What is Endometriosis?

Endometriosis is a common condition where tissue from the lining of the womb, grows in other areas of the body, such as ovaries, vagina, fallopian tubes, bladder, bowel, or rectum. It mainly affects women during their reproductive years. It can affect women from every social group and ethnicity and affects about 2 million women in the UK.

What are the symptoms of endometriosis?

The symptoms of endometriosis vary and some women may have no symptoms at all.

Most common symptoms include:

painful or heavy periods

pain during sex

long term pain in the lower back, pelvis or abdomen

bleeding between periods

difficulty in getting pregnant or infertility

long term fatigue

Why does endometriosis occur?

It is not yet known why endometriosis occurs. Several theories have been suggested but none have been proven.

How is endometriosis diagnosed?

The tests that are offered are

Ultrasound scan- this can identify whether there is an endometriosis cyst in the ovaries. A normal scan does not rule out endometriosis.

Laparoscopy this is ‘the gold standard test’ for the diagnosis of endometriosis.

How is endometriosis treated?

There are different treatment options and this will be discussed with you. Several factors influence the recommended treatment options, such as

Your age

Your main symptom (pain, fertility problems)

If you are planning a pregnancy

If you have had any treatments previously

Although there is no cure for endometriosis, the aim of treatment is to ease the symptoms so that the condition does not interfere with your daily life. Treatment can help to relieve pain, improve fertility, slow the growth of endometriosis, and prevent the disease from coming back.

Medical options for the treatment of endometriosis:

Pain relief– Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen act against the inflammation and help to ease pain and discomfort.

Hormone treatments- There are range of hormone treatments to stop or reduce ovulation (the release of an egg) to allow the endometriosis to shrink or disappear.

The combined oral contraceptive (COC) pill or patch-These contain the hormones oestrogen and progestogen and work by preventing ovulation and can make your periods lighter, shorter and less painful.

The intrauterine system (IUS)- this is a small T-shaped device which releases the hormone progestogen. This helps to reduce the pain and makes periods lighter. Some women get no periods at all.

GnRH agonists – these drugs prevent oestrogen being produced by the ovaries and cause a temporary and reversible menopause.

Surgical options for the treatment of endometriosis:

Surgery can remove or destroy the areas of endometriotic tissue. The type of surgery used will depend on where the tissue is and how extensive it is.

Laparoscopic surgery – Laparoscopic approach is the best way to treat the endometriosis. In laparoscopy, patches of endometriosis are removed by destroying them or cutting them out.

Laparotomy –   If the endometriosis is severe and extensive, you may be offered a laparotomy. This is a major surgery which involves a cut in the abdomen, usually in the bikini line.

In many women, endometriosis can come back after surgery. You may be advised to take hormonal drugs after surgery to help delay the return of symptoms.