Endometriosis
Endometriosis is a very common condition where deposits of the endometrium (the inner lining of a woman’s womb) grow outside of the womb, which can cause pain and other symptoms. The exact number of women with endometriosis is unclear because there are sometimes no symptoms, but estimates vary from 10% to 50% of women in the UK and it also frequently runs in families. It’s rare in women after the menopause. The endometrium consists of glands, lots of blood vessels and other supportive tissues and during the menstrual cycle, hormones cause the endometrium to thicken in order to nourish an embryo if a pregnancy occurs.
Endometriosis is an inflammatory condition where there is repetitive irritation from the deposits that are present outside of the womb. These deposits vary greatly in size from tiny to large, and can cause inflammation, and eventually scarring. This causes parts of pelvic organs to stick together, increasing the sensitivity of nerves and leading to chronic pain. The cervix (the neck of the womb) is commonly affected.
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Symptoms of endometriosis
Endometriosis often results in very painful periods (especially in teenagers) that can either come in cycles or be constant or long-standing pelvic pain. Alongside these more common symptoms, endometriosis can also present with a wide variety of other symptoms. Because of this, it can sometimes take time to reach the correct diagnosis.
Other symptoms of endometriosis include heavy periods (changing your tampon or pad more often than every two hours), bloating, pain or discomfort during sex, pain when opening your bowels or going for a wee, feeling tired all the time, and struggling to get pregnant.
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Over-the-counter treatments can help with the pain symptoms caused by endometriosis, although they won’t cure you of the condition or improve fertility.
You can take simple steps to ease the pain, such as using a hot water bottle, applying a heat patch, or taking a hot bath. Being comfortable and reducing stress will also be beneficial.
You can discuss with your pharmacist a trial of painkillers or anti-inflammatory medications such as paracetamol, co-codamol or ibuprofen. It can be helpful to start taking these a day or so before your period pain is expected.
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When should I see my doctor?
If you have symptoms you think could be explained by endometriosis, book a routine appointment with your doctor. Endometriosis can be tricky to diagnose, and your doctor will start with the basics of hearing your story, and if you are comfortable, examining you. Your doctor may then arrange further tests such as blood tests, or an ultrasound scan, followed by referral to the specialist team if they think it would be helpful.
Endometriosis treatment
Medical treatments for endometriosis aim to reduce your symptoms, assist you with managing the condition, and stop the disease from progressing. Painkillers can be increased to control the pain adequately. In about 30% of cases, the endometriosis clears by itself without treatment.
Your doctor may also discuss different hormonal treatments such as the contraceptive pill, or the coil, which aims to prevent ovulation and growth of endometrial deposits. The hormones aim to prevent the endometrial deposits from bleeding and causing inflammation.
Your doctor can also refer you for psychological support such as talking therapies, to assist with managing the symptoms and disease.
If you are referred to a specialist, they may consider doing a laparoscopy (keyhole surgery with a camera), to look at the pelvic organs and assess whether there are visible deposits. These can be sometimes treated surgically by either gentle scraping or removed using a laser or heat device.
If you’ve completed your family, and other endometriosis treatments haven’t worked then a hysterectomy – removal of the womb –may be an option.
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