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Endometriosis

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Fast facts

What is endometriosis?

Endometriosis is a common condition that can affect women mainly during their child-bearing years. It occurs when cells that normally line the uterus grow outside the uterus. Endometrial cells can grow on the ovaries, the fallopian tubes and on the outer surface of the uterus, forming growths that can cause scar tissue and bleeding every month during a woman's menstrual cycle.

Causes

The tissue that lines a woman's uterus is called the endometrium. Normally, this tissue layer thickens once a month and is shed during a woman's period. This is known as the menstrual cycle.

Endometriosis occurs when cells from the endometrium grow in places outside the uterus, including the ovaries, fallopian tubes and outer surface of the uterus. Like the normal tissue lining the uterus, endometrium that grows outside the uterus also thickens and sheds once a month during a woman's period. However, because of the location of the endometrium, the blood and tissue cannot escape. This may result in blood blisters or scar tissue forming, which can irritate the surrounding tissue and organs.

Endometriosis. 

While it is not known exactly what causes endometriosis, some possible explanations for the condition include:

Retrograde menstruation

Retrograde menstruation, also known as backwards menstruation, occurs when blood and tissue shed during a woman's period flow backwards into the fallopian tubes and pelvic cavity, instead of out of the vagina. It is thought that during this process, endometrial cells stick to these structures, which can potentially lead to endometriosis.

Immune system disorder

It is thought that endometriosis can occur as a result of problems of the immune system. Normally your immune system will recognise and destroy any endometrial tissue growing in the wrong place. If your immune system is not working properly, then endometrial cells are able to grow outside of the uterus.

Risk factors

Endometriosis is a condition that mainly affects women during their child-bearing years. However, endometriosis can also occur in women who have had menopause, a condition called postmenopausal endometriosis. Postmenopausal endometriosis can either be due to endometriosis that started during child-bearing years continuing through to the period after menopause, or in some women, endometriosis can develop in the postmenopausal period.

An important risk factor for endometriosis is having one or more relatives (mother, aunt or sister) with endometriosis.

Signs and symptoms

Some women with endometriosis may not experience any symptoms at all, or may experience one or more of the following:

Methods for diagnosis

To work out if you have endometriosis, your doctor may ask you questions about your symptoms, give you a physical examination and conduct some diagnostic tests.

To rule out other conditions and look for signs of endometriosis, a doctor may perform an ultrasound scan, which uses sound waves to create an image of your body's internal organs. To be sure that your symptoms are caused by endometriosis, the doctor my also recommend a minor surgical procedure called a laparoscopy, which will enable them to see your pelvis and abdomen directly and look for endometrial growths. This involves the doctor inserting a thin tube with a camera on the end of it, called a laparoscope, into the abdomen through a small cut near the bellybutton.

Laparoscopic examination to diagnose endometriosis. 

Endometriosis can be classed as minimal, mild, moderate or severe based on the location, amount and size of the tissue growths that form. Minimal or mild endometriosis do not usually affect a woman's chances of getting pregnant. However, women with moderate or severe endometriosis may have difficulty getting pregnant.

Types of treatment

There is no known way to cure endometriosis, but there are medications that may help relieve some of the symptoms. Surgery to remove endometrial growths or remove part of the reproductive system may sometimes be required.

Medication

Pain relief

Over-the-counter pain-relief medication, such as aspirin, paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, may help relieve the pain and cramping associated with endometriosis.

Hormonal treatment

Hormonal therapies are sometimes used to shrink endometrial growths and help relieve some of the associated symptoms. Some common hormone treatments that may be prescribed to treat endometriosis include:

Surgery

Laparoscopic surgery

Endometrial growths can be removed during laparoscopic surgery, also called keyhole surgery, which involves placing a thin tube with a camera on the end of it into the abdomen through a small cut near the bellybutton. During this procedure, a laser is used to remove growths. This procedure may reduce the symptoms of endometriosis and increase your chances of getting pregnant naturally. Unfortunately, the growths and symptoms may come back a few years after the surgery.

Hysterectomy

In severe cases, surgery to remove the uterus may be needed to treat the condition. This procedure is called a hysterectomy. It is usually only performed if other available treatments do not work, as it prevents women from being able to become pregnant in the future.

Complications

Having endometriosis may lead to trouble getting pregnant. Women with endometriosis also have a slightly higher chance of developing ovarian cancer and another type of cancer, called endometriosis-associated adenocarcinoma.

Prognosis

The outlook for people with endometriosis depends on how severe it is and where the endometrial growths are located. The available medical and surgical treatments are usually effective at relieving pain in most women. In women with mild endometriosis, surgery to remove the endometrial growths can increase their chances of getting pregnant, while women with severe endometriosis who are having trouble conceiving may be able to become pregnant with in vitro fertilisation (IVF) treatments.

Prevention

As it is not known exactly what causes endometriosis, there is no particular way to prevent it.

References

  1. Endometriosis Care Centre of Australia [Online]. Available from: link here [Accessed 12th May 2014].
  2. link here
  3. link here
  4. Murtaghs General Practice

9 Most frequently asked questions (FAQs)

What is endometriosis?
Endometriosis is a common condition that affects women during their child-bearing years. It occurs when cells that line the womb grow in areas outside the womb. These cells grow and shed in response to hormones that regulate a woman's menstrual cycle. This can lead to tissue growths and scarring around organs in the lower abdomen.
What causes endometriosis?
It is not known exactly what causes endometriosis. It may occur as a result of retrograde menstruation. This occurs when blood and tissue that is shed during a woman's period flows backwards into the fallopian tubes and pelvic cavity, instead of out of the vagina. It is thought that during this process, endometrial cells stick to these structures, which may lead to endometriosis. Another possibility is that endometriosis occurs as a result of the immune system not working properly, which means that your body doesn't recognise and destroy any endometrial tissue growing in the wrong place.
What symptoms are associated with endometriosis?
Some women with endometriosis may not experience any symptoms at all, while others may experience pain or cramping in the lower abdomen during and between periods, pain during sex and changes in menstruation, such as heavy bleeding or long or short periods.
How is endometriosis diagnosed?
Endometriosis can be very difficult to diagnose. A doctor will usually begin with collecting a medical history, performing a physical examination and conducting some diagnostic tests to rule out other conditions that could be contributing to the symptoms. For a final diagnosis, the pelvis and abdomen may need to be seen directly through a minor surgical procedure called a laparoscopy, in which an instrument with a video camera is used to examine the pelvic organs.
How is endometriosis treated?
Endometriosis may be treated with pain medications and hormone therapies to help relieve some of the symptoms. Sometimes surgery to remove endometrial growths or remove part of the reproductive system may be required.
Who gets endometriosis?
Endometriosis can affect any woman of child-bearing age. Women who are obese, or who have a close family member with the condition, are more likely to be affected. The symptoms of endometriosis usually go away when a woman reaches menopause and stops having periods.
Can endometriosis be prevented?
There is no known way to prevent endometriosis, but there are some things that may reduce your risk of developing the condition or reduce the severity of symptoms, including exercising daily and taking an oral contraceptive pill.
Does endometriosis affect fertility?
Endometriosis is a common cause of infertility, but not all women with the condition will have trouble getting pregnant. In cases where endometriosis is affecting fertility, laparoscopic surgery to remove endometrial growths may increase the chance of getting pregnant naturally. IVF treatment may also help women with severe endometriosis get pregnant.
Is endometriosis serious?
Endometriosis can be serious depending on the amount and location of the endometrial growths. In severe cases, endometriosis can cause extreme pain that can prevent women from carrying out everyday activities. There are medications and surgical treatment options available that can help to relieve the pain associated with the condition.

Related topics

Periods

A period occurs as part of a woman’s normal menstrual cycle, first starting between the ages of eight and 16 and continuing until menopause. An average menstrual cycle is 28 days. During a period, the uterus sheds its inner lining and this passes out through the vagina, with bleeding usually lasting two to seven days. Periods may be accompanied by period pain, menstrual headaches or migraines.

Polycystic ovary syndrome (PCOS)

Polycystic ovary syndrome (PCOS) is a long-term condition in women causing an imbalance in sex hormones. Symptoms include weight gain, acne, and increase in facial or body hair, which can all affect self-esteem. There are a range of treatments available to help manage the condition.

Premenstrual dysphoric disorder

Premenstrual dysphoric disorder occurs when a woman experiences severe psychological and physical symptoms before menstruation. The symptoms experienced are more severe than those of premenstrual syndrome.

Premenstrual syndrome (PMS)

Premenstrual syndrome (PMS) describes a range of physical and psychological symptoms that can occur in the two weeks before a woman has her period (also known as menstruation).While PMS symptoms are generally relatively mild and manageable, for some women they can be severe, to the point where they cause distress and disrupt normal activities.

About this article

Title: Endometriosis

Author: Dr Joanne Van der Velden PhD, BSc (Hons)

First Published: 18 Sep 2014

Last reviewed: 17 Jan 2022

Category: Information on Endometriosis

Average rating: 4.2 out of 5 (1163 votes)

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