Endometriosis - Symptoms, Diagnosis & Treatment

Endometriosis is a long-term disease where tissue similar to the lining of your uterus grows outside of the womb. It can cause you to experience uncomfortable symptoms and can even interrupt your daily life.

It commonly affects women between the ages of 25 and 40, but it can also affect younger women who are in their teenage years. Most women with this condition find that they don’t suffer after the menopause.

Endometriosis is common, however, it can cause pain, disruptions to your menstrual cycle and fertility issues.

With treatment, you can effectively manage the symptoms of endometriosis.

Symptoms

The first symptoms of endometriosis usually start with pain during your period. You can often feel the pain in your lower back, pelvic area and abdomen. It is common to experience periods that are heavier than usual. You might also notice light bleeding between cycles.

People who have endometriosis experience:

• Extremely painful period cramps
• Abdominal pain or back pain during your period and in between periods
• Pain during sex
• Heavy bleeding during periods or light bleeding in between your periods
• Difficulty getting pregnant (infertility)
• Painful bowel movements

Some people might experience other symptoms such as diarrhoea, constipation, fatigue, bloating and nausea. These symptoms are more commonly experienced before or during your period.

Although the disease is quite common, not everyone with endometriosis will experience symptoms.

Causes

The exact reason why some people suffer from endometriosis is unclear, however, there are a few possible things that can cause it.

Retrograde menstruation

Retrograde menstruation occurs when the blood flows through the fallopian tubes and into the pelvic cavity instead of out of the body. The blood contains endometrial cells which can stick to the pelvic walls and surfaces of the pelvic organs.

The cells may grow and continue to get thicker. They might also bleed during each menstrual cycle.^[1]

Transformed peritoneal cells

Hormones or immune factors might help to transform cells that line the inside of the abdomen (peritoneal cells), into cells similar to those that line the inside of the uterus.

Embryonic cell changes

The oestrogen hormone might transform embryonic cells, which are cells at their earliest development stage, into endometrial-like cell growths during puberty.

Surgical scar complications

Endometrial cells might attach to scar tissue from a cut made during surgery in the stomach area. This can include a C-section, making it common for women to develop endometriosis after having a child.

Endometrial cell transport

Blood vessels or the tissue fluid system can move endometrial cells to other parts of the body.

Immune system conditions

If you have an issue with your immune system, this may mean that your body is unable to recognise and destroy the endometriosis tissue.

Diagnosis

If you think you have endometriosis the first thing you should do is visit your GP. You will be asked to describe your symptoms before they carry out tests. It is important that you make a note of your symptoms, including when you experience them.

You can also visit your doctor if you are worried about painful or irregular periods, or you are concerned about your fertility.

Pelvic exam

A pelvic exam might be carried out by your doctor where they check for any unusual changes. They will be looking for things such as cysts, painful spots or scars behind the uterus. Unless a cyst has formed, small areas of endometriosis can’t be felt.

Ultrasound

Ultrasound scans might be used to capture images inside your body. It will either be pressed against the stomach area or placed into the vagina. Both tests might be carried out as a standard ultrasound can’t confirm if you have endometriosis.

MRI scan

An MRI is another exam that takes images of the organs and tissues in your body. It will be able to give your healthcare provider information about the location and size of the endometriosis growth.

Laparoscopy

A laparoscopy allows for the inside of your abdomen to be checked for endometriosis tissue. Before the procedure, you are given a medication that makes you drowsy and prevents pain.

 

Treatment

There are many treatment routes for endometriosis, with medical and surgical options available to help you manage your condition. Everyone reacts to the treatment options differently, so it is important you talk to your doctor to help you find a treatment that works best for you.

Pain medication

You can try over-the-counter (OTC) pain medications such as ibuprofen to help ease the pain.

Hormone therapy

Sometimes, taking hormone supplements can relieve pain and stop the progression of endometriosis. Hormone therapy can help your body regulate the monthly hormonal changes that promote the tissue growth that happens with endometriosis.

Hormonal contraceptives

Hormonal contraceptives such as birth control pills, patches and vaginal rings can reduce and eliminate the pain in people with less severe endometriosis.

Gonadotropin-releasing hormone (GnRH) agonists and antagonists

Gonadotropin-releasing hormone (GnRH) agonists and antagonists block the production of oestrogen which stimulates the ovaries. Blocking the production of oestrogen prevents menstruation and creates an artificial menopause.

Danzanol

Danzanol is another medication that is used to stop menstruation and helps to reduce the symptoms of endometriosis.

Conservative surgery

Conservative surgery is used for people who want to get pregnant or have experienced severe pain when hormonal treatments haven’t worked. The surgery removes or destroys endometrial growths without damaging the reproductive organs.

Hysterectomy

A hysterectomy is usually used as a last resort when all other options have been exhausted. During a hysterectomy, the surgeon removes the uterus and the cervix. They also remove the ovaries to prevent the growth of endometrial-like tissue. ^[2]

Complications

Fertility problems

Sometimes, because of the damage to the fallopian tubes caused by endometriosis, some women will experience fertility problems. Not all women will experience these issues and some will be able to get pregnant without treatment.

Adhesions and ovarian cysts

Adhesions are sticky areas of endometriosis tissue that join organs together.

Ovarian cysts are filled with fluid. They can sometimes grow and become very large and painful.

You can get both of these if endometriosis tissue is on or near the ovaries. They can be treated with surgery, however, there is a chance that they will return if the endometriosis returns.

Complications from surgery

Complications from endometriosis surgery are not usually serious, but like with all operations they come with risks. Common complications include:

• A wound infection
• Minor bleeding
• Bruising around the wound

Other more serious risks might include:

• Damage to an organ
• Severe bleeding inside the stomach
• A blood clot in the leg (DVT) or a blood clot in the lungs (pulmonary embolism)

Bladder and bowel problems

Endometriosis that affects the bladder or bowel can be difficult to treat and often requires surgery.

Surgery that is around the bladder may involve cutting away part of the bladder.

You should be referred to a specialist if your bowel or bladder is affected.

Living with endometriosis

Endometriosis can be difficult to live with, both mentally and physically. It is important that you understand your disease so that you are able to live a full and healthy life.

If you are struggling to come to terms with your diagnosis, or you are finding it difficult to deal with, there is support available to help. Endometriosis UK has a helpline that can provide you with emotional support.