Endometriosis: Everything you need to know

March is endometriosis awareness month and even though it’s such a common condition, there’s still only little awareness and knowledge about it out there. So, let’s take a look at everything you need to know about endometriosis.

What is endometriosis?

Endometriosis is a common condition where tissue similar to the one in your uterus, also called endometrial tissue, grows in other areas of your body. This most commonly affects your pelvis, bowels, and ovaries. And just as the lining of your uterus, this tissue is affected by your menstrual cycle and will grow and break down just the same as your uterine lining. However, unlike your period, this tissue doesn’t have an “escape route” and gets practically stuck in your pelvic cavity where it can cause all sorts of problems. These can include the formation of scars, general irritation, as well as adhesions where the broken-down tissue connects two or more organs in your pelvic with each other.

 

Symptoms of endometriosis

As we have already mentioned, the endometrial tissue growing outside your uterus is affected by your menstrual cycle. This means that it will grow and break down every month just like your uterine lining does. For some women this results in mild symptoms; for others, on the other hand, the symptoms can be severe. There is also a chance that you don’t experience any symptoms at all! If that’s the case and you have been diagnosed, you should still have regular check-ups to make sure there are no changes to your condition. So, what are the most common symptoms of endometriosis?

  • Pain in your pelvic region
  • Very painful periods
  • Heavy menstrual flow and/or spotting and bleeding between periods
  • Cramps around one to two weeks of your period
  • Struggling to conceive
  • Pain after sex
  • Tiredness & fatigue
  • An upset belly around the time of your period
  • Emotional symptoms like sadness, depression, anxiety, and frustration
  • Cysts in your ovaries
  • Blockage in your fallopian tubes

What causes endometriosis?

The exact cause of endometriosis is unfortunately unknown. There are many theories out there, although none of them have been proven scientifically. Experts believe that a combination of factors is to blame. But let’s look at some potential causes for endometriosis:

  • Retrograde menstruation: If you are suffering from retrograde menstruation, your menstrual blood will flow back through your fallopian tubes and into your pelvic cavity rather than exiting your body.
  • Hormones: Hormones can contribute to endometrial tissue growing outside your uterus.
  • Genes: Some studies show evidence that you are more likely to develop endometriosis if one or more of your family members are suffering from it.
  • Immune system: A faulty immune system means that your body might not be able to destroy any endometrial tissue that grows outside your womb.
  • Mullerian theory: This theory states that the endometrial tissue is already there from birth but is only activated once the hormones during puberty kick in.

 

Who is more likely to get endometriosis?

Research has shown that endometriosis is most common among women between 25 and 40 and usually only develops after your menstrual cycle has started. This doesn’t automatically mean that it won’t affect you if you’re younger or older, though! Studies have also shown that you are more likely to develop endometriosis if you haven’t had children yet. It still occurs in women who’ve had children already but it’s much less common! Also make sure to talk to your GP if your periods are irregular at all. Whether it’s longer, shorter, or heavier periods – irregularities in your menstrual cycle can put you at higher risk of developing endometriosis.

Stages of endometriosis

Generally, endometriosis can be categorised into 4 stages:

I) Minimal
II) Mild
III) Moderate
IV) Severe

If your endometriosis is in the first stage, you will likely only have small lesions and only a small amount of endometrial tissue in your ovaries. This gets more with a mild version of the disease, where you can also find some shallow amounts of the tissue in the lining of your pelvis. In the moderate stage, you are likely to have more lesions as well as deep amounts of endometrial tissue in your ovaries and pelvic lining. If your endometriosis is severe, you will have a great amount of tissue in your pelvis and ovaries and you might also have some lesions on your fallopian tubes and bowels.

Be aware that whatever the stage of your endometriosis, it doesn’t have an impact on the severity of your symptoms. Your doctor will judge the stage of your condition by the location, size, amount, and depth of endometrial tissue in your ovaries and pelvis.

 

How is endometriosis diagnosed?

Getting a diagnosis is often a long and frustrating process and takes about 7.5 years on average from first developing symptoms. Let’s look at what the process of getting a diagnosis could look like:

  • Medical history: Your GP will take note of your symptoms and any family history of endometriosis. They will likely also perform a general check-up to make sure there are no other conditions that could be causing your symptoms.
  • Physical examination: Your GP will probably perform a pelvic exam to feel for any cysts or scars behind your uterus. It is quite an easy examination but can be a little uncomfortable as your doctor will have to insert either two fingers or a speculum into your vagina while also pressing on your stomach.
  • Ultrasound: Your doctor will perform an abdominal or transvaginal ultrasound to get a clearer picture of the situation. In some cases, this will show cysts but it’s generally not the most effective way to diagnose endometriosis.
  • Laparoscopy: A laparoscopy is the only real definitive method for diagnosing endometriosis as it takes a direct look at the tissue. During a small surgical procedure, a camera is inserted into your abdomen via 3 small incisions. If your diagnosis is confirmed, your surgeon will likely try to remove the tissue in the same procedure.

How is endometriosis treated?

If endometriosis isn’t treated, it can be a debilitating condition and have a serious impact on your quality of life. As of now, there is no definite cure for endometriosis, but there are different medical and surgical treatments available that will help you to manage it. As with everything, not every treatment works for everyone, though, so your doctor will help you work out which is the right option for you.

 

Let’s look at some possible endometriosis treatments:

  • Pain meds: You can start by trying to ease any pain with over-the-counter pain relief like ibuprofen. If that isn’t strong enough, speak to your doctor about getting some pain relief prescribed.
  • Hormone therapy: Hormone supplements can help to relieve pain and stop your endometriosis from progressing further.
  • Hormonal contraception: Hormonal contraception like the pill, vaginal rings, and patches can help to manage symptoms by reducing the amount of tissue that builds up every month.
  • Conservative surgery: The goal of conservative surgery is to remove any unwanted endometrial tissue without damaging your uterus, ovaries, or fallopian tubes. This type of surgery is usually done via laparoscopy, as mentioned above.
  • Hysterectomy: A hysterectomy is usually a last-resort and will only be done if none of the other treatment options have worked and your symptoms don’t improve. Your surgeon will usually remove your uterus, cervix, and your ovaries as they produce the oestrogen responsible for the growth of endometrial tissue.

Let’s bust some common myths about endometriosis

  • Having endometriosis means you can’t get pregnant: That’s not necessarily the case! Even though it’s more difficult to get pregnant with endometriosis, there are many women with the condition who have successfully carried a baby to term.
  • Getting pregnant will cure my endometriosis: Although pregnancy is known to improve the symptoms of endometriosis, they generally return shortly after giving birth.
  • You can get endometriosis from having babies later in life: Just because you don’t have children in your 20s doesn’t automatically mean that you’ll get endometriosis.
  • Endometriosis will disappear after my menopause: Your symptoms will generally improve after menopause as you don’t have a monthly cycle anymore but some of the symptoms may never go away. A small amount of oestrogen in your ovaries is what’s to blame for this.
  • Endometriosis only means that your periods are painful: Super painful periods are definitely a symptom of endometriosis, but it’s by no means the only one. The condition can have a great impact on your daily life and cause fatigue, bleeding, heavier periods, and so on.

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