Endometriosis
What is endometriosis?
Endometriosis is a condition in which endometrial tissue — the tissue that is found in the lining of the uterus (the endometrium) — grows in places outside the uterus. The migrant endometrial cells may stick to the ovaries or the ligaments that support the womb (uterus), or settle in the pouch of Douglas (the area between the uterus and the rectum).
These endometrial cells that have migrated out of the uterus are known as endometrial implants. The implants can also attach to the fallopian tubes, the vagina, the vulva, the bladder and the bowel. In rare cases, they may be found in the lungs, limbs, or in old surgical scars on the abdomen.
The endometrial implants respond to hormonal changes within the body in exactly the same way as the endometrial tissue that lines the uterus, which is the tissue that comes away every month as your period. So, every month the displaced endometrial tissue may bleed. However, blood from the displaced endometrial patches has no outlet to leave the body, so it causes inflammation and eventually leads to the formation of scar tissue. The scar tissue can form what are called ‘adhesions’ which are fibrous bands of tissue that connect internal structures and body organs that would normally be separate. These adhesions cause a lot of pain by pulling and distorting the internal organs and make some movements very painful, for example, having sex or going to the toilet.
Endometriosis affects up to 10 per cent of women, and is a common gynaecological condition.
What are the symptoms of endometriosis?
The severity of symptoms can vary from woman to woman. Some women experience debilitating pain and symptoms, while others remain unaware they even have the condition. Some symptoms may include:
- period pain (known as dysmenorrhoea);
- pelvic pain starting several days before a period;
- heavy or irregular menstrual bleeding, including ‘spotting’ and blood clots;
- pain during sexual intercourse (known as dyspareunia);
- pelvic pain during ovulation;
- pre-menstrual syndrome;
- lower back pain;
- diarrhoea or constipation, especially during a period;
- pain in the abdomen and pelvis area when you are not having a period;
- infertility, which occurs in 30-40 per cent of women with endometriosis; and
- rectal bleeding and pain during bowel movements.
Some women experience stress and anxiety as a result of knowing their monthly period will bring pain and discomfort.
What causes endometriosis?
The exact causes of endometriosis are not yet fully known. Some experts suggest that during a woman’s periods, instead of flowing out through the vagina, some endometrial cells and blood travel backwards up the fallopian tubes and spill into the pelvic cavity (this theory is called retrograde menstruation). The endometrial cells then seed themselves onto the surface of tissues or organs in the abdominal cavity and begin to grow. Some degree of retrograde menstruation is thought to occur in most women, but not all women develop endometriosis, so clearly other factors are at play.
What doctors do know is that the progression of endometriosis is influenced by hormones and growth factors. The immune system may also play a role.
Research is continuing into theories that endometriosis is influenced by delaying having children, as pregnancy tends to slow or stop the progress of endometriosis.
What you can do
Consult a doctor if your period pain is intense or persistent; there is pain in the pelvic area that worsens during your periods; you have excessive menstrual bleeding or clotting; or you experience pain when having sex.
What your doctor can do for you
Your doctor can rule out other disorders that may be giving you the same symptoms and they may refer you to a gynaecologist. A gynaecologist may perform a laparoscopy to make the diagnosis of endometriosis, as this is the only definitive way to diagnose it. A laparoscopy is a procedure to view the inside of the abdomen with a small fibre-optic tube. Under a general anaesthetic, the tube is inserted through a small hole near your navel and the gynaecologist can look for any endometrial implants, adhesions or cysts in your abdomen.
There is no real permanent cure for endometriosis, although many women experience some degree of relief from their symptoms following either hormonal or surgical treatment. Endometriosis rarely continues to be active after menopause, but (extremely rarely) hormone replacement therapy can cause a recurrence of symptoms.
Options available to treat and manage endometriosis may include the following.
- Regular visits to your doctor or gynaecologist to monitor the progression of the condition.
- Treating painful symptoms. This may involve the use of anti-inflammatory or painkilling medications.
- Hormonal medications. Several different types are used. These include: the combined (oestrogen and progesterone) oral contraceptive pill; progestogens such as norethisterone (e.g. Primolut) or medroxyprogesterone (e.g. Provera, Ralovera); medications that inhibit the body’s release of gonadotrophin releasing hormone (which stimulates oestrogen production), such as danazol (Azol) or gestrinone (Dimetriose); or medications that interfere with the way gonadotrophin releasing hormone works, such as goserelin (Zoladex) or nafarelin (Synarel).
- Surgery to remove implants, adhesions and cysts, and to repair any damage the disease has done. In extreme cases a hysterectomy is performed.
- Natural therapies. Some women find diet, herbal or homeopathic treatments or acupuncture helpful in the treatment of endometriosis.
- A combination of the different types of treatments available, for example, hormonal medications may be used before or after surgery.
Last Reviewed: 18 April 2009
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