What is endometriosis?
The tissue, which lines your uterus (womb), is called the endometrium. As part of the menstrual cycle the endometrium grows and is shed, together with blood, during a period. Endometriosis occurs when fragments of endometrial tissue grow in places outside the uterus. This tissue may form cysts and lesions and grow on the ovaries, bladder, bowel, uterine surface and on other pelvic organs. In rare cases, endometrial deposits may be found outside the pelvic area. Endometrial deposits respond to the same hormones as the endometrium, i.e. they enlarge and can bleed and cause inflammation in the pelvis. It is common for scar tissue and adhesions to form. Endometriosis can affect women of all ages, including teenagers.It is not known what causes endometriosis, however there are several theories.
The most popular theory of retrograde menstrual flow (i.e. back flow of blood through the fallopian tubes and into the pelvic cavity) is now known to be outdated. Other possible theories suggest that in some women, remnants of a woman's own pre-natal tissue may develop into endometriosis, or that endometriosis may be an auto immune disorder and there may also be a genetic link.
Symptoms of endometriosis
The more classic symptoms are:
- mild/moderate/severe pain with periods
- painful intercourse
- subfertility or infertility
- bowel involvement, e.g. pain before defecation, painful wind, constipation, diarrhoea.
Other symptoms include:
- mild/moderate/severe pain with ovulation
- pain at other times
- abnormal menstrual bleeding
- pain before or with urination
- low energy level and constant tiredness
- depression and mood disturbances
- premenstrual Syndrome
- lower back pain.
If any symptoms regularly interfere with your lifestyle you may need a referral to a gynaecologist.
Cramping pain is the most common symptom. Pain can occur at any time during the menstrual cycle but it is usually associated with hormonal fluctuations especially at ovulation and period time. The pain does not necessarily reflect the extent or spread of the disease. Some women with only slight endometriosis can suffer excruciating pain, whilst others with more extensive disease can suffer little pain. It can be extremely severe, with some women liking it to labour pains. In severe cases, it can cause nausea, vomiting or blackouts. It generally occurs in the lower abdomen and can radiate down the legs, round into the lower back and through the vulva. Pain may be felt when having a bowel movement or passing wind. It is also common for women to complain of pain after having sexual intercourse or a vaginal examination. Passing urine can sometimes leave women with a dull ache.
Endometriosis can be difficult to diagnose, especially in the early stages. The only simple way to diagnose the disease is by a surgical procedure called a laparoscopy. This is done under a general anaesthetic by a specialist gynaecologist. This procedure involves a small incision (2cm) being made just below the navel. A lighted telescopic instrument called a laparoscope is inserted through the incision and the pelvic organs can be seen. During this procedure endometriosis lesions can be removed or organs, which have become stuck together or to the pelvic wall, can be separated.
As the cause of endometriosis is still not understood, treatment largely involves controlling or reducing the symptoms. Endometriosis varies a great deal from one woman to the next and so does its treatment. The most suitable treatment for you will depend on many factors, including:
- your age
- whether you plan to have children
- the severity of the symptoms
- the extent of endometriosis as seen at laparoscopy
- your preference.
Two kinds of medicines are available to treat endometriosis. One kind aims to reduce pain and/or inflammation. The other kind aims to suppress the growth of endometriosis by suppressing estrogen production or having a direct effect on the endometriosis itself. This hormone treatment can cause endometriosis tissue to shrink and possibly disappear. The Endometriosis Foundation has information sheets that explain how these drugs work and what the side effects may be.
Surgery is used to reduce symptoms and improve the chances of fertility. Endometrial implants, scar tissue and adhesions can be removed or released by heat, laser or aggressive excision (cutting out) at the time of laparoscopy or during an abdominal operation (laparotomy). This type of surgery can be combined with hormone drug treatment to shrink the endometrial tissue prior to or following surgery. More extensive surgery for severe endometriosis may be necessary. Laser surgery can also be performed. This is also done by laparoscopy. The laparoscope is fitted with a tiny video camera and a laser. The camera sends images to a video screen enabling the doctor to zoom in on the endometrial tissue, destroying it. This treatment is not suitable for all levels of endometriosis. Laser surgery is available at a few clinics but it is often too expensive for most women. Some private medical insurance schemes will cover laser surgery. Some women will require more invasive surgery. A hysterectomy is only done in severe cases of long-standing and extensive disease. Some women are also advised to have their ovaries removed and hormone replacement therapy may be recommended. Unfortunately reoccurrence of the disease after medical and surgical treatment is common. To find out about surgical and medical treatments which would be best suited to you, consult your gynaecologist.
Effects on women's lives
The effects of the disease on a woman can be serious and far-reaching. It can be distressing to live with a chronic condition like endometriosis. It can cause a great deal of anxiety if it results in a woman having fertility problems. Changing the diet can improve the symptoms of constipation, wind and bowel pain if the colon is involved. Some women find that their symptoms improve when they use complimentary therapies and remedies. The Endometriosis Foundation can provide more information on natural remedies if required.
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