What is Endometriosis?
Endometriosis is a condition where cells like the ones in the lining of the womb are found elsewhere in the body. During the menstrual cycle, every month hormones are naturally released by the woman’s ovaries causing the lining of the womb to grow in preparation for a fertilized egg. If pregnancy does not occur, this lining will break down, bleed and is released from the body as a period.
Endometriosis cells react in the same way but as they are located outside the womb they are not released from the body. During the monthly cycle hormones stimulate the endometriosis tissue, causing it to grow, then break down and bleed. This internal bleeding, unlike a period, has no way of leaving the body. This leads to inflammation, pain, and the formation of scar tissue (adhesions).
Endometriosis tissue can also be found in the ovary, where it can form cysts, called ‘chocolate cysts’ because of their appearance.
Endometriosis is most commonly found inside the pelvis, around the ovaries, the fallopian tubes, on the outside of the womb or the ligaments (which hold the womb in place), or the area between the rectum and the womb, called the Pouch of Douglas. It can also be found on the bowel, the bladder, the vagina and the rectum. Endometriosis tissue can also grow in the muscle layer of the wall of the womb (this is another condition called adenomyosis).
What are the symptoms of Endometriosis?
The classic symptoms of endometriosis are painful periods, painful sex and/or infertility.
Women with endometriosis may also report many other symptoms such as non-cyclic pain, ovulation pain, leg pain, back pain, heavy, prolonged or irregular periods, bowel and bladder symptoms (such as painful bowel movements, pain before or after opening bowels, bleeding from the bowel, pain when passing urine, pain before or after passing urine, blood in the urine, symptoms of an irritable bowel – diarrhoea, constipation, colic). Other symptoms can include lethargy, nausea, extreme tiredness, depression, feeling faint or fainting during periods.
Some women with endometriosis will have no symptoms at all. The amount of endometriosis does not always correspond to the amount of pain. Chocolate cysts on the ovary can be pain-free and only found as part of fertility investigations. A small amount of endometriosis can be more painful than severe disease. It depends largely on the site of the endometrial deposits.
All of the symptoms above may have other causes. It is important to seek medical advice to clarify the cause of any symptoms. If symptoms change after diagnosis it is important to discuss these changes with a medical practitioner. It is easier to put all problems down to endometriosis and it may not always be the reason.
What Causes Endometriosis?
There is no proven cause for endometriosis. There are several theories as to what can cause the condition. However, no theory could fully explain how endometriosis occurs and the actual cause remains unknown.
How is endometriosis diagnosed?
The only definitive way to diagnose endometriosis is by a laparoscopy. This is an operation in which a camera (a laparoscope) is inserted into the pelvis via a small cut near the navel. This allows the surgeon to see the pelvic organs and any endometrial implants and cysts. For further information on laparoscopy (link to RCOG leaflet).
Occasionally diagnosis is made during a laparotomy. A laparotomy is a major operation, which involves opening the abdomen through a larger incision (cut).
Scans, blood tests and internal examinations are not a conclusive way to diagnose endometriosis and a normal scan, blood test and internal examination does not mean that you do not have endometriosis. Because endometriosis manifests itself in a variety of ways, diagnosis can be difficult and often delayed. Recent research shows that there is now an average of 7.5 years between women first seeing a doctor about their symptoms and receiving a firm diagnosis.