Endometriosis is a condition which is increasingly recognised by doctors and patients. In its most severe form it is a distressing condition causing severe pain and subfertility. Some women have suffered from it for years before diagnosis; it can be difficult to diagnose, so if you are concerned about it, raise the subject directly with your doctor.
It is caused by the migration of cells that normally line the inside of the womb, to other sites in the pelvic area. It is thought that the cells move backwards through the Fallopian tubes. These tubes are not directly fixed to the ovaries but lie alongside them, so that if cells from the uterine (womb) wall do move backwards through them, they fall into the pelvic cavity and can attach to the ovaries, the outside of the fallopian tubes, the bladder, uterus, bowel and the pelvic wall.
The problem is that these cells act as if they are in the uterus. Every month they increase in size and then break down in the same way as when you have your period. Unfortunately, there is no way out as they are trapped in the pelvic area. Instead, they spread about and become sticky. Adhesions can then form between organs or to the pelvic wall. Swellings filled with dark blood can also form called 'chocolate cysts'.
These adhesions cause severe pain during your period, at ovulation, during sexual intercourse and when you open your bowels; symptoms can vary depending on where the adhesions are. The most common feature though, is increasing period pain which can start before you bleed and may continue through the whole of your period.
Endometriosis can affect fertility. If the fallopian tubes have become very stuck down, it may be difficult to conceive. Treatment options vary according to your age and your desire to become pregnant.
Diagnosis can only be confirmed by a laparoscopy. This is an operation in which a small opening is made near the tummy button, and a tube with a tiny camera at one end is inserted into the pelvic area. The camera enables the doctor to examine the pelvic area in detail and actually see the endometriosis. This allows for accurate assessment of the extent of the condition.
Treatment can be medical or surgical
Hormonal treatments aim to stop the production of certain hormones, thus preventing the stimulation of the endometriotic tissue. The hope is that the endometriosis will dissolve. Treatment can be in the form of tablets, or injections.
Treatments on offer which depend on the extent of the disease and the symptoms suffered include:
There are some other surgical treatments available if all other measures fail.
- Laparoscopic laser treatment
- Surgical excision of the affected tissue or organs
The National Endometriosis Society can provide you with further information.
The National Endometriosis Society
50 Westminster Palace Gardens
London SW1P 1RL
Helpline 020 7222 2776
National Endometriosis Society
This article published on
28 November 2005
Next review date 01/11/2013
Contraception and pregnancy