Endometriosis

Understanding endometriosis

Endometriosis is a common gynaecological condition that only affects women of reproductive age. Endometriosis occurs when the endometrium (the uterine tissue that causes your period) grows outside the uterus. Some other common parts of the body that endometriosis can occur are the fallopian tubes, vagina, vulva, cervix, bladder, rectum, ovaries, the outer surface of the uterus and the pelvic cavity lining. Endometriosis may occur without symptoms, but is a common cause of severe period pain and interruptions to a normal sex life and fertility. Because the endometrial cells are sensitive to hormones, particularly oestrogen, they become inflamed and bleed every cycle in the same way normal period-producing cells do. This is extremely painful for many women.

The cause of endometriosis

It is not known what the exact cause of endometriosis is, however, there is research that suggests that it could be a genetic condition, a hormonal imbalance, an immune system defect or a result of complications of other surgeries.

Symptoms of endometriosis

There are many symptoms that are associated with endometriosis, however, not everyone will have visible or obvious symptoms. Those with mothers or sisters with endometriosis are at a higher risk of developing the condition. Symptoms include:

  • Pelvic pain
  • Infertility
  • Painful periods
  • One-sided pelvic pain
  • Sex-associated pain
  • Pain before periods and during ovulation
  • Pain that worsens towards the end of a period
  • Painful urination or bowel movements
  • Diarrhoea
  • Heavy or irregular bleeding
  • Painful cramping

Diagnosing endometriosis

For a diagnosis, your doctor will ask about your symptoms, general health and will perform a pelvic exam to feel for any scars or cysts that may be present. An ultrasound may also be used to help look for ovarian cysts as a possible cause of your symptoms.

An investigatory or diagnostic surgery such as a laparoscopy (very minimally invasive) may be performed in some cases. This means the pelvic floor can be visualised, the presence of endometrium can be assessed and a sample can be taken for analysis.

Treating endometriosis

There are treatment options available that can help minimise any pain and inflammation, as well as controlling heavy bleeding.

  • Pain medication
  • Hormone treatment
  • Surgery (including newer laser treatments)

Pain medication

Over-the-counter pain and anti-inflammatory medication may help relieve mild pain. Your doctor may prescribe you anti-inflammatory non-steroidal medication in cases of intense pain.

Hormone treatment

Hormone treatment may be recommended if there is mild pain and a small growth. Hormones can be taken in the form of shots, pills or nasal sprays. Birth control pills can also help decrease the amount of menstrual bleeding.

Surgeries

Surgery is an option for those who have endometriosis in multiple locations, fertility problems or severe pain. Surgery options include:

  • Laparoscopy – minimally invasive exploratory and surgical technique that allows growths and scars to be removed or cauterised without harming healthy tissue
  • Laparotomy or major abdominal surgery – a large incision in the abdomen allows the doctor to remove endometrial growths if required
  • Hysterectomy – This surgery involves the removal of the uterus and will only be done if there is severe damage that cannot be controlled in any other way and the patient does not wish to become pregnant

Who can get endometriosis?

Endometriosis only affects women who are in their menstruating years. These years are typically between the start of menstruation and menopause. Roughly one in ten women around the world are affected by this condition, and it may be underdiagnosed. A recent study found that it took an average of eight years for endometriosis to be diagnosed, which represents a very long period of often debilitating, undiagnosed pain and disruption to a woman’s life.

Is there a cure for endometriosis?

There is no cure for endometriosis, but symptoms and growths can be treated. It is possible for many women to manage their symptoms with a combination of long-term treatments. Menopause typically naturally ‘cures’ endometriosis, and pregnancy suspends symptoms for the duration of pregnancy and often into breastfeeding.

Can endometriosis be sexually transmitted?

Endometriosis cannot be transferred between people. The cause of endometriosis is not known, but it is not believed to be an infectious disease or an infection.

Can endometriosis be inherited?

Although the cause of endometriosis is not yet known, research has shown that women who have mothers or sister with endometriosis are at a higher risk of developing it.

Will endometriosis stop me from having children?

Endometriosis will not necessarily stop you having children. Roughly 30-40 per cent of women with endometriosis will have trouble conceiving, however, 60-70 per cent will have no problem at all.

You should discuss your symptoms with your healthcare professional so they can help develop the best treatment plan for you if you wish to have children, since being on birth control pills for a long time can hinder your ability to get pregnant for some time after stopping hormonal birth control.

Will a hysterectomy cure my endometriosis?

As a last resort women may choose to have a hysterectomy. It is important that all endometriosis is removed at the same time if you choose to have a hysterectomy, or pain can continue.

Will pregnancy get rid of my endometriosis?

Some women find that pregnancy can reduce their pain symptoms, but this is not the case for everyone. Endometriosis tends to return after giving birth and breastfeeding has stopped.

Is endometriosis a form of cancer?

Endometriosis is not a form of cancer. The cysts are sometimes referred to as benign tumours by medical people, because they can behave similarly to tumours/cancer in specific, scientific ways, but it is not the same disease and you should not fear cancer. In some very rare cases, endometriosis implants can lead to cancer, but this is incredibly rare. Research into endometriosis and cancer risk is in progress.

Endometriosis quick facts

  • Endometriosis can be found on the ovaries, vagina, vulva, bladder, bowels and pelvic cavity
  • It can be found on the diaphragm and in the lungs in very rare cases
  • Endometriosis is estimated to affect one in ten women between the ages of 15 and 49
  • Endometriosis can start as early as some girls’ first period
  • There is no known cure for endometriosis
  • Endometriosis can be managed, but many treatments are not suitable for long-term use
  • Pregnancy can relieve certain symptoms, but is not a cure
  • A hysterectomy and removal of all of the disease may relieve symptoms but may not fully cure the endometriosis
  • There is no known cause for endometriosis but it is likely that a particular gene can predispose a woman to develop this disease
  • If a woman has a sister or mother that has endometriosis they are more at risk of developing it

If you have any pelvic symptoms, you should see your doctor. If you suspect your symptoms may be endometriosis-related, see your doctor for a clearer diagnosis and treatment plan, making sure to talk endometriosis over with them in detail.