Posted: April 24th, 2023

Endometriosis Discussion

Endometriosis

Endometriosis is a condition in which cells that normally line your uterus (womb) appear in other parts of your body. These cells, like your womb lining, can build up and break away on a monthly basis. This results in painful inflammation of the surrounding tissues. It’s difficult to treat, but there are some options.

An illustration of the womb and its surrounding structures.
Concerning endometriosis
Endometriosis affects approximately one in every ten women of childbearing age. However, it may affect up to six out of ten women who have extremely painful periods. Endometriosis usually goes away after menopause.

During your menstrual cycle, the lining of your womb thickens in preparation for a fertilized egg. If you do not become pregnant, the lining of your womb breaks down, releasing menstrual blood (a period) into your body each month. Hormones in your body regulate this process.

Endometriosis is characterized by the presence of cells similar to those that line your womb (endometrial tissue) elsewhere in your body. During your menstrual cycle, this tissue thickens, breaks down, and bleeds. The broken down tissue and blood are slowly eliminated by your body, but while they are present, they can cause pain, swelling, and scarring.

Endometriosis typically affects the tissues within your pelvis. It is most common in and around the ovaries, the ligaments surrounding them, and between the womb and the rectum (back passage). Endometriosis on your fallopian tubes or ovaries can cause fertility problems. See our endometriosis and fertility FAQ for more information. Endometriosis can affect other parts of the body, including the lungs, but this is uncommon.

Endometriosis is not a type of cancer; you cannot catch it or spread it to others.

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Endometriosis symptoms
Pelvic pain is a common symptom of endometriosis, and it is usually worse just before and during your period. The pain may worsen over time, and it may not go away when you take over-the-counter pain relievers like ibuprofen.

Other common symptoms include:

Pain during heavy sex periods
extreme exhaustion difficulty becoming pregnant (conceiving)

Some women become depressed as a result of chronic pain.

There are some symptoms that are less common. When you have a bowel movement, endometriosis on your bowel can cause pain. During your period, you may also pass blood in your feces. When you pass urine, endometriosis on your bladder can cause pain. You may also notice blood in your urine.

All of these symptoms could be caused by something other than endometriosis. Consult your doctor if you experience any of these symptoms.

Endometriosis symptoms usually subside during pregnancy and improve or disappear after menopause.

Some women experience no symptoms. Endometriosis may be discovered only after tests for other conditions, such as infertility.

infographic depicting the first endometriosis symptom: painful or heavy periods

An infographic depicting an endometriosis symptom: fatigue

The second symptom of endometriosis is pain in the lower abdomen, as depicted in this infographic.

Painful sex is the third endometriosis symptom depicted in this infographic.

Endometriosis’s fourth most common symptom is infertility problems.

Infographic depicting the fifth endometriosis symptom: depression.
Endometriosis diagnosis
Your doctor will inquire about your symptoms. Don’t be afraid to tell them about your problems, such as pain during sex or seeing blood when going to the toilet. It is critical that they are aware of these.

Your doctor may recommend the following tests to you.

A rectal or vaginal examination.
An ultrasound scan is performed with a sensor placed in your vagina. This can aid in identifying other causes of your symptoms. Even if you have endometriosis, there is a chance that it will not detect it.

A vaginal examination involves your doctor gently feeling for any abnormalities in and around your womb with gloved, lubricated fingers. They will lightly press on your abdomen with their other hand (tummy).

Your doctor will perform a rectal examination by inserting a gloved, lubricated finger into your anus (back passage). These examinations should be uncomfortable but not painful. Inform your doctor if anything hurts. If you prefer, you can request that someone accompany you while your doctor performs these tests.

Your primary care physician may refer you to a gynaecologist (a doctor who specializes in women’s reproductive health) for additional testing.

Endometriosis can be difficult to diagnose because the symptoms are similar to those of other medical conditions. The only way for doctors to be certain is to perform a laparoscopy. You’ll be asleep because you’ll be under general anaesthesia. A laparoscope will be used by your gynecologist to look inside your abdomen. This is a narrow tube with an eyepiece that they insert through a small cut in your abdomen. They may take a small sample of tissue (biopsy) to examine under a microscope in the lab.

If your gynaecologist performs a laparoscopy to diagnose endometriosis, the endometriosis may be removed at the same time. They may also advise having surgery to remove it later. See our treatment section for more information.

Instead of having this procedure right away, your doctor may recommend trying other treatments first to see if they help.

A magnetic resonance imaging (MRI) scan may also be recommended. This can aid in the diagnosis of endometriosis that has spread deep within your pelvis or is affecting your bladder or bowel.

Endometriosis treatment
If you require treatment for your symptoms, the type of treatment you receive will be determined by the severity of your symptoms as well as your desire to become pregnant in the future.

A variety of treatments can help you manage your symptoms, but they are not always effective in the long run. Symptoms reappear in up to half of those who have been treated. If this occurs, you may opt for another course of medication or additional surgery.

Your doctor will go over all of your options with you and help you decide which treatment is best for you.

Pain relievers
To relieve pain and discomfort, your doctor will most likely recommend a nonsteroidal anti-inflammatory drug such as ibuprofen. These are available over-the-counter at your local pharmacy. An alternative is paracetamol. Read the patient information leaflet that comes with your medication at all times. If you have any questions, consult your pharmacist.

Hormone therapy
Hormone treatments can help to reduce endometriosis tissue and thus reduce pain. They are not appropriate for treating endometriosis in women who are trying to conceive.

Your doctor may recommend the combined oral contraceptive pill to you. This may be for a few months at first, but if it’s beneficial, you should be able to continue taking it.

If that does not help or does not suit you, your doctor may recommend another type of hormonal treatment. These are some examples:

Progestogens can be taken as tablets, as an injection every three months, or in an intrauterine system (‘coil’). Gonadotrophin-releasing hormone (GnRH) agonists can be taken as injections or as a nasal spray.

Each of these treatments has its own set of side effects, and there may be time limits on how long you can use them without taking a break. Your doctor can explain these to you and help you decide which treatment is best for you.

Surgery
Endometriosis can be removed surgically in some cases. If your endometriosis is interfering with your fertility, this can help you get pregnant while also reducing pain. You’ll be asleep during your endometriosis surgery because you’ll be sedated. Because endometriosis can reoccur after surgery, you may need to have it done again in the future.

Laparoscopy (keyhole surgery) (keyhole surgery)
A laparoscopy, which is a type of keyhole surgery, may be performed on you. Your gynaecologist examines your abdomen (tummy) by making a small incision and inserting a narrow tube with an eyepiece (laparoscope). They can see and remove or destroy endometriosis patches using a laparoscope.

Laparotomy (open surgery) (open surgery)
Keyhole surgery may not be appropriate if you have severe endometriosis. You may require a laparotomy, which involves making a larger cut in your abdomen, usually along the bikini line. Your gynecologist will explain the procedure to you and why it is the best option for you.

If you don’t want to have children in the future, your gynecologist may recommend a hysterectomy. This is a more extensive procedure that involves the removal of your womb and, in some cases, your ovaries. This procedure can also be performed via keyhole surgery.

If your ovaries are removed, you will most likely experience menopausal symptoms such as hot flushes. Your doctor may advise you to use hormone replacement therapy (HRT). Discuss the pros and cons of this type of surgery with your gynaecologist, and read our hysterectomy FAQ.

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Endometriosis causes
Doctors aren’t sure why people get endometriosis. There are numerous theories about how it develops. It’s most likely the result of a combination of factors. Your immune system or hormones, for example, could be involved. Endometriosis can also run in families; if your mother or sister has it, you’re more likely to get it.

Endometriosis complications
Endometriosis complications are listed below.

Scar tissue has the ability to attach to organs in your pelvis and abdomen (tummy). These scars, known as adhesions, can be painful. They may also cause a blockage in your bowel.
You might have trouble getting pregnant (reduced fertility). This affects up to half of all endometriosis patients.
Endometriosis raises your chances of developing ovarian cysts. These can rupture, resulting in pain and decreased fertility.

Endometriosis is neither a cancer nor a cause of cancer. Overall, the risk of all types of cancer is the same for women who do not have endometriosis. However, there is a statistically significant increase in the risk of ovarian cancer. In one study, two out of every 100 women who did not have endometriosis developed ovarian cancer, compared to three out of every 100 who did.

If you have any questions about endometriosis complications, speak with your GP or doctor.
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Concerning endometriosis
Endometriosis affects an estimated 176 million women worldwide, regardless of ethnicity or socioeconomic status. Many people go undiagnosed and thus untreated.
Endometriosis is a condition in which tissue similar to the uterine lining (endometrial stroma and glands, which should be found only inside the uterus) is found elsewhere in the body [1].

Endometriosis affects an estimated 10% of all women during their reproductive years (from the start of menstruation to menopause) [2]. This equates to 176 million women worldwide who must deal with endometriosis symptoms during their prime years of life [3].

Endometriosis locations
Endometriosis is commonly found in the following locations:

Endometriosis lesions can occur anywhere in the pelvic cavity, including:

within the ovaries
the fallopian tubes on the peritoneum of the pelvis, the uterosacral ligaments, the cul-de-sac, the Pouch of Douglas, and the rectal-vaginal septum
Endometriosis tumors
Lesions caused by endometriosis*

Endometriosis tumors
Lesions caused by endometriosis*

Furthermore, it can be found in:

Scars from caesarian section, laparoscopy/laparotomy, and surgery on the bladder, bowel, intestines, colon, appendix, and rectum
However, these are uncommon locations. Endometriosis has been discovered inside the vagina, inside the bladder, on the skin, in the lung, spine, and brain in extremely rare cases.

Endometriosis symptoms
Pelvic pain is the most common symptom of endometriosis.

The pain frequently corresponds to the menstrual cycle, but a woman with endometriosis may also experience pain that does not correspond to her cycle; this is what makes this disease/condition so unpredictable and frustrating.

Endometriosis pain is so severe and debilitating for many women that it has a significant impact on their lives.

Endometriosis can also result in the formation of scar tissue and adhesions, which can distort a woman’s internal anatomy. Internal organs may fuse together in advanced stages, resulting in a “frozen pelvis.” This is unusual, but it does occur.

Endometriosis is thought to prevent 30-40% of women from having children (if you suspect you suffer from infertility, please see our section on endometriosis and infertility).

If you or someone you care about has endometriosis, it is critical to conduct as much research as possible. Even in the medical literature review, many myths and misconceptions about endometriosis persist.

Management of this disease may be a long-term process for many women. As a result, it is critical to educate yourself, find a good doctor, and consider joining a local support group.

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