Women’s health—endometriosis

What is endometriosis?

The tissue that lines the uterus is called the endometrium (or endometrial tissue). Endometriosis is a condition where endometrial tissue grows outside of the uterus. Usually, this is within the pelvis, such as on the ovaries, tissues or ligaments supporting the uterus, but can also spread to the bladder, bowel and appendix. While the exact cause of endometriosis is uncertain, a number of theories exist. It is likely that a number of factors contribute to the formation of endometriosis, including genetics, environmental and immune factors, reversal of menstrual flow and changes in the lining of the pelvic cavity.

How common is endometriosis?

Endometriosis affects about one in ten women of reproductive age.

What does endometriosis do?

Like the endometrium inside the uterus, the endometriotic implants swell and bleed in response to the monthly hormonal cycle. The body responds by surrounding the affected area with scar tissue. The formation of scar tissue (adhesions) can result in damage to pelvic structures and may cause these to stick together, so they are unable to move freely. Over time, the endometrial tissue may also enlarge and form cysts, particularly in the ovaries. These cysts are often referred to as “chocolate cysts” because they are filled with old blood which is chocolate-like in appearance.

What are the symptoms?

The symptoms of endometriosis are variable and do not always correspond to the severity of disease. You could have severe endometriosis and not experience many symptoms. Nonetheless, symptoms may include:

• pain with periods, ovulation, intercourse, when passing urine or opening bowels and chronic pelvic and lower back pain
• difficulty falling pregnant (infertility)
• abnormal bleeding—irregular or heavy periods, bleeding between your periods.

How is endometriosis diagnosed?

At present there is no simple screening test (such as a blood test or ultrasound) for endometriosis. A diagnosis can only be confirmed by examining a tissue sample (biopsy) which is obtained during a laparoscopy (keyhole surgery). This is usually a day surgery procedure under a general anaesthetic and any endometriosis identified may be treated at the same time.

What are the treatment options?

• Surgery: this has been shown to reduce pain and improve fertility. The endometriosis can be removed by cutting away or burning the affected areas. Only the areas affected with endometriosis are treated.

• Drug therapy: this has been shown to reduce pain and may have a role in managing disease in conjunction with surgery. Drug treatment has not been shown to improve fertility. A number of drugs may be used and include:
  • anti-inflammatory drugs
  • combined oral contraceptive pill
  • progestins
  • Danazol
  • GnRH analogs
• Natural and complementary therapies: many women find natural and complementary therapies helpful in the treatment of endometriosis. They can relieve the symptoms and may also assist the body to recover from drug or surgical treatments. Some women also find that natural and alternative therapies provide them with a sense of control. These therapies include dietary changes (increasing fruit and vegetabe intake), exercise, herbal medicine, traditional Chinese medicine, aromatherapy, homeopathy, massage and yoga. Women interested in using complementary therapies should consult a qualified practitioner who can properly advise them on a course of treatment. It is also important that women disclose their use of any complementary therapies to their doctor, particularly if they are also undergoing medical treatment for endometriosis.

How effective is treatment?

Despite effective therapy there is no cure for endometriosis. Regardless of the type of treatment, it is estimated that one in five women will have a recurrence of symptoms within five years. Treatment options are similar to those discussed above. In severe cases with ongoing symptoms, hysterectomy and removal of the ovaries is sometimes recommended.

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