Endometriosis is a common gynaecological condition where the cells that normally line the uterus (endometrial cells) grow outside the uterus. It affects around 10% of women and can have significant impacts on daily life.
Where Does Endometriosis Occur?
Endometriosis is most frequently found:
- On the ovaries
- On the peritoneum (the lining inside the abdomen), particularly the utero-sacral ligaments that support the uterus
Less commonly, endometrial cells can grow in more distant parts of the body. The condition often runs in families and may return even after successful treatment. Endometriosis generally becomes less active after menopause.
Who is at Risk?
Endometriosis can affect women of all ages but is most commonly diagnosed in women in their 30s and 40s, though it can also appear in late teens or early twenties.
It is more likely in women who:
- Have not had children
- Had children later in life
- Have a history of painful periods
Common Symptoms of Endometriosis
Symptoms vary widely. Some women experience many symptoms, while others may have none. The most common symptom is pain, usually in the lower abdomen. This pain often occurs with periods but can also appear during ovulation or at other times.
Other areas where pain may be felt include:
- Lower back
- During urination or bowel movements
- During sexual intercourse
- During internal examinations
Endometriosis may also be associated with:
- Infertility
- Heavy or irregular periods
- Bleeding from the bowel
What Causes Endometriosis?
One widely accepted theory is retrograde menstruation. Normally, menstrual blood flows out of the uterus through the vagina. In retrograde menstruation, some of the blood flows backward through the fallopian tubes into the abdomen.
This can deposit endometrial cells onto the peritoneum, ovaries, or bowel. These cells respond to hormonal changes just like the uterine lining, causing bleeding in these new locations. This can lead to:
- Adhesions (areas where organs stick together, potentially causing pain)
- Endometriomas (“chocolate cysts”) when bleeding occurs inside the ovary
How is Endometriosis Diagnosed?
Endometriosis can be difficult to diagnose because its symptoms resemble other conditions like pelvic infections or ovarian cysts.
Diagnostic tools include:
- Transvaginal ultrasound: Detects ovarian endometriomas and assesses other pelvic structures.
- Laparoscopy: A surgical procedure where a small camera is inserted into the abdomen to directly view endometriosis deposits. Sometimes endometriosis is discovered incidentally during other surgeries.
During a specialised ultrasound for deep infiltrating endometriosis, the examination may include:
- Assessing the uterus and ovaries for endometriosis deposits
- Measuring the size and involvement of any deposits
- Checking kidneys, bladder, and lower bowel for complications
- Evaluating adhesions and nodules behind the uterus
- Assessing uterine and ovarian mobility and tenderness
Proper bowel preparation may also be required for the best results.
Treatment Options
Treatment depends on factors such as age, symptom severity, fertility goals, and personal preferences. Options include:
Hormonal treatments:
- Progestogens: e.g., Provera, Depo-Provera
- GnRH analogues: e.g., Zoladex
- Danazol: suppresses endometriosis directly
- Ryeqo: a combination of 3 medications which block hormones from being released
These treatments aim to reduce endometriosis activity and relieve symptoms, often by suppressing the menstrual cycle. Side effects vary, so discussion with your doctor is essential.
Surgical treatments:
- Laparoscopy may be used to remove endometriosis deposits, reduce adhesions, and improve fertility or relieve pain.
Takeaway
Endometriosis is a complex condition that can impact daily life, fertility, and overall wellbeing. Early diagnosis and a personalised approach to management can make a significant difference. If you experience symptoms suggestive of endometriosis, discuss them with your healthcare provider and ask whether a pelvic ultrasound or specialist assessment is appropriate.