What is Endometriosis?

Overview  |  Symptoms  |  Causes  |  Diagnosis  |  Treatment 

Endometriosis is a gynaecological condition. It occurs when the endometrial tissue (cells that would usually line your womb) are found growing outside of your uterus and attached to other parts of your body. The tissue is usually commonly be found in the lower abdomen and pelvic area, including the fallopian tubes and ovaries. Sometimes, the tissue can be found on other organs including your bladder, vagina, bowel and less commonly your lungs.

Symptoms of Endometriosis

There are various symptoms of endometriosis, but not every woman shows symptoms.  Generally, the larger the patches of endometriosis, the worse the symptoms get.

  • Painful periods: This is the most common symptom of endometriosis. The pain can be felt in the pelvic area but feels different to regular period pain. It usually begins several days before menstruation and lasts the whole duration.
  • Changes to period: You may find your period becoming irregular and/or get bleeding between periods. Also, women suffering from endometriosis sometimes find they have heavier periods. Spotting may also occur.
  • Pain during intercourse: Pain may occur during sex and sometimes can last for a few hours after.
  • Problems with fertility: Sometimes the endometrial tissue may cause a blockage.
  • Fatigue: Feeling more tired than usual.

If the endometrial tissue finds its way to other organs you may suffer from other symptoms including:

  • pain during bowel movements
  • pain when urinating
  • blood in the faeces or urine
  • pain may sometimes occur in other parts of the body during your period, for example, your lungs, if endometrial cells are attached there

** Contact your doctor if you have any of these symptoms **

Causes Endometriosis?

Endometrioses can affect any woman but what the exact cause remains unknown. However, there are numerous theories on what may cause it, including genetics and retrograde menstruation – which is when the endometrial tissue travels through the fallopian tube and sticks to the lining of the abdomen.

How is Endometriosis Diagnosed?

Unfortunately, endometriosis is difficult to diagnose due to the symptoms being similar to other conditions. It is likely that your doctor will refer you to a gynaecologist who will ask you about your symptoms and run the recommended tests – a pelvic exam and sometimes an ultrasound scan. While these tests may give your doctor an idea of what is happening in your body, a laparoscopy is the only test that will offer a confirmed diagnosis. A laparoscopy, carried out under general anaesthetic, is an operation in which a small incision is made to allow a viewing tube to examine whether there are patches of endometrial tissue present or not.

Treating Endometriosis

Unfortunately, there is no known cure for endometriosis. Treatment is aimed at easing symptoms and slowing down progression. There are many things to think about when considering your treatment options including, feelings about surgery, whether you want children and your age.  In some cases, your gynaecologist may advise you on going without treatment, this usually happens if you are nearing menopause or only have mild symptoms.

** In roughly 3 out of every 10 cases, endometriosis can improve without treatment. However in every 4 out of 10 cases it gets worse**

Pain Management

Paracetamol

Only really works if you suffer from mild pain.

Non-steroidal anti-inflammatories (NSAIDs)

NSAIDs like ibuprofen are considered to be better for pain management associated with endometriosis. The anti-inflammatory properties in these types of pills reduce swelling caused by inflammation, which in turn  helps to ease any pain or discomfort felt. Your doctor will usually advise you to take these a few days before your period begins.

Codeine

Sometimes codeine/ codeine with paracetamol may be offered as a stronger painkiller, however, codeine has many side-effects, including constipation.

Hormone Treatments

Your gynaecologist is likely to recommend hormone treatment if your symptoms are causing you a lot of discomfort. The purpose of hormone treatment is to reduce the production of estrogen (oestrogen in the UK) in your body as endometrial cells need it to survive. Without estrogen, the endometrial cells will begin to shrink and may even disappear. There are various types of hormone treatments available which your doctor will discuss with you such as:

A levonorgestrel-releasing intrauterine system (IUS) better known as the coil

The IUS is a small plastic device which contains progestogen. It is a contraceptive with of thinning the uterus lining. It is inserted into the uterus by a doctor or nurse and reduces bleeding, or in some case stops it completely. It is used to reduce symptoms and pain associated with endometriosis.  It can last up to five years and then it needs to be replaced.

The combined oral contraceptive pill/patch

While the pill is not a proven treatment of endometriosis, a lot of women find that it eases their symptoms, especially if they are mild. The combined pill containing both estrogen and progestogen stops ovulation and reduces bleeding and period-associated pain.

Gonadotrophin-releasing hormones (GnRH)

This treatment reduces the level of oestrogen produced in your ovaries which in turn eases the symptoms of endometriosis. This treatment can be taken as an injection or nasal spray. The treatment is usually a six-month course.

Progestogen

Like the other hormone treatments, progestogen limits the effect of estrogen on endometrial cells, causing them to gradually shrink. Also, by preventing ovulation, estrogen levels are also reduced.

Surgery

If you are suffering from severe endometriosis – large patches of endometrial tissue – surgery may be advised. There are several types of operations that can be used in the treatment of endometriosis. A laparoscopic (keyhole) approach may be taken, with direct heat being applied to the endometrial patches to destroy them. If the endometrial patches are too large, then a more traditional approach may be taken. A hysterectomy is also an option if symptoms are particularly bad and you have completed your family.