Endometriosis is when tissue from the lining of the womb is elsewhere in the body. Usually, this is behind the womb near the ovaries or Fallopian tubes, but can be found anywhere in the body.
When on a period, spots of endometriosis also become inflamed resulting in pain or sticking together of tissues causing scar tissue, also known as adhesions.
Why endometriosis occurs remains a mystery. One theory is reverse menstruation where endometrial cells go the wrong way, through the Fallopian tubes and become attached to other pelvic organs. However, some scientists dispute this. So for now, we don’t know the exact reason why some women get endometriosis.
Endometriosis can cause lower abdominal pain, often worse on a period, or during and after intercourse. It is also linked to fertility problems. No cure has been found for endometriosis and so treatment is focussed on managing the condition.
Diagnosing endometriosis usually requires keyhole surgery to visualise areas of endometriosis. Rarely, endometriosis can be seen on ultrasound scan, when a large cyst of endometriosis (endometrioma) is on the ovary.
Surprisingly, the severity of endometriosis seen during surgery often doesn’t compare with the severity of symptoms. I have met women have severe endometriosis found during surgery, but experience very little in terms of pain. Then again, others have debilitating symptoms from just a couple of spots.
Keeping endometriosis under control is dependent on its severity and how it affects each individual woman. For example, treatment for pain is different from fertility problems.
Medical treatment starts with simple painkillers, but it is important to get to the root of the problem with hormonal treatment. Basically, anything that improves periods also helps endometriosis. Controlling the menstrual cycle to reduce bleeding will also dampen down endometriosis. So during pregnancy and after the menopause endometriosis goes away.
Sometimes medical treatment isn’t enough, and surgery might be useful. Endometriosis can be cut out or burnt away and scar tissues divided (adhesiolysis). However, after surgery, it’s important to continue medical treatment and the symptoms may come back.
Fertility is reduced for women with endometriosis, probably due to ongoing inflammation, although many women conceive naturally. Complications of endometriosis include blocked tubes or cysts of endometriosis on the ovaries (endometriomas) which impair ovulation. To determine the correct treatment requires a full fertility assessment.
Endometriosis is a horrible condition that can severely affect the quality of life. More information can be found at Endometriosis UK.