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Reviewed by Dr Philip Owen, consultant obstetrician and gynaecologist
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What is endometriosis?
Endometriosis is a condition in which the tissue (endometrium)
normally lining the womb (or uterus) grows on different organs outside the
uterus.
If the endometrium grows within the muscular layer of the womb
it is called adenomyosis, which is just a different type of
endometriosis.
The commonest areas to be affected are:
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the ovaries where cysts might appear; these are called
chocolate cysts because they contain brown material.
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the area behind the womb and in front of the rectum (large
bowel). This space is called the Pouch of Douglas and endometriosis here often
causes deep pain and painful intercourse (dyspareunia).
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less common sites include the bowel itself, the bladder and
sites outside the pelvis including the navel or operation scars.
Like normal endometrium, the endometriosis tissue undergoes
monthly changes according to the hormonal cycle and typically causes painful
periods (dysmenorrhoea).
Treatment is usually required if it causes painful symptoms.
Who is at risk of endometriosis?
Endometriosis is a very common condition affecting up to 10 per
cent of women between 16 and 50 years of age, often without producing any
symptoms.
Endometriotic tissue is under hormonal influence so it is
almost never seen in children or postmenopausal women. In extremely rare cases,
the condition is seen in men.
What causes endometriosis?
This is still uncertain, but the main theory suggests that
during a period, light 'backward' bleeding carries tissue from the
uterus to the pelvic area via the Fallopian tubes. This is called retrograde
menstruation.
What does endometriosis look like?
It appears as small blackish-blue nodules on the external lining
of the ovaries or elsewhere in the pelvis. In some cases it may lead to the
formation of cysts filled with altered blood, known as chocolate cysts.
Is endometriosis painful?
Endometriosis might cause discomfort or mild to severe pain
during a period (dysmenorrhoea), with
many sufferers experiencing chronic pain. Sexual intercourse can be painful,
and women with chocolate cysts may have a feeling of fullness in the lower
parts of their stomach.
Does endometriosis affect a woman's chances of becoming
pregnant?
In severe cases, formation of connecting tissues around
endometriosis near the Fallopian tubes or ovaries may reduce fertility.
Fortunately, most women with endometriosis have a mild form of
disease and their fertility is not impaired. Once pregnant, most women's
endometriosis gets better under the influence of the constant high levels of
female hormones produced in pregnancy.
How is endometriosis diagnosed?
Although the doctor may suspect endometriosis and start
treatment on the basis of symptoms alone, usually the diagnosis is made through
direct inspection of the pelvis. This is most commonly via
laparoscopy performed
by a gynaecologist.
Adenomyosis, in which endometriotic tissue is formed within the
muscle of the womb wall, is usually difficult if not impossible to diagnose
without performing a
hysterectomy because
it cannot be seen.
How is endometriosis treated?
There is a wide range of treatment available. The treatment
recommended by your gynaecologist will be influenced by many things including
your age, the severity of your symptoms, the severity of the endometriosis and
whether you wish to have children in the future or not.
Symptomatic treatment means treating the symptoms of the disease
rather than the disease itself. In endometriosis, this means pain relief which
can most effectively be provided by a group of medicines called the
non-steroidal anti-inflammatory drugs (NSAIDs).
Medical treatment of endometriosis aims to stop the fluctuations
in the woman's own hormone levels in an effort to remove the stimulation
for growth of the endometriosis. Such treatments include progestogens,
danazol (eg
Danol), the
oral contraceptive
pills and a group of drugs called
gonadorelin
analogues.
In keeping with all hormonal preparations, side effects are
common and it is important to be aware of these before commencing any
treatment. Be sure to ask your doctor about the possible side effects of any
medicine you are prescribed.
Although medical treatment is usually successful in alleviating
symptoms, relapses may occur after treatment has stopped. Surgical treatment is
then often appropriate and can include keyhole surgery (laparoscopic surgery)
to remove or destroy endometriosis or open surgery to remove ovarian
cysts.
A
hysterectomy may
be suggested if the main symptoms are
heavy and painful
periods and the woman's family is complete.
Living with endometriosis
Endometriosis is a condition that cannot always be cured
although the symptoms can usually be sufficiently relieved to allow the woman
to pursue a normal life. Symptoms will go away at the time of the
menopause.
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Based on a text by Dr Niels Lund, specialist
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Last updated 04.07.2008
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