What is endometriosis?

The endometrium is the tissue lining the inner cavity of the uterus (womb). Endometriosis is the presence of endometrial-like tissue located outside of the uterus. It was once thought to be the same as the endometrium shed each month as a period, however we now know that there are differences in these tissues.

This abnormal tissue contains endometrial glands and stroma, which secrete substances that irritate the surrounding tissues, causing them to bleed. The immune system responds to the release of these substances by releasing inflammatory proteins causing swelling and inflammation.

The disease itself and the body's own inflammatory response to the endometriosis can cause severe pelvic pain. Adhesions (scar tissue) can form over time and these adhesions can result in the pelvic organs sticking together and distorting the normal pelvic anatomy.

Endometriosis is one of the most commonly seen gynaecological diseases, yet is poorly understood by both medical professionals and patients alike. Despite having a similar incidence to asthma or diabetes, it remains largely unknown among the general public, and for many women, their diagnosis is delayed an average of nine years after the onset of symptoms.

It can be difficult to diagnose and for many women, their symptoms are often ignored or misdiagnosed. For those who do not have any painful symptoms, they may only learn they have the condition during investigations for infertility, as endometriosis is one of the leading causes of infertility.

What are the symptoms of endometriosis?

The most common symptom is severe pain before and during menstruation. This pain is much worse than ‘normal' menstrual cramps and is not relieved with basic pain medication. Extreme pain as part of your period is not normal and should be investigated.

Other symptoms can include:
-Pain at ovulation time (mid-cycle)
-Pain during or after sex or orgasm
-Painful bowel movements
-Painful urination
Cyclical bleeding from the rectum
-Cyclical blood in the urine (haematuria)
-Cyclical shoulder pain
-Fertility issues.

Other symptoms reported by some women include:
-Heavy menstrual bleeding or clotting
-Flu-like symptoms during menstruation
-Nausea, diarrhoea and/or constipation during menstruation.

What causes endometriosis?

While several theories have been suggested, researchers are not certain what causes endometriosis. It is likely that women are born with a finite amount of endometriosis and it is thought to have a strong genetic link. Those with a first degree relative with the condition, such as a mother or sister, have an increased risk of developing it.

Can endometriosis affect my chances of getting pregnant?

Endometriosis is one of the leading causes of infertility. However, it is estimated that up to 70% of women with the condition will conceive. Removing endometriosis and using assisted reproduction techniques can help.

How is endometriosis diagnosed?

If you think you may have endometriosis, you should consult your doctor, who may refer you to a gynaecologist for further investigation. The only way the condition can be diagnosed is by a laparoscopy. This procedure involves inserting a small tube into your body through a small incision in your abdomen, in order to view the endometrial tissue and take a sample for testing. The diagnosis is then confirmed by the laboratory.

Women are recommended to see a consultant who is experienced with this condition, as it can easily be missed during a laparoscopy.

How is endometriosis treated?

Excision (surgical technique to cut out the tissue) is the most successful form of treatment. It gives the surgeon the best opportunity to remove all of the disease on all planes.

Ovarian endometriosis (chocolate cysts) may be drained or carefully excised. If drained, the chance of recurrence is almost 100%).

Many women are offered medical (hormonal treatments) to manage their endometriosis. It is important to remember that these treatments can only treat the symptoms at best and cannot be used when trying to conceive.

Surgical excision of endometriosis offers the best chance of a pain free life and studies have shown that surgery (with removal of endometriotic lesions) can enhance the chance of spontaneous pregnancy in women with peritoneal endometriosis.

In women with ovarian endometrioma, surgery is one of the options to enhance the chance of spontaneous pregnancy.

There is no strong evidence that surgery improves spontaneous pregnancy rates in women with deep endometriosis.

There is no cure for endometriosis, only good management.

Where can I get more information/support?

The Endometriosis Association of Ireland is a self-help group in Ireland, aiming to give women an opportunity to share information and give support. Contact the Endometriosis Association at Tel: (01) 873 5702, Email: info@endo.ie or click on www.endo.ie.

Reviewed: July, 2019


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