What is Endometriosis?
Endometriosis is a condition that results in endometrial tissue, which is normally only found inside the uterus, growing in other parts of the body.
This tissue typically appears in the pelvic area, such as the ovaries or fallopian tubes. In some cases, it can also grow in other distant regions of the body. (1)
Endometriosis impacts upon the lives of 11 percent of women, which equates to approximately six and a half million aged between 15 to 44. It’s also a condition which can make falling pregnant much tougher. (2)
Apart from during pregnancy, illness or menopause, the average woman has a menstrual period every month.
Blood and tissue from the uterus sheds and expels through the vagina. This cycle occurs roughly every 28 days. (3)
With endometriosis, the tissue growing outside of the uterus behaves in the same manner. Endometrial cells build up, break down and bleed on a monthly basis.
Unlike a regular period, the blood from this process cannot leave the body. This means the affected areas become inflamed and over time it leads to scarring. (4)
There are various theories as to why this disorder happens, for example, genetic predisposition. However, the definitive cause of endometriosis still remains unknown. (5)
Symptoms of endometriosis can include one or more of the following: (6)
Pelvic pain is a key symptom of endometriosis. It describes discomfort which occurs in your lower abdomen, lower back, or both. Pain can range from mild to extreme.
Severe Menstrual Cramps
Menstrual cramps can be painful and uncomfortable. However, cramping which is severe enough to prevent you from going about your day to day activities could be a sign of endometriosis.
Endometriosis can result in very heavy bleeding during your period. This type of bleeding can require frequent changes of sanitaryware.
Occasionally you may also bleed through your clothing. Heavy menstrual bleeding can be debilitating, lead to embarrassing situations and interfere with your quality of life.
Painful Sexual Intercourse
Pain that manifests during sex can be a symptom of endometriosis. You may also experience pain after sex.
Bleeding Between Periods
If you are bleeding in between your menstrual periods, you might have endometriosis. Bleeding can be light (spotting) or heavy, depending on the individual. (7)
Endometriosis is staged according to the extent endometrial tissue has spread beyond the uterus. These are referred to as endometrial implants.
Other variables for staging include size, depth and amount of implants. The stages of endometriosis do not necessarily correlate to pain level or risk of infertility.
Similarly, symptoms of the condition can manifest differently depending on the woman. The stages of endometriosis progress as follows: (8)
No endometrial tissue is growing outside your uterus.
Endometriosis at this stage is minimal. You likely have no more than a few endometrial implants.
Existing implants are shallow rather than deep.
The condition is now classed as mild. Endometrial implants are beginning to multiply, and are slightly deeper.
Moderate endometriosis is identified by the presence of numerous implants that are deep.
The endometrial tissue may be growing in one or both of your ovaries. This can cause endometriomas (cysts in the ovaries).
Adhesions, which are a type of internal scar tissue, have begun to form. At this stage, it is still thin or translucent rather than dense.
Stage 4 endometriosis is severe. Endometrial implants are multiple and deep rooted.
One or both ovaries may be affected by large endometriomas. Adhesions have also multiplied and grown dense.
These thick adhesions can cause organs to stick to each other. For example, the back of the uterus may merge upon the rectum.
If you suspect you have symptoms of endometriosis, it is important to consult your doctor, preferably a gynecologist.
Your doctor will perform a physical examination and review your symptoms. You may receive a transvaginal ultrasound. This entails inserting a probe into your vagina to examine your reproductive organs.
However, the only definite method to establish the disorder is through a laparoscopy. This is classed as a minor surgical procedure.
Two incisions will be made in your abdomen next to your belly button. An instrument with a camera called a laparoscope is then inserted into the cuts.
If endometrial tissue is spotted growing in an area deemed as unusual, your doctor will collect a tissue sample. This will then be examined in a laboratory to confirm or rule out endometriosis. (9)
There is no cure for this condition, which means treatment is focussed on helping patients control symptoms: (10)
Non Steroidal Anti Inflammatory Drugs (NSAIDs)
NSAIDs are drugs that work to reduce inflammation and pain. Most NSAIDs are available over the counter, with minimal side effects.
These forms of medication can help you manage the pain of endometriosis.
Birth Control Pills
Birth control pills are a type of hormonal contraceptive. They may contain either progestin (progesterone substitute) or estrogen.
These pills can contribute towards regulating periods and reducing lengthy, heavy flows. This contraceptive may also alleviate pain as a result of the condition.
However, if you stop taking birth control pills, your symptoms will return. For this reason, numerous women with endometriosis take oral contraceptives indefinitely.
Gonadotropin Releasing Hormone Agonists (GnRH Agonists)
GnRH agonists are a type of hormonal therapy. They block the production of the hormones responsible for menstruation and ovulation. In turn, this prevents endometrial tissue from growing.
These drugs are taken in the form of an injection or a type of nasal spray.
This treatment is not prescribed for any longer than six months. If treatment is repeated, a break of several months is required.
Essentially, gnRH agonists put your body into a state of menopause. Side effects can include hot flashes, vaginal dryness and weight gain.
Progesterone and Progestin
Injections, intrauterine devices (IUDs), and pills containing progesterone or progestin can relieve symptoms.
Progestin and progesterone serve as a type of contraceptive. They reduce the frequency of menstrual periods or stop them completely.
IUDs containing progestin can help to decrease the size of endometrial implants. Both of these hormones may result in weight gain, depression or irregular bleeding.
Danazol blocks hormones related to your menstrual cycle. This drug significantly reduces the frequency of your period and can stop it entirely.
It has more disruptive side effects than other forms of treatment. These can include weight gain, fatigue, muscle cramps, and hot flashes.
Danazol does not prevent pregnancy, but can cause harm to a fetus in the womb. Therefore, it is recommended to use non-hormonal contraceptives, such as condoms for the duration of treatment.
Laparoscopy can be used as both a diagnostic tool and a treatment for endometriosis. It is typically recommended for women with deep endometrial implants to alleviate pain.
The aim of laparoscopic surgery is to preserve healthy tissue while removing any adhesions or endometrial implants.
A laparoscope is inserted into your abdomen through small incisions. This instrument allows the surgeon to examine endometrial implants in closer detail.
These implants are then removed in one of two possible ways. The first method is excision. Endometrial implants are simply cut out of affected areas.
The second type of removal involves destroying implants with high heat. Blood vessels are instantly cauterized (sealed) as a result of the heat, meaning no stitches are needed.
A laparotomy is a major surgical procedure. It is often a last resort for treating endometriosis when all other methods have failed.
This surgery involves removing endometrial implants that may not be visible with a laparoscope.
Your fallopian tubes and ovaries may be removed if they are severely damaged by endometriosis. Similarly, your uterus might also have to be removed in what is referred to as a hysterectomy.
Despite the severity of this form of treatment, endometrial implants may recur. However, removing uterus, ovaries and fallopian tubes causes irreversible infertility.
What is endometriosis? Endometriosis is a disorder in which endometrial tissue grows in areas of the body outside of the uterus.
What are the signs of endometriosis? The signs of endometriosis include pelvic pain, heavy menstruation, severe menstrual cramps and pain during sexual intercourse. You might also bleed between your periods.
How do you develop endometriosis? The cause of endometriosis is not fully understood. Genetics may play a role in your likelihood of developing the condition.
How are you diagnosed for endometriosis? Your doctor will review your symptoms. Endometriosis can only be reliably diagnosed through a laparoscopy.
What is the best treatment for endometriosis? Treatments can include NSAIDs, birth control pills or gonadotropin releasing hormone agonists. Progesterone, progestin and danazol may also be used. Surgery can also be an option for more severe cases.
What are the long term complications of endometriosis? Endometriosis can cause damage to your ovaries or fallopian tubes. This can result in fertility issues. (11)
Is endometriosis considered a disability? If your doctor can provide evidence your symptoms are severe enough to prevent you from working, you may be eligible. (12)
Is there any cure for endometriosis? There is no cure for endometriosis. However, treatments exist to help manage symptoms. (13)
Is endometriosis life threatening? Endometriosis is not classed as a life threatening illness. However, it can increase your risk of certain cancers, such as ovarian cancer. (14)
It can be tricky to diagnose endometriosis as symptoms are deemed non-specific. This means many other conditions can result in similar symptoms.
Additionally, signs of the disorder can differ dramatically depending on the individual. However, if you suspect endometriosis, it’s best to record your symptoms before visiting your doctor. (15)