Endometriosis occurs when the endometrium (tissue lining of the uterus), grows outside of the uterus. These cells are responsive to the hormones that regulate your periods and bleed and leak fluid at the time of your period, causing inflammation and scarring in your pelvis, on organs such as your ovaries, fallopian tubes, peritoneum, and bowel. On your ovaries, a cyst called an endometrioma can form. Endometriosis is a progressive, chronic condition which is often painful and affects women’s quality of life.
What causes endometriosis?
The causes of endometriosis are not completely known, but may include:
- Retrograde menstruation – menstrual blood flowing backwards along the fallopian tubes into the pelvis, instead of out of the body as usual. This blood can contain cells from the endometrium, and they attach to surfaces of pelvic organs and start growing.
- Genetic factors – it is up to 10 times more likely to develop in women who have a close relative affected by the condition.
- Previous uterine surgery
Other possible risk factors include:
- Long, heavy or frequent periods
- Starting your period early
- Having your first pregnancy when you’re older
- Problems with the immune system
- Low body weight
- Alcohol use & high stress levels
Not every woman with endometriosis experiences symptoms, but they can include:
- Heavy periods or irregular bleeding
- Abdominal or pelvic pain before and during a period, when having sex or going to the toilet
- Bleeding from the bladder or bowel, or changes in urination or bowel movements
- Feeling bloated
- Being tired and moody, especially around the time of your period
- Difficulty falling pregnant (infertility).
The suspicion of endometriosis is raised on taking a history about your periods, pain or other symptoms, and performing a pelvic examination.
A vaginal ultrasound can help to detect large areas of endometriosis on your ovaries, bowel, bladder or ligaments. It can also help to detect scarring of tissues within your pelvis.
You may need to have a laparoscopy (keyhole surgery), which allows visualisation of endometriosis tissue in your abdomen, as well as surgical removal (resection) of the disease for histopathological diagnosis.
Treatment of endometriosis
Endometriosis can usually be treated with medications or surgery. Factors affecting the choice of treatment are:
- your symptoms
- the severity of your endometriosis
- whether you wish to become pregnant in the future
Medications include hormone-based treatment and pain relief. Hormone treatments can reduce pain and suppress the growth of endometriosis, but only as long as you take them, so the endometriosis may recur.
Surgical treatment aims to remove as much of the endometriosis as possible, and include laparoscopic (keyhole) surgery where a small cut is made in your abdomen to allow examination and removal of the endometrial tissue. Sometimes a laparotomy (incision on your abdomen) is required. Surgery may also be combined with medications.