What exactly is endometriosis?

What exactly is endometriosis?

Endometriosis occurs when tissue similar to the inner lining of the womb (endometrium) is found elsewhere, usually in the pelvis around the womb ovaries and fallopian tubes.

Endometriosis can sometimes be a difficult condition to diagnose. It is a chronic condition that can affect your physical, sexual, psychological, and social wellbeing

Treatment options include pain-relieving medications, hormones, and/or surgery.

It is a very common condition, affecting around 1 in 10 women. You are more likely to develop endometriosis if your mother or sister has had it. Endometriosis usually affects women during their reproductive years. It can be a long-term condition that can have a significant impact on your general physical health, emotional well-being, and daily routine.

What are the symptoms?

Common symptoms include pelvic pain and painful, sometimes irregular or heavy periods. It can cause pain during or after sex and can lead to fertility problems. You may also have pain related to your bowels, bladder, lower back, or the tops of your legs, and experience long-term fatigue. Some women with endometriosis do not have any symptoms.

Endometriosis can cause pain that occurs in a regular pattern, becoming worse before and during your period. Some women experience pain all the time but for others, it may come and go.

What causes endometriosis?

The exact cause of endometriosis is not known but it is hormone-dependent. This means that, just like the endometrium which response to hormonal changes resulting in a period, the endometrial-like tissue located outside the womb also bleeds. This bleeding can cause pain, inflammation, and scarring, and can damage your pelvic organs.

Endometriosis may be found: on the ovaries, where it can form cysts (often referred to as endometriomas or ‘chocolate cysts)in the peritoneum (the lining of the pelvis and abdomen)in or on the fallopian tubes on, behind, or around the womb in the area between the vagina and the rectum.

Endometriosis can also occur within the muscle wall of the womb (adenomyosis) and occasionally on the bowel and/or bladder. It may sometimes be found in other parts of the body, but this is rare.

How is it diagnosed?

Endometriosis can be a difficult condition to diagnose. This is because the symptoms of endometriosis vary so much that the symptoms are common and can be similar to the pain caused by other conditions such as irritable bowel syndrome (IBS) or pelvic inflammatory disease (PID

What will happen if I see a healthcare professional? 

You should be asked: about any pain you have and whether it has a pattern or is related to anything, in particular, you should be asked about your periods – are they painful and how heavy are they? whether you have any pain or discomfort during sex. You could be asked about problems with your bowels or urinary symptoms at the time of your period, about any difficulty you may have experienced getting pregnant if you have one or more of the above symptoms.

Your Gynaecologist may carry out an internal examination with your consent. This helps to localize the pelvic pain and the doctor can feel for any lumps or tender areas. You will be offered a chaperone during this examination. You will be able to discuss any concerns and you will have an opportunity to ask other questions. from a good Doctor. Insist on answers and don't be afraid to ask questions. it's your body and you need to know. 

Your Doctor may offer further tests, for example, an ultrasound scan, and start treatment to help your symptoms. If your symptoms do not improve with the treatment offered or if you are unable to tolerate the treatment your Doctor will refer you for further tests and treatment.

What tests might I be offered? 

Tests usually include a pelvic ultrasound scan. This may be a transvaginal scan to check the uterus and ovaries. It may show whether there is an endometriotic (also known as a ‘chocolate’) cyst in the ovaries or may suggest endometriosis between the vagina and rectum. You may be offered a laparoscopy, which is the only way to get a definite diagnosis. This is carried out under a general anaesthetic. Small cuts are made in your abdomen and a telescope is inserted to look at your pelvis. You may have a biopsy to confirm the diagnosis and images may be taken for your medical records.

Your healthcare professional may suggest treating the endometriosis at the time of your first laparoscopy, either by removing cysts on the ovaries or treating any areas on the lining of your pelvis. This may avoid a second operation. Sometimes, however, the extent of endometriosis found means that you may need further tests or treatment.

The procedure, including any risks and the benefits, will be discussed with you. After your operation you be will be told the results. You can often go home the same day after a laparoscopy. An MRI scan may be suggested if the condition appears to be advanced.

Pain-relieving medication

There are several different medications to help relieve your pain. These can range from over-the-counter remedies to prescribed medications from your healthcare professional. In more severe situations, you may be referred to a specialist pain management team.

Hormone treatments

These treatments reduce or stop ovulation (the release of an egg from the ovary) and therefore allow the endometriosis to shrink by decreasing hormonal stimulation.

Some hormone treatments that may be offered are contraceptives and will also stop you from becoming pregnant. 

Other hormonal treatments are available but these are not contraceptives. Therefore, if you do not want to become pregnant, you will need to use a contraceptive as well. Non-contraceptive hormone treatments include:

Fertility treatment

Getting pregnant can be a problem for some women with endometriosis. Hormonal treatment is not advisable when you are trying to conceive and surgical treatment may be more appropriate. Your healthcare professional should provide you with information about your options and arrange a timely referral to a fertility specialist if appropriate.

Many things can be done so don't give up.

Complementary therapies

Although there is only limited evidence for their effectiveness, some women may find the following therapies help to reduce pain and improve their quality of life:

reflexology

transcutaneous electrical nerve stimulation (TENS)

acupuncture

vitamin B1 and magnesium supplements

traditional Chinese medicine

herbal treatments

homeopathy.

and many more.

I hope this helps and guides you to better health

Carole Astin

Medical Professional, Content Writer, Health blogger & Founder member of Qatar Expat Women

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