Endometriosis

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What is Endometriosis?
Endometriosis is the second most common gynaecological (relating to the female reproductive system) disorder after uterine fibroids. It is generally a benign condition (not linked to cancer), but is a progressive, debilitating disease affecting women almost exclusively during their reproductive years. It involves fragments of the lining (the endometrium) of the womb (or uterus) becoming implanted elsewhere in the body, for example, near the ovaries and bladder.

• Like the lining of the womb itself, the implanted fragments build up through each month, then break down and bleed, responding to the changing concentrations of the female hormones (oestrogen and progesterone; chemical signals carried in the blood) during the menstrual cycle.

• Though the lining of the womb itself is shed during menstruation, blood from an implant outside the womb has no way to leave the body.

• Consequently, internal bleeding, inflammation and internal scarring can occur resulting in considerable pain. Sometimes cysts called endometriomas form in the ovaries and may rupture, often causing excruciating pain.

How do you get Endometriosis?
How endometriosis occurs still remains unclear.

How serious is Endometriosis?
Endometriosis may significantly impair health and reduce the ability to become pregnant (fertility). Common symptoms of endometriosis are:

Pain occurring in the back and lower abdomen (trunk) at the time of the periods (a condition called dysmenorrhoea).

• Difficulty or pain during sexual intercourse (a condition called dyspareunia).
  
• Infertility
  
• Pelvic (lower trunk) pain.

Less common symptoms are:

• Difficulty or pain in passing faeces (a condition called dyschesia).
  
• Premenstrual spotting, dysfunctional (not normal) uterine bleeding.
  
• Pain or difficulty in passing urine (a condition called dysuria).

It is important to note that these symptoms are also found in other diseases.

How long does Endometriosis last?
Because the condition and symptoms are linked to the extent of reproductive life, its occurrence will vary between different people.

• Because symptoms are also found in other diseases, diagnosis of endometriosis can take a long time and many investigations.

• It can only be reliably confirmed by examining inside the pelvic region (lower trunk) of the body, using a camera device called a laparoscope.

• The device is put into the body through a small cut in the abdominal all.

• The frequency of symptoms reflects the sites where the fragments of endometrial tissue are lodged and tends to be most frequent at the time of menstruation, although the severity of symptoms does not always correlate with the extent of the disease.

• Endometriosis stops when the menopause is reached, as there are no longer female hormones to stimulate the fragments of endometrium into growth.

How is Endometriosis treated?
The treatments recommended will depend on several factors such as type and severity of symptoms, the desire to have children, age and general health. Endometriosis can be treated by:

• Analgesics, if the only problem is mild or moderate pain during periods.

• Surgically removing the endometrial fragments from where they are lodged. In some cases this can be done using a laser and laparoscopy (key-hole surgical technique).

• By giving medicines which stop the reproductive cycle such as luteinising hormone-releasing hormone (LHRH) agonists. These medicines stop the endometrial fragments from growing by preventing the body from making the female sex hormones (particularly oestrogen) that stimulate the growth. The specialist will recommend the duration of the treatment.

• Other drugs used to control hormones might also be used, for example, birth control pills, progesterone pills and others.