What exactly is Endometriosis?

Do you find yourself curled up in bed with severe period pain, popping painkillers nearly every month Quick to YouTube? Something could be wrong! Endometriosis is one of the causes of severe period pain … but what exactly is it?

What is endometriosis?

  • The endometrium is the tissue that lines the inner cavity of the uterus (womb)
  • Endometrial cells are shed every month during menstruation
  • Endometriosis occurs when the endometrium grows outside of the uterine cavity
  • It is a painful condition as these endometrial growths bleed in the same manner as the endometrial lining inside the uterus does every month during menstruation
  • Endometriosis is a non-cancerous (benign) condition

Where in the body can endometriosis occur?

  • Common sites: ovaries, fallopian tubes, the surface that lines the pelvis, the outer surface of the uterus, the outer surface of the intestines
  • Less common sites: bladder, vagina, cervix
  • Rare sites: previous surgical scars, on the liver, in or around the lungs or brain

How would I know if I could have endometriosis?

  • Severe pain during menstruation or ovulation
  • Lower back pain or pelvic pain
  • Deep pain during sexual intercourse
  • Infertility
  • Painful bowel movements and/or pain when urinating during menstruation
  • Diarrhoea, constipation, bloating or nausea during menstruation

Are some women more at risk of endometriosis than others?

  • Endometriosis is a condition affecting women in their reproductive years
  • It is rare in postmenopausal women
  • 1 in 10 women aged 25-34 years old are affected

Other risk factors

  • Never having given birth
  • Delaying falling pregnant to an older age
  • Early age at onset of menstruation
  • Late menopause
  • Genetic factors: if your mom or aunt has endometriosis
  • Tall, thin women with a low body mass index/BMI
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What causes endometriosis?

  • The cause is mostly unknown
  • Retrograde menstruation: this occurs when menstrual blood flows back through the fallopian tubes and into the pelvic cavity (instead of out of the body)
  • Direct transfer of endometrial tissue during surgery to other sites (i.e. surgical scars)
  • An altered immune system response
  • Coelomic metaplasia

How is endometriosis diagnosed?

  • Symptoms experienced by a patient may suggest the diagnosis.
  • Pelvic examination: may reveal scars behind the uterus, large cysts, however smaller areas of endometriosis may be harder to detect.
  • Ultrasound scan (sonar): may reveal ovarian cysts from endometriosis.
  • If a trial with medication (i.e. hormonal birth control or GnRH agonist) leads to an improvement in pain, endometriosis may be considered as a possible cause.
  • Laparoscopic surgery: this surgery allows the gynaecologist to look inside the pelvic area for endometriosis tissue/implants.
  • A tissue sample may need to be taken during a laparoscopy to confirm the diagnosis.

How is endometriosis treated?

No cure is available, but treatment is available to control and reduce symptoms

a. Medication

  • if not planning a pregnancy: hormonal birth control (extended or continuous cycle to either prevent menstruation or reduce the number of times per year of menstruation)
  • if planning a pregnancy: GnRH agonists
  • new agents: Visanne (made from a progesterone substance known as dienogest)

b. Surgery

  • considered when symptoms are severe, hormonal treatment fails or if there are fertility problems

c. Anti-inflammatory medication for pain relief

  • Pain-relief is available as over-the-counter medication from your local pharmacy. These shouldn’t be taken chronically, though, as it can cause dangerous side-effects

If you’re struggling with endometriosis, or just need some advice, why not chat to one of our doctors? They’d be happy to help.