What is endometriosis? 

Endometriosis is a condition that affects women of childbearing age. The condition causes tissue that is like the tissue you would normally find on the lining of the uterus to grow somewhere else, such as the ovaries or the fallopian tubes. This tissue builds up, breaks down and bleeds as normal but as it is in a different place, it cannot leave the body as normal so it becomes trapped. 

Endometriosis can be considerably painful. The condition is a life-long condition that can affect your life significantly and contribute to feelings of depression. 

What are the symptoms of endometriosis?

There are a number of symptoms that are associated with endometriosis. Unfortunately, the symptoms are common with a number of conditions which can make diagnosis difficult. 

Symptoms of endometriosis include:

  • Pain in your pelvis - this can become more painful during your period,
  • Feeling tired,
  • Pain during your period that is severe enough to stop you from doing certain things, and even leading to time off work or school,
  • Experiencing pain during or after you’ve had sex,
  • Heavy periods - and heavy periods that last for more than seven days - or bleeding between your periods,
  • Feeling sick during your period,
  • Diarrhoea 

Additionally, the condition and its symptoms can lead to feelings of depression. If you find that you’re experiencing these symptoms, you should speak to your GP about the possibility of endometriosis. 

How is endometriosis diagnosed?

Diagnosis can be difficult, due to the fact the symptoms are common. This can lead to a misdiagnosis - incorrectly identified as ovarian cysts, irritable bowel syndrome (IBS) and pelvic inflammatory disease. 

If you think you may be experiencing endometriosis, you may have your tummy and vagina examined by your doctor. Other ways of looking into these concerns includes ultrasound scans and blood tests. However, these methods are not always conclusive. 

To determine an endometriosis diagnosis, a laparoscopy is needed. This is a procedure sees a camera with a light being inserted through a small incision on your tummy to look for signs of endometriosis. 

Alternatively, you could use contraceptives such as the injection, which is administered every 12 weeks or the implant, which a doctor puts into your upper arm and it can stay there for up to five years. 

Some women choose to have the Mirena coil fitted to help with the symptoms of endometriosis. The Mirena coil is a T-shaped intrauterine system (IUS) device that is placed in your womb by a medical professional. This contraceptive method releases the progestogen hormone into the body for a period of up to five years. The IUS can be useful for those who cannot use the combined pill - however, there are potential side effects to using this method such as mood swings, and it can be uncomfortable when first inserted. 

How is endometriosis treated?

There are a number of options to treat endometriosis, but unfortunately there is no cure for the condition at present. 

To help to alleviate the pain, painkillers like paracetamol and ibuprofen can be taken. This can be enough to help someone experiencing mild endometriosis - but, if you have been taking painkillers for a number of months and you’re still in considerable pain, you should let your doctor know.

Hormone medicines and contraceptive options can help with endometriosis symptoms. Hormone treatment is used to limit or stop the production of oestrogen in the body, the hormone that encourages the tissue to grow and spread. 

Contraceptive options to help include the combined oral pill like Yasmin, Microgynon and Cilique. It may be advised by a medical professional to take as many as three packets of the pill successively without a break. This is to minimise your bleeding, or to improve the symptoms you experience that is linked to the bleeding. 

If these options aren’t helping your symptoms of endometriosis, surgery is an option. There are a number of things to consider before opting for surgery, which should be discussed with your doctor. Surgery is performed in order to cut away at, or destroy the endometriosis tissue using heat that has formed. This is called conservative surgery and is done through a laparoscopy. This can alleviate symptoms but it is not impossible for the tissue to return after surgery. 

Complex surgery, on the other hand, involves removing part of other organs like the bowel or bladder. For the bowel, endometriosis tissue can be found on the surface or it can penetrate the wall. Similarly, for the bladder, tissue can be found on the surface or inside of the bladder wall. 

How common is endometriosis?

According to Endometriosis UK, roughly 1.5 million women are currently living with the condition. Between seeing the doctor initially about your concerns of endometriosis to getting a firm diagnosis, the process takes on average 7.5 years. 

What are the risks of endometriosis?

There are a number of things that are thought to be more of a risk, if you are diagnosed with endometriosis.

  • Infertility: An association between endometriosis and infertility has not been firmly established but there appears to be a link between the two, as those who experience the condition have trouble falling pregnant. 
  • Early periods: You are seemingly more likely to start your period at a younger age.
  • Heavy periods: Those with endometriosis tend to have heavier periods and they can last for more than 7 days.

What causes endometriosis?

The cause of endometriosis has not been determined entirely, but there are a number of theories that consider what could be the underlying problem.

The theories behind endometriosis includes:

  • Genetics: it is believed that experiencing endometriosis is just one of those things that comes down to your DNA.
  • Retrograde menstruation: Sampson’s theory considers that a woman’s menstrual blood flows back into her system, rather than leaving the body. When the lining comes away, it flows into the fallopian tubes and then embeds itself on the organs of the pelvis. 
  • Immune system: some believe that women experiencing endometriosis may have issues with their immune system - their body is not able to recognise and destroy the tissue created by endometriosis that is growing outside of the uterus. 
  • Cells are in the bloodstream: One theory suggests that endometrial tissue particles can move around the body in your blood, so it can be found in areas like the eyes.
  • Metaplasia: If metaplasia occurs, one type of cell morphs into another type. This can occur as a reaction to inflammation so cells can adapt to their environment. The development of endometrial cells would occur as an embryo, when the baby’s womb is forming. 

What are the complications of endometriosis? 

There are a number of complications that can arise from endometriosis:

  • Fertility problems: Women experiencing endometriosis often struggle to fall pregnant, possibly due to damage to the fallopian tubes. Not all women with endometriosis will have issues conceiving. Having surgery to remove patches of tissue can help, but it cannot be guaranteed that surgery will help you conceive naturally. 
  • Adhesions: If endometriosis tissue is on or near the ovaries, sticky areas of tissue can lead to organs joining together. At present, there isn't a known way to prevent adhesions. Adhesions can cause nausea, bloating and cramping. 
  • Ovarian cysts: This refers to a sac filled with fluid that develops on the ovary. This is common, and can often help to diagnose endometriosis. Normally, you won't experience symptoms, but if the cyst ruptures, you could experience pelvic pain, heavy or irregular periods, bloating and increased need to wee. 

Is endometriosis hereditary?

Genetics is believed to be one of the potential reasons behind endometriosis, so many believe it is a hereditary condition.