Expert / 17 March, 2021 / Dr Larisa Corda
Endometriosis involves tissue which normally lines the inside of the womb, being found in the muscle of the womb or outside of it. Instead of being shed each month, it can build up around other organs, such as the bowel or bladder. This causes scarring that can ultimately lead to pain or infertility. It can affect a woman at any stage of her life.
The symptoms of endometriosis are varied. Whilst some women are badly affected, others might not have any noticeable symptoms. There is also no apparent correlation between the severity of symptoms and the extent of the disease, as many women who have mild symptoms can end up having wide spread disease, and vice versa.
The cause of endometriosis is not yet fully understood. We know it has a slightly higher chance of occurring if you have a mother or sister with the condition, but the main cause is likely to environmental or, in other words, non genetic.
One possible cause could be some of the womb lining flowing up through the fallopian tubes and embedding itself on the organs of the pelvis, rather than leaving the body as a period. Another hypothesis is a problem with the immune system that means the body’s defence system goes into over drive and creates inflammation. Or cells that belong to the lining of the womb spreading to other parts of the body through the blood and lymphatic system.
It’s likely the condition is caused by a combination of all these different factors.
Common symptoms include painful or heavy periods, pain during sex, or pain with bowel movement or urination.
Sometimes the pain occurs at other phases of the menstrual cycle and can be incredibly debilitating. Many women need time off work, and are unable to do normal activities. Because the condition is partially associated with inflammation, which is when the body’s defence mechanisms go into over drive, management starts off with alleviating inflammation through lifestyle measures. These include diet, exercise, stress relief and reducing your exposure to endocrine disruptors in any products you may be using. It is also vital to cut out smoking and alcohol.
If this isn’t enough, then there are a whole range of medical interventions that can be used, that vary between contraceptives such as the pill or Mirena coil, to surgery.
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Depending on how extensive the endometriosis is and what your symptoms are, your doctor will discuss the various management options with you. The more drastic the treatment, the greater the risk it carries, in particular with more extensive surgery. There is also a significant chance that endometriosis can recur. Medical and holistic management is really important as too much surgery, whilst initially improving symptoms, can in itself cause scarring and damage to surrounding organs. Treatment must involve a careful balanced approach. If you have extensive endometriosis, it’s important you’re managed in a multidisciplinary centre to be able to offer you the best guidance and management in this.
Diagnosing endometriosis is difficult and most cases are suspected on symptoms alone. There is new research emerging to suggest that the severity of period and bowel related symptoms appears to indicate the size of endometriosis and also how extensive it is in the pelvis.
Not everyone will need an operation to diagnose the condition, as sometimes we can find clues on an ultrasound scan. A laparoscopy or keyhole surgery is the gold standard for diagnosing it definitively and can also be used to treat it. A laparoscopy is where a surgeon passes a thin tube through a small cut in your tummy so they can see any patches of endometriosis tissue. Sometimes this is the only option for women who can’t take contraceptives for medical reasons or because they wish to become pregnant.
Infertility is one of the main complications of endometriosis, and this needs to be managed carefully between an endometriosis and fertility specialist. They will discuss various options, such as whether surgery is needed and whether to do this before or after any fertility treatment.
Learning to recognise what isn’t normal and seeking help as soon as possible from your doctor if you have any worrying symptoms is vital, as well as utilising lifestyle strategies to help manage your symptoms in the long run. Your GP can refer you to a gynaecologist who can then assess you and undertake investigations.
Two million women in the UK alone are affected by endometriosis, yet you may be surprised to find that it takes on average between 7 to 10 years to diagnose.
Up to 31% of women suffer from a sexual dysfunction, such as pain, or problems conceiving, yet never go and seek medical help for this. There seems to be a problem with our society finding period talk shameful or embarrassing, and doctors not doing enough to investigate symptoms such as painful menstruation.
In truth, due to the taboo and lack of awareness surrounding conditions such as endometriosis, it remains under-diagnosed and festers for many years, causing scarring that is not just internal, but also psychological. This is due to the many debilitating symptoms it inflicts on the women affected. Being diagnosed is just the first hurdle for many. Suffering often persists due to lack of effective management being instituted early, leading to crippling anxiety, social isolation and depression that affects every area of a woman’s life, from her relationships to her career, tragically even leading some women to take their own life.
Reversing these statistics is a priority as well as ensuring that the condition is diagnosed as early as possible, before it has a chance to cause long term physical and psychological damage. It’s time we started discussing endometriosis and gynaecology much earlier in life and removing the current stigma and taboo that exists around it.
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