Endometriosis
What is endometriosis?
Endometriosis (commonly shortened to ‘endo’) is a condition where tissue similar to that which lines the uterus (womb) grows outside of the uterus, particularly in the pelvic area.
The presence of this tissue (known as endometrial tissue) in other parts of the body can lead to several painful symptoms and sometimes cause infertility. Around 10% of women of reproductive age are affected by this condition. Endometriosis is a condition that needs to be diagnosed by a doctor. While it doesn’t get better by itself, there are several approaches to treatment that can help.
Where is endometriosis found?
The uterine lining (endometrium) is the layer of tissue that is shed each month when a woman has her period, and where an embryo implants when she becomes pregnant. When this tissue grows outside the womb, it’s known as endometriosis, which is most commonly found:
on the ovaries or fallopian tubes
in the lining of your abdominal cavity (peritoneum)
on the outside of your uterus and its ligaments
Less commonly, endometriosis can also be found:
between your rectum and uterus
on your bowel
on your bladder
in abdominal surgery scars
on organs outside the pelvic area, although this is very rare
What causes endometriosis?
The exact cause of endometriosis is still unknown. However, there are a number of factors that can increase your risk of developing the condition. These include:
Family history
Undetectable menstruation abnormalities
Other
Family history
Family history — Women with a close relative who also has endometriosis are up to 7-10 times more likely to develop the condition themselves.
Undetectable menstruation abnormalities
Retrograde (backwards) menstruation — This is when the menstrual flow moves in the wrong direction. Blood may flow out of the vagina, as well as backwards along the fallopian tubes and into the pelvic cavity. In 90% of cases, this causes no issues, as the body breaks down or absorbs this blood. However, in around 10% of women, this tissue which contains endometrial cells begins to grow outside the uterus.
Metaplasia — This is when one type of normal adult cell changes into another type of normal cell. In the case of endometriosis, normal pelvic tissue is replaced by endometrial tissue.
Other
There are other factors which have been associated with an increased risk of endometriosis, which include:
never giving birth
having a first pregnancy at an older age
getting your first period before 11 years of age
heavy bleeding during periods and periods that last more than five days
having shorter regular period cycles (less than 27 days)
going through menopause at an older age
a low body weight
What are the signs and symptoms of endometriosis?
The most common symptom of endometriosis is pain. The severity of the pain is related to the location of the endometriosis, rather than the severity of the disease. Symptoms of endometriosis may include:
period pain which is not relieved by pain medication
pain before, during or after your period
pain when ovulating
pain during sex, or when going to the toilet
severe abdominal or pelvic pain
lower back or leg pain
pain that gets worse over time
pelvic pain that prevents you from going to work, school or playing sports
heavy bleeding during your period which may contain blood clots
bleeding or spotting between periods, or after sex
blood in the urine
the need to urinate more frequently, or having trouble holding on when your bladder is full
blood in your stools (poo)
changes in bowel habits
symptoms that resemble irritable bowel syndrome (IBS) such as constipation, diarrhoea and bloating
lethargy or feeling faint
mood swings and irritability
depression and anxiety
fertility problems
How is endometriosis diagnosed?
Getting a diagnosis of endometriosis is not easy and can take a long time due to the large number of symptoms that need to be investigated. On average, it takes around seven years from first symptoms to a diagnosis.
The only way to accurately diagnose endometriosis is via a laparoscopy — a surgical procedure done under a general anaesthetic.
During a laparoscopy a telescopic tube with a light on it (laparoscope) is inserted into the abdomen through a small cut made in your belly button. The laparoscope allows your doctor to see if there is any endometrial tissue within your pelvis.
Endometriosis is often classified as different stages, which is based on how much endometriosis is present. These stages are:
Stage 1
Minimal (stage 1) — small endometrial patches, inflammation and mild adhesions (scarring)
Stage 2
Mild (stage 2) — many endometrial patches along with possible scarring between the uterus and the rectum
Stage 3
Moderate (stage 3) — symptoms of stage 1 and 2 plus scarring that involves the ovaries
Stage 4
Severe (stage 4) — symptoms of stages 1, 2 and 3 plus scarring to other organs like the bladder and bowel, and changes to the shape of the pelvic organs
How is endometriosis treated?
At present, the aim of treatment is to manage symptoms. Treatment is designed to reduce pain and improve fertility. The standard line of treatments are:
Pain relief medication
Hormonal treatments
Surgery
Pain relief medication
Pain relief medication — Over-the-counter (OTC) pain medications such as paracetamol, and non-steroidal anti-inflammatories (NSAIDs) may be used.
Hormonal treatments
Hormonal treatments — Hormonal treatments such as the contraceptive pill, an implant, injection or intrauterine device (IUD) may be used to suppress the growth of endometrial cells and bleeding.
Surgery
Surgery — Surgery is designed to remove as many patches of endometriosis as possible along with any nodules, cysts, and adhesions. This may reduce pain and may improve fertility. The most common surgical option is a laparoscopy. It is possible for endometriosis to grow back even after surgery.9In severe or recurrent cases that don’t respond with other treatment or a laparoscopy, a hysterectomy may be recommended.
Complications of endometriosis
The biggest complication associated with endometriosis is infertility. Around 30% of women with the condition have difficulty conceiving naturally. Some women may need the assistance of IVF to have a baby.
When to see a doctor
If you’re experiencing any of the symptoms of endometriosis, you should visit your doctor, especially if you want to fall pregnant. Diagnosing your condition can take time so the sooner you see your doctor, the sooner you can receive treatment. It may also be possible that your symptoms are related to something other than endometriosis, so it’s important to receive the right diagnosis to ensure appropriate treatment.
What else can you do?
While there is no cure for endometriosis, there are some complementary therapies and lifestyle measures that some women find helpful in managing and living with endometriosis. However, more scientific studies are required to support claims of their effectiveness in reducing symptoms or improving fertility. Other things you can try include:
Chinese medicine techniques, including acupuncture to reduce pain
herbal preparations to reduce inflammation and pain
Omega-3 and fish oil supplements to reduce inflammation
magnesium supplements
taking vitamin Bs and B6
using heat packs to relieve pain
regular exercise
getting enough sleep
eating a healthy diet
stress management and relaxation techniques
Your local MediADVICE pharmacist is available to help you manage your health and we can recommend a range of products to assist with the symptoms of endometriosis. Speak to your MediADVICE pharmacist about your symptoms so we can recommend products and medications that may be suitable for you.
Visit your local MediADVICE today.
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