A number of women seeing their gynaecologist eventually find that many of their symptoms are caused by endometriosis. The signs and symptoms of this disorder might vary tremendously – and often there is much delay in making a correct diagnosis. Endometriosis can be a difficult condition to deal with, both physically and emotionally. Fortunately, there are now various options of treatment available.
What is endometriosis?
This is a disorder of females in which tissue similar to the tissue that forms the lining of your uterus (womb) grows outside of your uterine cavity. The lining of the uterus is called the endometrium. Endometriosis occurs when endometrial tissue grows on the ovaries, bowel, and tissues lining your pelvis or any other tissue in the body. It is unusual for endometrial tissue to spread beyond your pelvic region, but it is not impossible. Endometriosis can cause pain — sometimes severe — especially during menstrual periods. Fertility problems also may develop.
What are some symptoms of endometriosis?
The primary symptom of endometriosis is pelvic pain, often associated with menstrual periods. The severity of your pain is not necessarily a reliable indicator of the extent of the condition. You could have mild endometriosis with severe pain, or you could have advanced endometriosis with little or no pain. Other symptoms of endometriosis include the following:
• pain during or after sex
• pain when passing urine or stool during your period
• feeling sick, constipation, diarrhoea, or blood in your urine during your period
• difficulty getting pregnant
• painful periods
• pain in the lower abdomen before and during menstruation
• cramps one or two weeks around menstruation
• heavy menstrual bleeding or bleeding between periods
• lower back pain that may occur at any time during your menstrual cycle
Surprisingly, some women with endometriosis may have no symptoms at all. It is important that you get regular gynecological exams, which will allow your gynecologist to monitor any changes especially if you have two or more symptoms mentioned above.
Endometriosis is sometimes mistaken for other conditions that can cause pelvic pain, such as pelvic inflammatory disease (PID) or ovarian cysts. It may be confused with irritable bowel syndrome (IBS), a condition that causes bouts of diarrhoea, constipation and abdominal cramping.
What causes endometriosis?
The exact cause of endometriosis is not known. Several theories have been suggested, including:
• genetics – the condition tends to run in families, and affects people of certain ethnic groups more than others
• retrograde menstruation – when some of the lining of the uterus flows up through the fallopian tubes and embeds itself on the organs of the pelvis, rather than leaving the body as a period
• a problem with the immune system
• transformation of peritoneal cells
• embryonic cell transformation
• endometrium cells spreading through the body in the bloodstream or lymphatic system – a series of tubes and glands that form part of the immune system.
In reality none of these theories fully explain why endometriosis occurs.
Making the diagnosis
If you have symptoms suggestive of endometriosis you should see your gynaecologist. A detailed history and physical examination should be carried out. A pelvic examination is often required to rule out other gynaecological disorders. Other investigations like an ultrasound scan, magnetic resonance imaging (MRI) and laparoscopy might be arranged. Laparoscopy is a procedure that allows the gynaecologist to view inside your abdomen.
A laparoscopy examination can provide information about the location, extent and size of the endometrial implants. Your gynaecologist may take a tissue sample (biopsy) for further testing. Often, with proper surgical planning, your gynaecologist can fully treat endometriosis during the laparoscopy examination so that you need only one surgery.
Treatment for endometriosis
Despite what you might hear from other doctors, there is currently no cure for endometriosis, but there are treatments that can help ease the symptoms.
Treatments include:
• painkillers – such as ibuprofen and paracetamol
• hormone medicines and contraceptives – including the combined pill, the contraceptive patch, an intrauterine system (IUS), and medicines called gonadotrophin-releasing hormone (GnRH) analogues
• surgery to cut away patches of endometriosis tissue
• an operation to remove part or all of the organs affected by endometriosis – such as surgery to remove the uterus (womb) (hysterectomy)
Once a diagnosis is made your doctor will discuss the options with you. Sometimes they may suggest not starting treatment immediately to see if your symptoms improve on their own. You might also want to get a second opinion prior to starting treatment as well.
Complications
One of the main complications of endometriosis is difficulty getting pregnant or not being able to get pregnant at all (infertility).
Surgery to remove endometriosis tissue can help improve your chances of getting pregnant – although there is no guarantee that you will be able to get pregnant after treatment.
Surgery for endometriosis can sometimes cause further problems such as infections, bleeding or damage to affected organs.
Conclusion
Endometriosis is often a painful disorder in which tissue similar to the tissue that normally lines the inside of the uterus — the endometrium — grows outside the uterus. The pain caused by endometriosis can sometimes be very severe — especially during menstrual periods. Fertility problems may also develop. There is no cure available at this time, but once a diagnosis is made your gynaecologist might recommend one of the many treatment options available for treating your symptoms.
Ask Your Dr is a health education column and is not a substitute for medical advice from your physician. The reader should consult his or her physician for specific information concerning specific medical conditions. While all reasonable efforts have been made to ensure that all information presented is accurate, as research and development in the medical field are ongoing, it is possible that new findings may supersede some data presented.
Dr Brett Hodge MB BS DGO MRCOG is an obstetrician/Gynaecologist and Family Doctor with over thirty-eight years in clinical practice. Dr Brett Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 497 5828).
