Endometriosis head pic

Endometriosis

So a bunch of you are asking endomeowhat? But for some of you endometriosis is a constant pain in the... ovaries. Endometriosis is a condition in which cells from the lining of the uterus (womb) grow in other areas of the body. It can be very uncomfortable and disruptive to daily life and in a proportion of cases will cause infertility so it’s well worth talking about.

+   What is it?

To understand endometriosis we first have to talk about periods. Every month your ovaries produce hormones that tell the cells lining your uterus to swell and get thicker ready for if you get pregnant. If you don’t get pregnant the body then gets rid of these extra cells and you have your period.

In the case of endometriosis the cells that line your uterus grow elsewhere in the body, outside the uterus. They too thicken before your period and may bleed a little but unlike the ones in your uterus are not shed. They form what are referred to as endometrial tissue implants and can cause a number of unpleasant symptoms including, pain and infertility.

The implants usually form on:

  • The ovaries
  • The bowel
  • The rectum
  • The bladder
  • The lining of the pelvis

But can form elsewhere in the body

+   Symptoms

There are a number of symptoms common to endometriosis however some people with the condition never experience any obvious symptoms.

  • The condition is typically diagnosed in women aged 25-35 as although the implants often grow from the onset of periods they can take a while to build up and for the symptoms to become obvious
  • The severity of symptoms will also depend on the placement of the implants; different placement can cause more or less pain and discomfort but is not necessarily an indication of how developed the disease is
  • Pain is an obvious symptom:
    • Pain in the lower abdomen during or before periods
    • Pain during or following sex (that sucks)
    • Pain with bowel movements (a polite way of saying when you poo)
    • Pelvic or lower back pain
    • Cramps, for a week or two before periods and during

+   Causes

The cause of endometriosis is unclear. Some smart people have made some smart guesses, the most likely being that some of the cells that detach form your uterus flow back towards the ovaries rather than leaving the body. This backwards flow is not uncommon and it is likely that in most cases the immune system prevents the cells from attaching and growing in the wrong place. It is thought in the case of women with endometriosis that the immune system doesn’t do its job quite right and the cells that flow backwards are allowed to attach leading to endometrial tissue implants.

There are a number of factors that may increase your risk in getting endometriosis:

  • Family history of endometriosis
  • Frequent periods
  • Periods that last 7 days or more
  • If you were very young when you started your period
  • If you had a closed hymen

+   Treatment

Treatment will differ person to person depending on age, severity of the symptoms, severity of the disease and whether or not you want children

  • If you have relatively mild symptoms and don’t really want to have children, you may settle for
    • Regular exams every 6-12months to check it’s not getting worse
    • Exercise and relaxation may help relieve the pain and other symptoms
    • Ibuprofen and paracetemol to help with the pain
    • In some cases you may be prescribed stronger pain killers by your doctor
  • If you have more severe symptoms
    • You may decide to go on a hormone medication to stop the disease progressing further
    • Oestrogen and/or progesterone pills continuously for 6-9 months
      • A progesterone injection may be given but it has some potential side effects like depression and weight gain
    • Creates a state of pseudopregnancy (replicates the conditions if your body was pregnant) stopping your periods
    • Can help with symptoms
    • Will not prevent scarring or reverse any damage already done
  • Surgery
    • You can just have surgery to remove the areas of endometriosis. This will not prevent endometriosis from reoccurring but if you want to have kids may help with any fertility problems you are having
    • If you do not want kids in the future you may consider getting a hysterectomy this is where they remove your uterus and in the case of endometriosis they also often remove both ovaries and fallopian tubes
      • It is the closest to a cure that endometriosis has and it is very hard for the condition to return after the uterus is removed
      • If both ovaries are not removed there could be a return of symptoms

+   Complications

Other than long term pain the main other complication of endometriosis is infertility or problems with fertility

  • Infertility
    • Not all women with endometriosis have problems getting pregnant
    • Removal of scarring and endometrial tissue implants can increase the chance of getting pregnant
    • Fertility treatment and medicine can also effectively increase the chance of getting pregnant
  • Cysts
    • Sometimes large cysts form on the pelvis which may then burst
  • Cancer
    • In really rare cases the endometrial tissue implants cells will turn cancerous after menopause

Linked stories

See also in the Clinic