, the rectum, the posterior vaginal wall and the bowel. Despite this serious picture, the disease is usually diagnosed late. The main reason is that the symptoms are not specific and are frequently confused with other diseases.
Why Are the Symptoms Noticed Late?
1. Pain being treated as normal
Because severe menstrual cramps are common in society, they are usually accepted as normal. However, pain that regularly restricts daily life may point to an underlying pathological condition.
2. Symptoms being widespread and mixed
DIE can show itself with many different symptoms such as severe pelvic pain during menstruation, pain during sexual intercourse (dyspareunia), pain when urinating or during bowel movements, constipation, abdominal bloating and infertility. These symptoms can be confused with irritable bowel syndrome, urinary tract infections or musculoskeletal diseases.
3. The diagnostic process being long and complex
Deep infiltrating endometriosis cannot always be detected with a routine gynaecological examination and standard ultrasonography. Diagnosis most often requires special imaging methods (specialised pelvic MRI, rectal ultrasonography) and a specialist experienced in this field.
4. Lack of awareness
A lack of sufficient awareness about endometriosis among both patients and some health professionals can delay the diagnosis. This in turn leads to progression of the disease and to a fall in quality of life.
In Which Situations Should You Be Suspicious?
An evaluation for deep infiltrating endometriosis is recommended in the following situations:
- Severe, persistent pelvic pain during menstruation
- Pain during or after sexual intercourse
- Difficulty and pain when passing stool or urine that coincides with the menstrual period
- Chronic constipation, bloating, changes in bowel habits
- Long-standing infertility
Deep infiltrating endometriosis is a manageable disease when it is diagnosed early. However, a delay in diagnosis can lead both to progression of the disease and to a more complex treatment process. For this reason, when suspicious symptoms are present, it is very important to consult a specialist experienced in endometriosis.