Endometriosis is a common condition in which small pieces of the lining of the womb (the endometrium) are found outside the womb. This could be in the fallopian tubes, ovaries, bladder, bowel, vagina or rectum.
Endometriosis commonly causes pain in the lower abdomen (tummy), pelvis or lower back. It may also lead to fertility problems. However, some women have few or no symptoms.
The exact cause of endometriosis is not clear however, hormone levels seem to be a feature.
The endometriosis cells behave in the same way as those within the womb, so every month they grow during the menstrual cycle and are shed as a bleed.
Normally prior to a period, the endometrium thickens in preparation for a fertilised egg in response to a release of the hormone oestrogen. When pregnancy does not occur, the lining breaks down and leaves the body during the period.
Endometriosis tissue anywhere in the body will go through the same process of thickening and shedding however, it has no way of leaving the body. This leads to pain, swelling and sometimes damage to the fallopian tubes or ovaries, resulting in fertility problems.
Symptoms of endometriosis can vary and some women have no symptoms at all, while others have severe pain. The most common symptom is pelvic pain, not unlike period pain.
Other symptoms of endometriosis include:
- Chronic pelvic pain - a chronic illness is one that lasts a long time, sometimes for the rest of the affected person's life. The term chronic refers to time, not how serious the condition is
- Dyspareunia - pain during intercourse
- Changed periods, such as a small loss of blood before the period is due (spotting), irregular bleeding or heavy periods
- Painful bowel movements
Endometriosis on the bowel may cause swelling of the lower abdomen, pain during bowel movement or blood in the faeces during a period. Endometriosis on the bladder can cause pain when urinating or blood in the urine during a period. Symptoms of endometriosis usually disappear following the menopause.
No one knows for certain what causes endometriosis or why some women experience it and others don't. Endometriosis can affect any woman of childbearing age.
You're more likely to develop endometriosis if you:
- Have a mother or sister who has endometriosis
- Start your periods early
- Have frequent, heavy or painful periods
- Have difficulty conceiving
- Go through the menopause late
How is endometriosis diagnosed?
Your consultant will ask you about your symptoms, medical history and examine you. He/she may also wish to perform a vaginal examination. The only way to be sure that you have endometriosis is to have a laparoscopy.
A laparoscopy is a procedure that allows the consultant to look inside the abdomen. The procedure involves passing a narrow, flexible, tube-like telescopic camera (a laparoscope) into the abdomen through a small cut and the consultant will examine the organs in your pelvis by looking at pictures sent to a monitor.
This diagnostic procedure takes approximately 30 minutes and is usually undertaken as a day case under general anaesthesia.
The tissue of mild or moderate endometriosis can sometimes be removed at the same time, which may prolong the procedure. If the consultant finds severe endometriosis, he or she may remove a small piece of the endometrial tissue for testing in a laboratory to confirm that it is endometriosis and not cancer.
Currently, there is no cure for endometriosis however; treatments are available for managing the symptoms and aim to:
- Relieve the pain and heavy bleeding
- Shrink or slow the growth of the endometrial tissue on other organs
- Improve fertility
Drugs used to treat endometriosis do not improve fertility however; surgery can help if the endometriosis is interfering with the normal workings of the womb and ovaries.
Some women with endometriosis who want to have children may need fertility treatment and the type of treatment will depend on age, the severity of the symptoms and whether or not the patient wishes to have children.
Over-the-counter medicines, such as ibuprofen can be taken.
Hormonal medicines that reduce the amount of oestrogen in the body will reduce the size of the endometriosis and should ease the symptoms. Examples include:
- Gonadotrophin-releasing hormone (GnRH) analogues (eg buserelin)
- Progestogens (eg norethisterone)
- Androgens (eg danazol)
The combined oral contraceptive pill can also be used.
These hormonal treatments all have different side effects.
Treatment with medication will not cure endometriosis and symptoms usually return when women stop taking them.
The aim of surgery is to remove as much of the endometriosis as possible while still enabling the patient to go n to have children. Surgery may be require if:
- The patient has severe pain and isn't responding to painkillers or hormonal medicines
- The patient wishes to have children but is having trouble conceiving
- Examination showed that the endometriosis is larger than 4 to 5cm (1.5 to 2 inches)
- The endometriosis is interfering with the normal workings of organs such as the bowel
The endometriosis may be cut away or destroyed with heat from an electric current or a laser (endometrial ablation). This is usually performed with a laparoscopy in which the consultant will make small cuts in the abdomen and then use a laparoscope to view the inside of the pelvis and remove the endometriosis. This is also referred to as keyhole surgery.
There is a possibility that the consultant may need to convert to open surgery and this is only done if it is impossible to complete the operation safely using the keyhole technique.
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