Endometriosis

Endotriosis

Endometriosis can cause painful periods, persistent pain in the pelvic area, infertility, and other symptoms. The symptoms can range from mild to severe. Treatment options include painkillers, hormone treatments, and surgery.

The endometrium is the tissue that lines the inside of the womb (uterus).

Endometriosis is a condition where endometrial tissue is found outside the uterus. It is ‘trapped’ in the pelvic area and lower tummy (abdomen) and, rarely, in other areas in the body.

The exact number of women who develop endometriosis is not known. This is because many women have endometriosis without symptoms, or with mild symptoms, and are never diagnosed.

Investigations to diagnose endometriosis are only done if symptoms become troublesome and are not eased by initial treatments (see below). Estimates vary so that from about 1 in 10 to as many as 5 in 10 of all women develop some degree of endometriosis.

If symptoms develop they typically begin between the ages of 25-40. Sometimes symptoms begin in the teenage years. Endometriosis can affect any woman. However:

  • Sometimes it runs in families. Therefore, endometriosis is more common in close blood relatives of affected women.
  • Endometriosis is rare in women past the menopause, as to develop endometriosis you need oestrogen, the female hormone. Oestrogen levels fall after the menopause.
  • The combined oral contraceptive pill (often called ‘the pill’) reduces the risk of developing endometriosis. This protective effect may persist for up to a year after stopping ‘the pill’.

There have been several theories over the years. One theory was that some cells from the womb (uterus) lining (the endometrium) get outside the uterus into the pelvic area. They get there by spilling backwards along the Fallopian tubes when you have a period.

Currently we do not know what causes endometriosis. Most experts agree that there are many responsible factors, possibly including genetic, immunological, and hormonal reasons.

Patches of endometriosis tend to be ‘sticky’ and may join organs to each other. The medical term for this is adhesions. For example, the bladder or bowel may ‘stick’ to the uterus. Large patches of endometriosis may form into cysts which bleed each month when you have a period. The cysts can fill with dark blood; this is known as ‘chocolate cysts’.

Patches of endometriosis can vary in size from the size of a pinhead to large clumps. Many women with endometriosis have no symptoms. If symptoms develop they can vary, and include those listed below.

In general, the bigger the patches of endometriosis, the worse the symptoms. However, this is not always the case. Some women have large patches of endometriosis with no symptoms. Some women have just a few spots of endometriosis, but have bad symptoms.

  • Painful periods. The pain typically begins a few days before the period and usually lasts the whole of the period. It is different to normal period pain which is usually not as severe, and doesn’t last as long.
  • Painful sex. The pain is typically felt deep inside, and may last a few hours after sex.
  • Pain in the lower tummy (abdomen) and pelvic area. Sometimes the pain is constant, but is usually worse on the days just before and during a period.
  • Other menstrual symptoms may occur. For example, bleeding in between periods.
  • Difficulty becoming pregnant (reduced fertility). This may be due to clumps of endometriosis blocking the passage of the egg from an ovary to the Fallopian tube. Sometimes, the reason for reduced fertility is not clear.
  • Other symptoms include pain on passing poo (faeces), pain in the lower abdomen when you pass urine, and, rarely, blood in the urine or faeces. Very rarely, patches of endometriosis occur in other sites of the body. This can cause unusual pains in parts of the body that occur at the same time as period pains.