Endometriosis

What is endometriosis?

Endometriosis is a common condition in women in which tissue that is similar to the uterine lining grows in other parts of the abdomen and pelvic area. This tissue growth causes painful symptoms that can affect everyday life, such as heavy and painful periods as well as pelvic pain. It can also cause fertility problems.

The inner lining of the uterus is called the endometrium. Layers of this tissue build up and are then shed during menstruation. If an egg is fertilized, the endometrium isn’t shed and helps to support the pregnancy in the early stages.

In women with endometriosis, tissue that is similar to endometrial tissue grows in other places, including the:

• Ovaries
• Fallopian tubes
• Lining of your abdomen and pelvis (called the peritoneum)
• Intestines
• Bladder/ureters
• Diaphragm
• Outside of the uterus
• Rectum
• Vagina

During the menstrual cycle, this endometrial-like tissue can become inflamed and can cause cysts in the ovaries, as well as nodules, superficial lesions, adhesions, scar tissue, and bleeding within these lesions.

Is endometriosis a serious condition?

Endometriosis is common and can significantly impact everyday life and cause long-term symptoms such as pain, fertility issues and disruptions to the menstrual cycle. Symptoms of endometriosis can usually be managed with treatment. Sometimes, surgery is required.

Who is affected by endometriosis?

Endometriosis usually affects women between the ages of 25 and 40, but it can also affect teenagers and perimenopausal women. Most women with endometritis find that the symptoms alleviate after menopause, but some still experience pain and discomfort.

What are the risk factors for endometriosis?

Factors that may increase your risk of developing endometriosis include:

• A family history of the condition
• A shorter menstrual cycle
• Menstruation that started before the age of 11
• Uterus or fallopian tube defects

What causes endometriosis?

The exact cause of endometriosis is unknown. However, there is a genetic link – a family history of endometriosis increases the risk of developing the condition.

What are the symptoms of endometriosis?

The most common symptom of endometriosis is pain, which can be mild or intense. The pain is usually felt in the pelvic area, abdomen or lower back. Other symptoms can include:

• Abdominal or back pain during or between periods
• Heavy periods or spotting in between periods
• Infertility
• Painful bowel movements
• Painful menstrual cramps
• Painful sex

There is no link between the severity of endometriosis symptoms and the severity of the condition.

Some women with endometriosis have no symptoms and the condition is diagnosed during a procedure or investigation for another condition.

How is endometriosis diagnosed?

Diagnosis begins with a discussion of your symptoms and medical history. Your doctor will ask about family history of the condition and any previous pregnancies.

A pelvic exam will be performed and if needed, an ultrasound. Depending on these results, an MRI may be required and then a laparoscopy which can confirm a diagnosis and treatment.

A laparoscopy uses a small camera (a laparoscope) to view inside the body. A small tissue sample (a biopsy) may be taken, which is sent for investigation in a lab to confirm a diagnosis.

How is endometriosis treated?

Treatment for endometriosis will depend on several factors, such as its severity, the severity of symptoms, your age and family planning.

Treatment usually focuses on managing pain and improving fertility, which is done with medication, surgery, or both.

Medications include pain relief and hormone therapies. Hormonal options include:

• Birth control:
• Oral: Both estrogen and progesterone or progesterone-only birth control can help women have lighter periods which are less painful.
• Intrauterine Device (IUD): A progesterone containing IUD can help women have lighter periods which are less painful.
• Intramuscular Progesterone Injections (DEPO): Can also help women have lighter, more infrequent, and less painful periods.
• Gonadotropin-releasing hormone (GnRH): These medications stop the production of hormones that cause the menstrual cycle, therefore alleviating pain.
• Danazol: This also stops the production of hormones which cause the menstrual cycle.

For some women, surgery may be recommended to treat endometriosis. Surgery can be an effective option to relieve pain and improve fertility through the removal of any tissues involved with endometriosis. Sometimes, symptoms can return after surgery, particularly if the endometriosis is severe.

Surgical procedures to endometriosis include:

• Laparoscopy: The laparoscope is inserted into a small incision in the abdomen. Small instruments are used to remove the endometriosis lesions and other affected tissues.
• Robotic Surgery: Small instruments are inserted into a small incision. The surgeon uses these instruments to remove the endometriosis lesions and other affected tissues.
• Hysterectomy: This procedure removes the uterus in severe cases. In some cases, ovaries are also removed.

For women with endometriosis who are trying to conceive, IVF can aid conception.

Sometimes, endometriosis may go away on its own or the symptoms lessen as the lesions become smaller and there are fewer of them. This can also be the case after menopause as the level of the hormone estrogen drops.

It is always important to discuss any of the symptoms of endometriosis with your doctor. If left untreated, the endometrial-like tissue growing outside the uterus can cause cysts, scar tissue or adhesions, leading to long-term pain.