Endometriosis is a chronic, systemic and inflammatory disease that affects approximately one in ten women of reproductive age. Despite how common it is – more than 190 million women worldwide live with it, and around one million in Spain – it paradoxically remains one of the least understood conditions and one with the longest delays in diagnosis. For many women, it takes between 8 and 10 years to obtain an explanation for their symptoms, which has a profound impact on their physical, emotional, sexual and reproductive health.
The disease develops when tissue similar to the lining of the uterus grows outside it. It can implant in the pelvic cavity around the uterus, on the ovaries, on the uterine ligaments, on the bladder or in the bowel. Although it is in the wrong place, this tissue responds to the hormones of the menstrual cycle: it becomes inflamed and bleeds each month, but cannot be shed naturally, which causes pain and, over time, can lead to adhesions and affect the functioning of various organs.
The most common symptom is severe menstrual pain that many women learn to regard as “normal” from a very young age. This normalisation of pain is one of the main reasons the disease is not detected earlier. But endometriosis is not limited to discomfort during menstruation: it can cause pain at other points in the cycle, discomfort during sexual intercourse and pain when using the toilet. Many women live with chronic pain that affects their daily activities, work, rest and emotional wellbeing. Extreme fatigue, digestive discomfort and urinary problems are also common.
The impact on reproduction is one of the most significant aspects. Endometriosis is one of the leading causes of female infertility. It can damage the ovaries, reduce egg quality, alter the functioning of the fallopian tubes or hinder embryo implantation. For many women, the diagnosis only arrives when they try to conceive and encounter difficulties.
A further problem is that there is no simple test that allows for early diagnosis. There is no specific blood test and, in the early stages, lesions are not always visible on an ultrasound scan. By the time it is finally identified, the disease has often progressed, making it more complex to manage.
The exact cause of endometriosis is still unknown, although it is believed to involve a combination of genetic predisposition and immunological, hormonal and environmental factors. In recent years, research has explored the role of endocrine disruptors – found in plastics, cosmetics and processed foods – and their potential contribution to the development and progression of the disease. Increasing attention is also being paid to the relationship between diet, the gut microbiome and uterine health, an emerging line of research that could help to better understand the diversity of symptoms.
Although there is currently no cure, there are treatments that can significantly improve day-to-day life. Painkillers and hormonal treatments can reduce pain and slow the activity of the tissue growing outside the uterus. In selected cases, surgery allows for the removal of these lesions, especially when they cause very intense pain or compromise fertility. In addition, complementary approaches such as physiotherapy, psychological support, nutrition and stress management are proving useful in improving quality of life.
Research is essential to improve early detection, gain a better understanding of the causes of the disease and develop new therapeutic options. Three specialists take part in this debate, representing complementary and decisive approaches.
Francisco Carmona leads the ENDO-HEALTH project, which studies the health and social impact of delayed diagnosis. His team is developing a digital tool that will enable more efficient and personalised monitoring of patients without overburdening the healthcare system. They are also working with secondary schools to explain the disease to teenagers and reduce stigma and the normalisation of pain from an early age. This educational approach is key to preventing late diagnoses in the future.
María Luisa Sánchez-Ferrer is investigating biological markers that could help identify which women are at greater risk of developing more complex forms of the disease. She is also studying the impact of endometriosis on the physical and emotional wellbeing of those affected. Together with Pilar Coy, she is working on a new device to collect fluid from inside the uterus in a minimally invasive way that is less painful than a traditional biopsy – an advance that could enable earlier and more accurate diagnoses.
For his part, Juan Antonio García Velasco, an international reference in assisted reproduction, is studying how endometriosis affects fertility and is working on strategies to improve reproductive outcomes for these women. He is also researching therapeutic options that can reduce pain and manage the disease without resorting to unnecessary surgery.
Thanks to research like this, progress is being made towards earlier detection and more effective treatment. However, improving endometriosis care also requires a cultural shift: we must stop assuming that menstrual pain is normal, listen to patients, and place this disease on the public health agenda. Only then can we reduce the suffering and the impact that millions of women in Spain and around the world still endure.
Speakers:
-
Francisco Carmona, director of the Endometriosis Unit at Hospital Clínic de Barcelona (HCB) and senior lecturer at the Faculty of Medicine of the Universitat de Barcelona (UB).
-
María Luisa Sánchez-Ferrer, head of section of Obstetrics and Gynaecology at the Virgen de la Arrixaca Universal Clinical Hospital in Murcia (HUVA), principal investigator at the Murcian Institute for Biosanitary Research Pascual Parrilla (IMIB), and professor of Gynaecology at the University of Murcia (UM).
-
Juan García-Velasco, scientific director of IVIRMA Global, director of IVI Madrid, professor of Gynaecology at the Rey Juan Carlos University in Madrid (URJC), and member of the ”la Caixa” Foundation fellows’ community.
Moderator:
-
Raquel Bonilla, editor at A Tu Salud, the health supplement published by La Razón.
Projects with the support of ”la Caixa” Foundation:
