Each month this tissue breaks down causing internal bleeding which has no way of leaving the body. This leads to inflammation, pain and the formation of scar tissue. In the ovary the endometriosis tissue can bleed and cause fluid contained areas which are called endometriomas (chocolate cysts). These cysts are usually detected by an ultrasound scan.
Endometrios is very common, it is estimated that endometriosis is present in between 10% - 25% of young women and up to 35% of women with fertility problems.
What are the Symptoms/Signs of Endometriosis?
Although women may not show any signs of endometriosis, the common symptoms of endometriosis include:
Painful and or heavy periods.
Premenstrual pain
Pelvic pain possibly radiating to back and thighs
Moderate to severe pain at the time of ovulation
Painful sex
Pain when passing urine and or blood in the urine
Pain and difficult with opening bowels
Bleeding from the bowel with the periods
Difficulty in becoming pregnant
The amount of endometriosis does not always correspond to the amount of pain and discomfort. A small amount of endometriosis can be more painful than severe disease depending on the site of endometrial deposits. The majority of women with this condition will experience some of these symptoms. Some women will have no symptoms!
Why does Endometriosis Occur?
The exact cause is unknown, although a few theories have been
put forward:
Genetic predisposition to the condition
Researchers are looking into the gene that could identify women predisposed to endometriosis. A woman who has a mother or sister with endometriosis has a six times greater risk of developing endometriosis.
Retrograde menstruation
Some of the menstrual blood flows backwards through the fallopian tubes and into the pelvis. Some of this endometrial tissue implants and causes endometriosis.
Lymphatic or circulatory spread
Blood vessels and lymphatic channels carry Endometrial tissue into the pelvis where it proliferates.
Immune dysfunction
There are theories suggesting an altered immune response that could lead to the development of endometriosis possibly by failing to prevent implantation of endometrial tissue that has entered the pelvis by retrograde menstruation.
How is Endometriosis Diagnosed?
History and Examination:
A thorough history may highlight suspicion about endometriosis. The commonest symptom is pelvic pain which may be worst around menstruation or after intercourse. However, many women have atypical symptoms and the diagnosis is often delayed or missed altogether.
A vaginal examination may demonstrate painful symptoms or reveal nodules of endometriosis in the pelvis.
Ultrasound Scan:
An ultrasound scan may show the presence of endometriosis cysts, although not all cysts are
caused by endometriosis and some types of endometriosis may not be seen on a scan.
Diagnostic Laparoscopy:
This is the only definitive way to diagnose endometriosis. In this operation a telescope is
inserted into the pelvis under general anaesthesia via a small cut near the navel. This allows
the surgeon to see the pelvic organs and any endometrial spots or cysts. It may also be
possible to surgically treat the endometriosis at the time of diagnosis.
Tissue biopsy
Slide showing endometrial glands and stroma from outside the womb
Treatment for Endometriosis
Aims of treatment:
Pain relief
Reducing endometrial growth
Removing the endometriosis by excision
Delaying recurrence of the disease
Optimizing and preserving fertility
For effective long-term treatment of endometriosis various treatments are available. The treatment varies according to a variety factors:
Age at diagnosis
The severity of symptoms
The severity of the disease
Most importantly, the desire to have children
The treatment is carried out as a partnership between the patient and doctor.
Conservative management ('wait and see')
If the symptoms are very mild, fertility is unaffected or if menopause is approaching, this approach may be suitable.
Drug treatment for endometriosis
May bring about an improvement in the pain symptoms
May shrink or slow down the progression of the condition
Is commonly used before surgery or before IVF treatment
Delays recurrence of the disease
Is NOT effective in the long term
Commonly used drugs:
Chris Barnick
Chris Barnick is regarded as one of the best in
London Gynaecology. He has delivered babies and performed gynaecological operations for more than 25 years.
A specialist
Private Obstetrician at OBGYN Matters in central London he qualified at Guys Hospital in 1984. He has trained and worked ever since in top London teaching hospitals
