The endometrium is the tissue that lines the inside of the womb (uterus). Endometriosis is a common condition where endometrial tissue is found outside the uterus. This often causes pain and sometimes problems with fertility.
Currently it is not known what causes endometriosis. There are many possible causes including genetic, immunological and hormonal reasons. Some women only discover they have endometriosis when they have trouble getting pregnant.
What are the symptoms of Endometriosis?
Some women experience severe pain and symptoms, having a huge impact upon their quality of life, while others have no symptoms and are unaware they even have the condition.
- Painful periods. The pain typically begins a few days before the period and usually lasts the whole of the period. It often gets worse as time goes on.
- Painful sex. The pain is typically felt deep inside and may last a few hours after sex.
- Pain in the pelvic area. Sometimes the pain is constant but it is usually worse on the days just before and during a period.
- Other symptoms may occur - for example, heavy or irregular periods, including passing clots and bleeding or spotting in between periods.
- Difficulty becoming pregnant (reduced fertility which affects about 30-50 per cent of women with endometriosis). This may be because endometrial tissue is blocking an egg travelling from the ovary to the fallopian tube. Sometimes, the reason for reduced fertility is not clear.
- Other symptoms include diarrhoea, bloating or constipation, pain passing faeces, pain passing urine, and, rarely, blood in the urine or faeces.
- Very rarely, patches of endometriosis develop elsewhere in the body. This can lead to strange pains at the same time as period pains.
What causes Endometriosis?
Currently, we don’t know why some women develop endometriosis. It is thought that the immune system and hormonal factors may play a role.
How is the diagnosis of endometriosis confirmed?
- Keep a diary of your symptoms as your experience is very important to raise the suspicion of endometriosis. Period apps and trackers can help with this.
- Your doctor will examine you to exclude other causes for your symptoms including infections.
- Your doctor may organise an ultrasound scan which can show evidence of endometriosis but equally may be normal.
- Your doctor may refer you to see a gynaecologist who may conduct further tests to establish a diagnosis.
- Gynaecologists may decide to do a laparoscopy to confirm diagnosis. This is a procedure done under anaesthetic which allows them to see inside the pelvis using a thin telescope. Patches of endometriosis can be seen by the doctor.
Initial treatment without a conclusive diagnosis may be advised. The way to confirm a diagnosis of endometriosis is to have a laparoscopy. However, many women develop symptoms that could be due to endometriosis such as painful periods - but have not yet had a laparoscopy. In such circumstances, your Integriti GP or doctor may suggest an initial treatment of pain relief and/or "the pill" or the IUS (Mirena/Kyleena), if you require contraception as well. These treatments are used to treat period pains anyway, even without endometriosis. If the symptoms improve with this initial treatment (as often they do) then a laparoscopy may not then be needed.
Treatment for endometriosis
Sometimes a combination of several types of treatments is used to treat endometriosis. Your treatment choice will depend on the severity of your symptoms and whether you want to become pregnant now or in the future. Hormone treatments can help for pain but do not improve fertility. Surgery may be needed if infertility is caused by endometriosis. Endometriosis rarely continues to be active after menopause, but hormone replacement therapy can (very rarely) cause a recurrence of symptoms.
Pain relief- Anti-inflammatory medicines and other pain relievers can be used for pain relief. Non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol are commonly used, sometimes in combination. Regular dosing of pain relievers is usually recommended during the time of pain.
Hormonal treatments – may reduce or stop the growth of patches of endometriosis, which can help with pain. They aim to suppress the body’s natural menstrual cycle. Most hormonal treatments act as contraceptives and are generally only used in women who do not wish to become pregnant. It may take a few months of treatment to get full benefit, so keep going with the treatment even if you don’t see much improvement at first
Complimentary Therapy – Acupuncture may be helpful in the treatment of painful endometriosis. Managing your lifestyle with a good diet and regular exercise is often useful to help you manage a difficult condition both physically and psychologically. Although this may have no impact on pain, it may help you to develop strategies to cope with your symptoms. Please consider trying mindfulness and relaxation techniques.
Laparoscopic surgery - During surgery, patches of endometriosis, adhesions (tissue stuck together) and cysts may be removed. Surgery can help relieve severe pain, but other treatments are often tried first for the treatment of pain alone. Surgical treatment of endometriosis may be used if you are struggling to get pregnant as it can improve fertility
Success of treatment and side-effects
Hormonal treatments are all similar in the success of pain relief, but they will suit each woman differently. Also, the treatments have different possible side-effects. You may try one and it may be fine. However, it is not unusual to switch from one treatment to another if the first does not suit. It is very important to discuss possible side effects with your Integriti GP for the various treatments during your consultation.
When to see your doctor or an Integriti GP. Please do not ignore your severe period pain and book a consult if:
- your period pain is severe or persistent;
- you have pelvic pain which gets worse during your periods;
- you have heavy bleeding or clotting;
- you have pain when having sex; or
- you are missing work, school, or social activities because of your symptoms.
As a team we will try our very best to help you in the way that you want.
"No decision about you without you"
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