What is endometriosis?

The dictionary will tell you that endometriosis is "the presence of functioning endometrial tissue where it does not belong". Endometrium is the name of the tissue that lines the uterus. Every few weeks the endometrium thickens to form a comfortable nestling place for the foetus. Normally this is shed during your period and recreates itself again in the next cycle. Sometimes, endometrial cells grow on the outside of the uterus. The body responds by covering these rogue cells with scar tissue. These cells still react to hormones released during the menstrual cycle, so when menstrual bleeding begins, the scar tissue surrounding the cells becomes red and swollen, resulting in intense pain.

Where does it grow?

Common sites for endometrial growth - called implants or lesions - include the ovaries, the fallopian tubes and the bladder as well. In fact, endometrial lesions can be found anywhere in the pelvic cavity, and sometimes in the bowel, intestines, colon, appendix, rectum and on Caesarean and laparoscopy scars as well. In rare cases, endometriosis has been found inside the vagina, on the skin, even in the lung, spine and brain.

Who gets it?

Endometriosis used to be called "the career woman’s disease" because it was most often found in professional women who delayed childbearing but further research has shown that endometriosis can affect any woman during the menstruating years. Symptoms can start with or after the first menstruation, but the disease is rarely found after menopause. Overall, as many as 5-15% of reproductive-age women have endometriosis.

Overall, as many as 5-15% of reproductive-age women have endometriosis.

How common is endometriosis?

The actual number of women who have endometriosis is unknown because many women do not display symptoms.However, endometriosis is seen in more than half of teenagers who have menstrual periods that are painful enough to be evaluated further. By and large, endometriosis is very rare before puberty and symptoms of endometriosis usually disappear after menopause.

What causes it?

The cause of endometriosis remains unknown although several different hypotheses have been put forward. Endometrial cells may be carried up through the uterus into the pelvis during menstruation, or they could have travelled to other parts of the body through the circulatory system.

No theory has ever been entirely proven but most experts agree that endometriosis is exacerbated by the hormone oestrogen.

Is there a cure for endometriosis?

No, but the symptoms can be managed through a combination of treatments. Basically you can have either surgical treatment or hormone therapy or both. Hormone therapy works by manipulating the hormones that control menstruation and the swelling of your endometrium and endometrial lesions. The medication can be taken orally or through an injection.

Treatment varies depending on whether you are treating pain or infertility. Treatment may include medication to shrink the implants, laparoscopy to destroy implants, or surgery to remove the uterus and ovaries.

What are the symptoms?

The most common symptom of endometriosis is recent worsening of period and pelvic pains which often - but not always - correlate to the menstrual cycle.

Pain may be felt before, during or after menstruation, during ovulation, in the bowel during menstruation, when passing urine, during or after sexual intercourse and in the lower back region. Other symptoms, usually during period, may include diarrhoea or constipation, abdominal bloating, heavy or irregular bleeding and fatigue.

Symptoms may remain stable, decrease without treatment or suddenly increase. Symptoms may resolve with treatment and then return later. Often symptoms decrease during pregnancy.

The other well known symptom associated with endometriosis is infertility. It is estimated that 30-40% of women with endometriosis may have difficulties in becoming pregnant. Endometriosis is thought to be responsible for up to 10% of infertility problems.

How is it diagnosed?

An experienced gynaecologist should be able to recognise symptoms suggestive of endometriosis if you are honest about the history and pattern of your symptoms.

Ultrasounds, MRI scans, and gynaecological examinations may be performed but the only reliable way to definitively diagnose endometriosis is by performing a laparoscopy and to take a biopsy of the tissue.

Is endometriosis cancer?

Although endometrial lesions are sometimes referred to as "benign tumours" because they "behave" similarly to cancer, endometriosis is not cancer.

Is endometriosis sexually transmitted or infectious?

Endometriosis cannot be transferred from one human being to another. The cause of endometriosis is not yet known but it is not an infectious disease.

Is endometriosis inherited?

The cause for endometriosis is not yet known but research does show that first-degree relatives of women with this disease are more likely to develop endometriosis.

What are some natural ways to manage the pain?

Try a hot bath or heating pad to relieve the pain. Relaxation and breathing techniques often help. Your partner can also play a role in making you feel better, whether it is a lower back massage, leaving you alone for a while or experimenting with different and more comfortable positions for intercourse.

What should I do if I suspect I have endometriosis?

Although there is no cure, health care providers can teach you how to manage endometriosis and live a comfortable and active life. The earlier you detect the disease, the less risk there is to your fertility and reproductive organs as well.

The most important thing you can do if you suffer from the symptoms of endometriosis is to consult and seek professional advice from your gynaecologist.

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