Gynaecology Endometriosis

What is Endometriosis?

Endometriosis is a very common condition where cells similar to those of the lining of the womb (the endometrium) are found elsewhere, usually in the pelvis and around the womb, ovaries and fallopian tubes. These cells react to the ovarian hormones the same way that the endometrium does. The sites where these cells are found will develop scarring and adhesions. It can affect women from every social group and ethnicity. Endometriosis is not an infection and it is not contagious. Endometriosis is not cancer.

Endometriosis

What could endometriosis mean for me?

The main symptoms or endometriosis are pelvic plain, pain during or after sex, painful sometimes heavy periods and for some women problems getting pregnant.

Endometriosis can affect many aspects of a woman’s life including her general physical health, emotional wellbeing and daily routine.

Endometriosis is common and many women may have no symptoms. It is estimated that between 2% and 10% of the women within the general population have endometriosis and that up to 50% of infertile women have endometriosis.

Endometriosis is a long-term condition which can affect women during their reproductive years (usually from their 20’s until their 40’s).

Women who have endometriosis may have the following symptoms/conditions:

  • Painful periods (dysmenorrhea) which do not respond to over the counter pain relief.
  • Some women have heavy periods
  • Pain during or after sexual intercourse (dyspareunia)
  • Lower abdominal pain
  • Pelvic pain which can be long term
  • Difficulty in getting pregnant or infertility
  • Pain related to the bowels and bladder (with or without abnormal bleeding)
  • Long term fatigue

Some luckier women do not have any symptoms at all.

  • Pain is a common symptom of endometriosis. The pain can be a dull ache in the lower abdomen, pelvis or lower back. Pain affects each woman differently, where it hurts, when it hurts and how much it hurts. The pain and side effects of endometriosis can make you feel depressed.
  • Most women with endometriosis get pain in the area between their hips (known as the pelvis) and the tops of their legs. Some women get pain only at certain times, such as during their periods, when they have sex or when they open their bowels. Other women have pain all the time.
  • Some women with endometriosis become pregnant easily while others have difficulty getting pregnant. The pain may get better during pregnancy and then recur after the birth of the baby. Some women find that their pain resolves without any treatment.

What causes Endometriosis?

During the menstrual cycle, under the influence of the female hormones oestrogen and progesterone, the lining (endometrium) of the womb thickens in readiness for a fertilised egg. If pregnancy does not occur, the lining is shed as a period.

Endometriosis occurs when the cells of the lining of the womb are found in other parts of the body, usually the pelvis. Each month this tissue outside the womb thickens and breaks down and bleeds in the same way as the lining of the womb. This internal bleeding is only minimal but causes inflammation and it is this inflammatory response which causes pain and adhesions which affect the reproductive organs.

Endometriosis commonly occurs in the pelvis. It can be found:

  • On the ovaries where it can form chocolate cysts
  • In or on the fallopian tubes
  • Almost anywhere on, behind or around the womb
  • In the peritoneum (the tissue that lines the abdominal wall and covers most of the organs in the abdomen)
  • Adhesions can form between affected parts of the body and nearby structures.
  • Less commonly, endometriosis may occur on or in the bowel and bladder, or deep within the muscle wall of the uterus (adenomyosis). It can also rarely be found in other parts of the body.

Why does Endometriosis occur?

It is not yet known why endometriosis occurs. A number of theories have been suggested but none have been proved. The most commonly accepted theory is that, during a period, light ‘backward’ bleeding carries tissue from the womb to the pelvic area via the fallopian tubes. This is called ‘retrograde menstruation’ and may well account for most of the common sites of endometriosis.

Diagnosis

For many women, it can take years to get a diagnosis. This is because:

  • No one symptom or set of symptoms can definitely confirm a diagnosis of endometriosis
  • The symptoms of endometriosis are common and could be caused by a number of other conditions such as irritable bowel syndrome (IBS) and pelvic inflammatory disease (PID)
  • Different women have different symptoms
  • Some women have no symptoms at all

There is no simple test for endometriosis. The only way to make a definite diagnosis is by a performing a laparoscopy. Living without a diagnosis can be distressing. Many women may fear the worst about why they think they are in pain or why they are having problems becoming pregnant.

What happens when I see Dr McMurray?

At your appointment, Dr McMurray will ask specific questions about your periods and pain. It is important that you provide as much information as possible, as this will help point to the correct diagnosis. You may find it helpful to write down your symptoms beforehand and take your notes along to the appointment with you. In this way, you will be sure to provide all the information required. Some women find it helpful to bring a friend or partner along with them as well. Dr McMurray will perform a pelvic ultrasound scan. This can sometimes gives clues about the presence of endometriosis, such as the presence of a complex cyst or a womb that is tilted backwards (retroverted).

If you have significant symptoms or findings on scanning consistent with endometriosis or if infertility is a concern then you will be offered a laparoscopy.

Making a decision about treatment

You should be given full information about your options for treatment. This should also include information about the risks and benefits or each option.

Several factors may influence your decision about treatment. These include:

  • How severe your symptoms are
  • Your age and whether you wish to have children in the future
  • Whether you want to become pregnant- some hormonal treatments which help to reduce the pain will stop you from becoming pregnant
  • How you feel about surgery
  • What treatment you have had before
  • You may decide that no treatment is the best way forward. This could be because your symptoms are mild, you have not had problems getting pregnant or you are nearing the menopause, when symptoms may get better.

What treatment can I get?

Pain Relief

Pain relieving drugs reduce inflammation and help ease the pain

Hormone Treatments

There is a range of hormone treatments to stop periods or reduce the number of periods that you have:

The hormonal methods include:

The combined oral contraceptive pill often taken 3 packets taken back to back to reduce the frequency of a period to once every 12 weeks

  • The intrauterine system (IUS e.g. Mirena Coil): this is a small T-shaped device which releases the hormone progestogen. This helps to reduce the pain and makes periods lighter. Some women get no periods at all with this.
  • GnRH analogues- these drugs induce a temporary and reversible menopause and is often used to give women a break from periods for up to 6 months.
  • Surgery

Surgery can be fertility sparing to remove areas of endometriosis or more radicle including a hysterectomy in women who no longer wish to have children. There are different types of surgery, depending on where the endometriosis is and how extensive it is. How successful the surgery is can vary and you may need further surgery. Dr McMurray will discuss this with you before any surgery.

  • Laparoscopic surgery is the usual method employed for this type of surgery
  • Open surgery is sometimes employed
  • In the most severe forms of endometriosis joint procedures may be undertaken with other types of surgeons including those who special in the large bowel (colorectal) and the bladder (urologists).

What if I am having difficulty getting pregnant?

  • Getting pregnant can be a problem for some women with endometriosis.
  • This can often be overcome with surgery
  • IVF may be necessary in the more extensive disease

Living with Endometriosis

Not all cases of endometriosis can be cured and for some women there is no long-term treatment that helps. With support many women find ways to live with and manage this condition.

Support

Support organisations provide invaluable counselling, support and advice

Useful Organisations: http://www.endometriosis.ie/

Complementary therapies

Complementary therapies include reflexology, traditional Chinese medicine, herbal treatments and homeopathy. They may be effective at relieving or helping to cope with chronic pain. Some women have found that dietary changes such as eliminating certain food types, such as dairy or wheat products, may help relieve symptoms. Therapies such as TENS, acupuncture, vitamin B12 and magnesium help some women with painful periods. There is currently insufficient evidence to show whether such therapies are effective at relieving the pain associated with endometriosis.

Geraldine Rudkins is one of the Southeast of Irelands leading Acupuncture & Herbal Medicine Clinic based in Kilkenny Ireland. Geraldine offers a wide range of natural healthcare alternative to modern medicine such as Acupuncture, Cupping Therapy and Chinese Herbal Medicine. Geraldine can be contacted at www.geraldinerudkins.com.

Is there anything else I need to know?

  • Taking the combined oral contraceptive pill (COC) pill or contraceptive patch treats the symptoms of endometriosis.
  • Becoming pregnant and then breast feeding helps endometriosis as they stop periods.
  • Some women find that recreational exercise improves their well being, which may help to improve some symptoms of endometriosis.
  • No treatment is guaranteed to work all the time for everyone.
  • Support groups are run locally for women with endometriosis.
  • Internet forums may be first place many women turn to for support. The quality of information can be variable.