What is Endometriosis?
Endometriosis is a condition where tissue similar to the lining of the uterus (the endometrial stroma and glands, which should only be located inside the uterus) is found elsewhere in the body.
Who can develop Endometriosis?
It is generally acknowledged that an estimated 10-15% of all women during their reproductive years (from the onset of menstruation to menopause) are affected by endometriosis.
How do I know if I have Endometriosis?
The most common symptom of endometriosis is pelvic pain. The pain often correlates to the menstrual cycle, however a woman with endometriosis may also experience pain at other times during her monthly cycle.
For many women, but not everyone, the pain of endometriosis can unfortunately be so severe and debilitating that it impacts on their life so much that they may not be able to carry out day to day activities.
Pain may be felt:
in the bowel during menstruation
when passing urine
during or after sexual intercourse
in the lower back region
Other symptoms may include:
diarrhoea or constipation (in particular in connection with menstruation)
abdominal bloating (in particular in connection with menstruation)
heavy or irregular bleeding
The other well known symptom associated with endometriosis is infertility. It is estimated that 30-40% of women with endometriosis are subfertile.
How does it cause pain?
Every month, while the endometrium within the uterus is growing and then shedding, the endometrial glands situated elsewhere also grow and bleed. This bleeding is not usual for the abdominal cavity and the tissue responds by scarring, contracting and often sticking to surrounding structures. These adhesions stop the normal movement of structures within the pelvis and can also affect nerves in underlying tissue, both causing acute pain. Furthermore, excess bleeding within the pelvis may irritate the lining causing discomfort.
Are there any signs?
The best way to check for endometriosis is by having your Gynaecologist observe your personal medical history and the results of a pelvic examination.
If the ovary is involved, such as with an ovarian cyst (endometrioma), this may show up on an ultrasound. The doctor will comment if the ovaries do not move freely or are tender when the probe pushes on them, suggesting endometriosis.
There is a significant diagnostic delay of endometriosis because symptoms of the disease are not easily recognised in primary care or even by women themselves.
Endometriosis can only be diagnosed via laparoscopy with “visual inspection” unless disease is visible in the vagina or elsewhere, today there is no simple test that can be used to diagnose endometriosis, which may be why there is a diagnostic delay of up to 12 years in some healthcare settings.
At present the only reliable way to definitively diagnose endometriosis is by performing a laparoscopy and to take a biopsy of the tissue. This is what is known as “the gold standard”.
How is it treated?
There is no known cure for endometriosis. But, there are treatments which can help relieve your symptoms and improve your quality of life.
The trick is to find the right solution for you! This means talking with the doctor about your symptoms, how they affect your daily life, and discussing whether you want to have children now or in the future.
The cause of endometriosis remains unknown, we do know that the disease is exacerbated by oestrogen. Therefore, hormonal treatments for endometriosis are designed to attempt to temper oestrogen production in a woman’s body. Hormonal therapy is used to suppress the menstrual period to prevent the monthly bleeding.
There are several types of medications that act by shrinking the lining of the uterus and the endometriotic lesions:
Laparoscopic surgery is the only definitive way to diagnose endometriosis, and in most cases the disease can be diagnosed and treated in the same procedure.