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Endometriosis occurs when tissues similar to the lining of the womb grow in other places, including the ovaries and the fallopian tubes. Endometriosis can affect women from puberty to menopause but is mostly found in women of child-bearing age.
The hormonal changes of a woman’s menstrual cycle can affect the misplaced tissue, causing that area to often become inflamed and painful. Over time the tissues will grow, thicken, break down and bleed. That broken down tissue has nowhere to go and becomes trapped in the pelvis. This can cause painful irritation, scar formation and fertility problems.
The cause of endometriosis is still currently unknown. However, there are a few theories that may offer an explanation.
1. Retrograde menstruation
This is when a woman’s menstrual flow moves in the wrong direction. It moves towards the fallopian tube and into the pelvic cavity instead of through the cervix and out the vagina. Retrograde menstruation is common amongst those that have periods. It is often marked by extremely heavy periods and intense abdominal cramping in the lower back and pelvis.
2. Genetic predisposition
Some recent research has suggested that endometriosis can be genetic, being passed down between family members. A recent study examined participants and found that 6% of the participants with endometriosis were found to have a first-degree relative who also had the condition. This was compared to 3% who did not have a first-degree relative with endometriosis.
3. Immune dysfunction
In some cases, a woman’s immune system is unable to fight endometriosis. Research has shown that women who have been diagnosed with endometriosis also have reduced immunity to other conditions.
Symptoms of endometriosis can vary greatly from woman to woman. Some women can experience relatively mild symptoms, and others more severe. It is important to note that some women do not experience any symptoms. The most common symptom of endometriosis is pelvic pain. You may also experience the following symptoms:
It can be difficult to diagnose endometriosis. If you experience any of the above symptoms, we recommend you book an appointment with your GP. They will typically ask you to describe your symptoms and where any pain is occurring. Tests for detecting endometriosis include:
1. A pelvic exam
Your GP will examine your pelvis for abnormalities such as cysts or uterine scarring. However, this is not always the most effective way to obtain a diagnosis. More often than not, you will be referred for a scan or a laparoscopy.
2. Ultrasound or an MRI scan
These scans can help to identify cysts associated with endometriosis and in some cases, give a surgeon detailed information about the location and size of endometrial implants.
3. Laparoscopy
In some cases, your GP may refer you for a surgical procedure that allows a surgeon to view inside your abdomen where they can look for signs of endometrial tissue present outside the uterus. Often, with proper surgical planning, a surgeon can fully treat existing endometriosis adhesions during the laparoscopy.
Your gynaecologist will discuss treatment options and plans for you and outline the risks and benefits of each. Here are a few of the options available to you:
Pain medication
Anti-inflammatories (NSAID’s) and analgesics such as ibuprofen and paracetamol can be used to help manage pain.
Hormone treatment
Hormone treatment works to limit or stop the production of oestrogen in your body as that encourages endometriosis to grow and shed. Options include the combined oral contraceptive pill or progestogens including the contraceptive injection, implant and intrauterine system (IUS).
Surgery
As discussed above, you may be referred by your GP for a laparoscopy (keyhole surgery) where small incisions are made in your stomach so endometriosis tissue can be destroyed and removed. It’s important to note that all types or surgery carry a risk of complication and as endometriosis is a lifelong condition, symptoms may recur after surgery.
Fertility is one of the most common concerns of women with endometriosis. Endometriosis does not cause infertility; however, it may be more difficult for a woman to become pregnant if she has endometriosis.
The Royal College of Obstetricians and Gynaecologists (RCOG) estimates that between 60-70% of women with endometriosis can conceive naturally.
Due to lack of research, the links between fertility and endometriosis are not fully known.
Check out these resources on endometriosis for further information:
Endometriosis UK - https://www.endometriosis-uk.org/
NHS guidance - https://www.nhs.uk/conditions/endometriosis/
Pain UK - https://painuk.org/members/charities/endometriosis-uk/
