Endometriosis

Endometriosis is a very common but often underdiagnosed condition, affecting 1 in 7 women during their lifetime. It occurs when tissue similar to the lining of the uterus (the endometrium) grows outside of the uterus. These lesions, or implants, can appear on the ovaries, fallopian tubes, uterus, and other pelvic organs. This abnormal tissue responds to hormonal changes during your menstrual cycle, leading to inflammation, pain, scar tissue formation, and sometimes infertility.

Symptoms

The severity of symptoms can vary widely. Some women may have mild endometriosis with intense pain, while others may have extensive endometriosis but minimal symptoms. The most common symptoms include:

Chronic pelvic pain, often worse during menstruation
Heavy or irregular periods
Pain during intercourse
Painful bowel movements or urination during menstruation
Fatigue, diarrhea, constipation, bloating, or nausea, especially during periods
Infertility or difficulty conceiving

Women can have one or more of these symptoms that can affect many aspects of daily life, including work, relationships, and mental health. Endometriosis can sometimes take years to diagnose, as symptoms may overlap with other conditions, such as irritable bowel syndrome (IBS).

Causes

The exact cause of endometriosis is not known, or fully understood. The leading theory is that of ‘Retrograde Menstruation’.

Retrograde menstruation: This occurs when menstrual blood flows backward into the fallopian tubes instead of leaving the body, which may cause endometrial-like cells to stick and make deposits within the pelvis

Other factors may contribute:

Immune system disorders: A compromised immune system might fail to detect and destroy endometrial tissue growing outside the uterus.
Genetics: Endometriosis tends to run in families (mother, sisters, daughter), suggesting a genetic link.

Diagnosis and Treatment

Diagnosis of endometriosis can often be a challenging journey for many women. A thorough evaluation by a gynaecologist that manages endometriosis is often crucial for diagnosis. This usually involves:

Gynaecologist consultation and examination
Pelvic imaging such as ultrasound or MRI
Laparoscopy, a minimally invasive surgery to both diagnose and treat endometriosis by removing or destroying tissue.

Treatment options depend on your symptoms and goals:

Pain relief to alleviate symptoms
Hormonal treatments to suppress menstruation
Laparoscopic surgery for removing or treating endometrial tissue
Fertility treatments for those trying to conceive

Challenges

Women with endometriosis can suffer with the symptoms for years before it is diagnosed:

Symptoms may often be downplayed (‘Part of being a woman’, ‘It’s all in your head’)
Endometriosis can mimic other conditions (e.g. IBS, food intolerances)
An otherwise normal investigation (e.g. Pelvic ultrasound / MRI) can provide a false reassurance

If you’re experiencing pelvic pain, difficulties falling pregnant or other symptoms that could be explained by underlying endometriosis, it is important to consult a gynaecologist that specialises on Endometriosis.

Adenomyosis

While similar in some ways to endometriosis, adenomyosis is a condition where the endometrial tissue grows into the muscular wall of the uterus (the myometrium). This can lead to an enlarged and inflamed uterus, with more intense symptoms particularly related to menstruation.

Symptoms of Adenomyosis:

Heavy or prolonged menstrual bleeding
Severe cramping and pain during periods
A feeling of pelvic pressure or bloating
Painful intercourse

Unlike endometriosis, which can affect a variety of organs outside the uterus, adenomyosis is confined to the uterine muscle, but it can still cause significant discomfort and heavy periods.

Diagnosis and Treatment:

Diagnosis of adenomyosis can often be challenging. It often involves clinical suspicion, and imaging investigations such as pelvic ultrasounds or MRIs. Treatment options are similar to those for endometriosis and may include:

Pain relief with NSAIDs
Hormonal treatments to regulate or stop periods
Surgical options, including a hysterectomy in severe cases