Endometriosis is a chronic condition that affects millions of women and girls throughout the world. It is a painful condition wherein the endometrium, the tissue that lines the uterus, attaches itself to areas outside the uterus creating lesions.
Lesions may form in many areas of the body, but some of the more common growths occur on the exterior of the uterus, as well as on the ovaries and fallopian tubes. Other areas include the supporting structures of the uterus, the pelvic cavity lining, the cervix, the vaginal cavity, and the bladder. While lesions can also affect the exterior folds of the vagina and the perineum - the muscle and tissue dense area between the vagina and the rectum - growths in these sites are less common.
Endometriosis causes moderate to severe pain, due to the fact that lesions are in essence, sites of internal bleeding. These areas react to the hormonal changes directly associated with a woman's monthly cycle.
In much the same way as the uterus lining breaks down each month, endometrial lesions also break down. The difference is, as the uterus sheds its lining, blood and tissue are allowed to be flushed from the body through the vagina. On the other hand, there is no outlet for tissue and blood shed by endometrial growths.
Not only do these lesions cause pain, but they can also cause cysts and scar tissue to develop, which may affect fertility.
The primary symptom of endometriosis is pelvic pain, often associated with your menstrual period. Although many women experience cramping during their menstrual period, women with endometriosis typically describe menstrual pain that's far worse than usual. They also tend to report that the pain has increased over time.
Common signs and symptoms of endometriosis may include:
Painful periods (dysmenorrhea). Pelvic pain and cramping may begin before and extend several days into your period and may include lower back and abdominal pain.
Pain with marital intercourse. Pain during or after sex is common with endometriosis.
Pain with bowel movements or urination. You're most likely to experience these symptoms during your period.
Excessive bleeding. You may experience occasional heavy periods (menorrhagia) or bleeding between periods (menometrorrhagia).
Infertility. Endometriosis is first diagnosed in some women who are seeking treatment for infertility.
Other symptoms. You may also experience fatigue, diarrhea, constipation, bloating or nausea, especially during menstrual periods.
The severity of your pain isn't necessarily a reliable indicator of the extent of the condition. Some women with mild endometriosis have extensive pain, while others with advanced endometriosis may have little pain or even no pain at all.
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 diarrhea, constipation and abdominal cramping. IBS can accompany endometriosis, which can complicate the diagnosis.
See your doctor if you have signs and symptoms that may indicate endometriosis. The cause of chronic or severe pelvic pain may be difficult to pinpoint. But discovering the problem early may help you avoid unnecessary complications and pain.
There is no cure for endometriosis and it can be difficult to treat. The aim of treatment is to ease the symptoms so that the condition does not interfere with your daily life.
Treatment will be given to relieve pain, slow the growth of endometriosis, improve fertility and prevent the disease from coming back.
Your gynaecologist will discuss the treatment options with you and outline the risks and benefits of each.
When deciding which treatment is right for you, there are several things to take into consideration, including:
your age
whether your main symptom is pain or difficulty getting pregnant
how you feel about surgery
whether you have tried any of the treatments before
Treatment may not be necessary if your symptoms are mild and you have no fertility problems. In about a third of cases, endometriosis gets better by itself without treatment.
One course of action is to keep an eye on symptoms and decide to have treatment if they get worse.
Support from self-help groups can be very useful if you are learning to manage endometriosis.
Non-steroidal anti-inflammatories (NSAIDs), such as ibuprofen and naproxen, are usually the preferred painkiller used to treat endometriosis. This is because they act against the inflammation (swelling) caused by endometriosis, as well as helping to ease pain and discomfort. It is best to take NSAIDs the day before (or several days before) you expect the period pain.
Paracetamol can be used to treat mild pain. It is not usually as effective as NSAIDs, but may be used if NSAIDs cause any side effects, such as nausea, vomiting and diarrhoea.
Codeine is a stronger painkiller that is sometimes combined with paracetamol or used alone if other painkillers are not suitable. However, constipation is a common side effect, which may aggravate the symptoms of endometriosis.
Surgery can be used to remove or destroy areas of endometriosis tissue, which can help improve symptoms and fertility. The kind of surgery you have will depend on where the tissue is. The options are:
laparoscopy (the most commonly used and least invasive technique)
laparotomy
Any surgical procedure carries risks. Discuss them with your surgeon.
During a laparoscopy (a surgical procedure to gain access to the inside of your pelvis), endometriosis tissue can be destroyed or cut out using delicate instruments that are inserted into the body. This is also known as keyhole surgery.
Laparoscopy is now commonly used to diagnose and treat endometriosis. All grades of endometriosis can be successfully treated with this minimally invasive technique (where only small cuts are needed to insert the instruments). Heat, a laser or an electric current may be applied to destroy the patches of tissue.
Ovarian cysts or endometriomas, which are formed as a result of endometriosis, can also be easily treated using this technique, which can be used alongside medication such as GnRH analogues.
Although this kind of surgery can relieve your symptoms, they can sometimes recur, especially if some endometriosis tissue is left behind at the time of surgery.
This is major surgery that is used if your endometriosis is severe and extensive. Recovery time is longer than that for keyhole surgery. The surgeon makes a wide cut and opens up the area to access the affected organs and remove the endometriosis tissue.