What is Endometriosis?
Endometriosis is a condition where the cells which form the lining of the womb (the endometrium) exist outside the womb. They can be found growing in many different places, but most commonly on pelvic organs (uterus, tubes, ovaries, bowel, bladder) or the lining of the pelvis.
What Causes Endometriosis?
There are a number of different theories as to how endometriosis occurs. Endometrial cells may implant in the pelvis after flowing backwards out the fallopian tubes at the time of the menstrual period. Other theories include cells travelling through the blood stream or lymphatic system, or spontaneous transformation of the normal lining (peritoneum) covering the pelvic organs into endometrial tissue.
What are the symptoms of Endometriosis?
The symptoms are caused by the endometrial cells responding to the ovarian hormones like they normally would in the uterus. This means that if pregnancy does not occur, then bleeding occurs in the pelvis leading to pain and scarring over time.
Symptoms can range from minimal discomfort to severe and debilitating pain. The pain is most commonly worse around the time of the menstrual period, but can also occur between periods.
Depending on the location of the endometriotic deposits, there may be pain associated with opening the bowels, passing urine, or during intercourse.
The severity of symptoms and the amount of endometriosis aren’t necessarily related. Some women with only a small amount of endometriosis can have severe symptoms, and vice versa.
Are there any long term problems with Endometriosis?
Untreated endometriosis can cause chronic pain. The recurrent inflammation that occurs when the endometriotic deposits bleed can cause scarring and damage to pelvic organs like the fallopian tubes. Both the inflammation and the physical scarring can lead to difficulties in falling pregnant.
If endometriosis is present in the form of ovarian “chocolate cysts”, this can lead to pain associated with cyst complications (rupture, bleeding, twisting) along with complications of surgical management. If multiple surgeries are required for removal of these cysts, this can also lead to a reduction in fertility.
How is Endometriosis Diagnosed?
While endometriosis may be suspected on the basis of symptoms and some ultrasound scan findings, diagnosis still requires visualisation of the endometriosis at operation (usually keyhole surgery).
How is Endometriosis Treated?
A number of factors need to be taken into account when discussing a treatment plan for endometriosis, including desire for fertility and the severity of symptoms. It is important that an individualised treatment plan be developed for each woman in consultation with her doctor.
Medical treatment options include non-hormonal options (use of paracetamol or non-steroidal anti-inflammatory pain relief), hormonal treatments (combined pill, long acting progestins, progestin containing IUCD), and ovarian suppression (using medication to induce menopause so the endometriotic cells aren’t stimulated by ovarian hormones).
Surgical treatment involves the removal of the endometriosis, ideally via keyhole surgery. The extent of the surgery will depend on how widespread the endometriosis is, along with other factors such as the desire for future fertility. Even after surgery, some ongoing medical treatment may be required.
If fertility has been affected by endometriosis, even after surgery, a consulatation with a fertility specialist may be recommended to discuss the best options for falling pregnant. These options can range from stimulating ovulation with medicines through to IVF.
The above information doesn’t take the place of a medical consultation so please seek further advice if your symptoms continue to concern you.