Consultant Gynaecologist and Specialist in Pelvic Floor Surgery

Endometriosis

What is endometriosis?
Endometriosis is a condition where endometrial tissue (the tissue that lines the inside of the womb (uterus). is found outside the womb. It is ‘trapped’ in the pelvic area and lower abdomen, and rarely in other areas in the body.

Endometriosis can cause painful periods, persistent pain in the lower abdomen, difficulty conceiving, and painful sex. The symptoms can range from mild to severe. Treatment options include painkillers, hormone treatments, and surgery.

Up to 1 in 10 to as many as 5 in 10 of all women develop some degree of endometriosis. If symptoms develop they typically begin between the ages of 25-40 and rarely in the teenage years.

Endometriosis can affect any woman, but more common in close blood relatives of affected women. It is rare after the menopause and the oral contraceptive pill (‘the pill’) reduces the risk of developing endometriosis. This protective effect may persist for up to a year after stopping ‘the pill’.

What causes endometriosis?

The cause of endometriosis is unknown. It is suggested that some cells from the lining of the womb (the endometrium) get outside the uterus into the pelvic area by back flow along the fallopian tubes during menstruation (period).

These endometrial cells survive in these areas outside the lining of the womb such as the ovary, bladder, bowel, or fallopian tube as they respond to the female hormone oestrogen, just like the lining of the uterus does each month. Throughout each month the cells multiply and swell, and then break down as if ready to be shed at the time of your period. However, because they are trapped inside the pelvic area, they cannot escape. They form patches of tissue called endometriosis.

 

What are the symptoms of endometriosis?

Many women with endometriosis have no symptoms, while some women may have large patches of endometriosis with no symptoms whilst others have just a few spots of endometriosis, but have bad symptoms.

 

How is the diagnosis of endometriosis made?

Endometriosis is suspected from symptoms and usually confirmed by laparoscopy (Key hole surgery). This is a minor procedure that involves making a small cut on the abdominal wall just below the belly button (umbilicus) under anaesthetic. A laparoscope (thin telescope) is passed through the small cut to look inside the abdomen and pelvis and look for patches of endometriosis.

What treatment options are available?

The main aim is to improve symptoms such as pain and heavy periods, and to improve fertility if this is affected.

If symptoms are mild you may not require any treatment.

Simple analgesics

• Paracetamol can be effective for painful periods if symptoms are mild.

• Non Steroidal Anti-Inflammatory Drugs such as ibuprofen, diclofenac, naproxen, may be more effective than paracetamol.

Hormonal Treatment

Hormone treatment works by reducing the amount of oestrogen produced, or by blocking the effect of oestrogen on the endometrial cells, thereby starving the cells of oestrogen and as a consequence the patches of endometriosis gradually burn out.

The combined oral contraceptive pill (‘the pill’)Many women report improved symptoms and lighter periods on ‘the pill’

Mirena intrauterine system (IUS).The IUS is a small plastic device made plastic whch contains a progestogen hormone called levonorgestrel. It relieves symptoms of endometriosis and greatly reduces or even abolishes periods. It can is effective

Gonadotrophin Releasing Hormone (GnRH) analogue: This suppresses oestrogen production by the ovaries. A 3-6 month course of treatment is usually quite effective but side effects may occur such as hot flushes, dry vagina, diminished sex drive, headaches due to the very low levels of oestrogen. The side effects can be alleviated by a small dose of oestrogen and progestogen as hormone replacement therapy (HRT)

Surgery for endometriosis

Surgical removal of larger patches of endometriosis and ovarian cysts is sometimes required. This can be done via laparoscopy (a thin telescope-like instrument) which is inserted into the abdomen to remove patches of endometriosis (by heat destruction or excision) and ovarian cysts.

An open abdominal operation is sometimes required for more complex cases.

If you have completed your family and other treatments have failed, a hysterectomy (removal of the womb) and removal of the ovaries may be an option.

Does endometriosis recur?

Endometriosis can recur up till the menopause when periods cease and there is no estrogen stimulation of the womb lining. Further treatment will need to be considered if symptoms recur.

Further help and information www.endometriosis-uk.org