What is endometriosis?

Endometriosis is a chronic, progressive, oestrogen-dependent inflammatory disease, estimated to affect 11% of women. It is defined as the presence of endometrial-like cells outside the womb (uterus). The most common areas in which endometriosis is found are the on the uterus, fallopian tubes and ovaries.  Endometriosis is also frequently found in non-genital areas such as the bowel, bladder and ureters (tubes that connect the kidneys to the bladder). It is also known to affect the diaphragm, lungs, and many other organs and locations.

Endometriosis commonly goes undiagnosed or is misdiagnosed and it typically takes 6 to 10 years from the time a woman experiences her first symptoms to the time she receives a diagnosis.

What are the symptoms of endometriosis?

The most common symptom of endometriosis is pelvic pain, that can range from mild to debilitating. The pain most frequently occurs around the time of your period (menstruation) but depending on where the disease is located in your body, pain can occur anytime throughout the month.

Some women also report pain during sex, when passing stool or during urination.  Endometriosis may also present as back pain and be the cause of infertility.

Approximately 40 percent of women with endometriosis experience infertility and approximately 40 percent of all women with infertility have endometriosis.

What causes endometriosis?

No one knows the exact cause of endometriosis but a number of theories have been proposed;

  • Retrograde menstruation – one theory is that endometrial tissue becomes deposited into the pelvic and abdominal cavities when menstrual debris pass backwards from the uterus via the fallopian tubes into the pelvis. However, retrograde menstruation is not the only cause of endometriosis, as many women who have retrograde menstruation do not develop endometriosis.
  • Genetics – there may be an inherited component. A woman with a close family member who has endometriosis is more likely to develop endometriosis herself.
  • Immune system dysfunction – the immune system does not work correctly to destroy endometrial tissue outside the uterus.
  • Embryonic cell growth – embryonic cells lining the abdomen and pelvis develop into endometrial tissue within those cavities.
  • Lymphatic and hematogenous spread – the lymphatic system transports endometrial cells to various parts of the body.

What are the risk factors for endometriosis?

Endometriosis can develop in any woman (even those who have had their uterus or ovaries removed) but some but some risk factors increase the risk, including;

  • Age – endometriosis is most common in women aged 30 to 40 years
  • Beginning menstruation at an early age
  • Menstrual cycles of less than 27 days or periods lasting more than 7 days
  • Not having had children
  • Genetics – one or more relatives having the condition
  • Medical history: Having a pelvic infection, uterine abnormalities, or a condition that prevents expulsion of menstrual blood.
  • Caffeine, alcohol consumption, and lack of exercise: These can raise levels of oestrogen.

Asthma, some autoimmune diseases, chronic fatigue syndrome and ovarian and breast cancer have all been linked to endometriosis.

How is endometriosis diagnosed?

The gold standard investigation for endometriosis is laparoscopy, minimally invasive surgical procedure. Laparoscopy allows your gynaecologist to visualise and biopsy suspected endometriosis, which is then confirmed by microscopic examination.

How is endometriosis treated?

There’s no cure for endometriosis and it can be difficult to treat. Treatment aims to ease symptoms so the condition does not interfere with your daily life. There are both medical and surgical treatment options;

Medical Management

Pain medication – pain killers (such as paracetamol), anti-inflammatories (such as ibuprofen) can be tried to lessen the pain. They do not stop progression of the disease.

Hormone treatment – hormone treatment (such as combined oral contraceptive or progestogens), work by reducing or stopping the production of oestrogen, which otherwise promotes the growth of endometriosis tissue.  It is important to understand that hormone treatment will not reverse any adhesions caused by endometriosis or improve fertility.

Different hormone treatments are equally effective at treating endometriosis but they have different side effects.

Progestogens used to treat endometriosis include:

• the Mirena intrauterine system, a small device that’s placed in the womb and releases progestogen

• the contraceptive injection

• the contraceptive implant

• the progestogen-only-pill (POP)

Surgical Management

Patches of endometriosis tissue can sometimes be surgically removed to improve symptoms and fertility. Surgery has pros and cons and it’s important to discuss these with your gynaecologist.

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