What is endometriosis?
Endometriosis is a condition when the ‘lining of the uterus’ (also known as endometrium) is found outside the uterus. During menstrual period, this endometriotic tissue also bleeds and swells up but unlike the cells in the womb this blood has nowhere to escape. That’s why pain during periods is a common symptom of endometriosis.
The common sites for endometriosis are behind the uterus (along uterosacral ligaments), ovaries and bowel. Endometriosis is very common affecting 10% of women in the UK, although not all will experience the symptoms. It affects women of child bearing age regardless of race and ethnicity.
What are the symptoms of endometriosis?
In addition to pain during periods, pain associated with intercourse is also a typical symptom of endometriosis. Sometimes this pelvic pain can last throughout the cycle. Pain can also be associated with endometriotic ovarian cysts (chocolate cysts or endometrioma) and involvement of bowel. Bowel involvement (rectovaginal septum endometriosis) is relatively uncommon but may lead to severe symptoms during periods.
How do you diagnose endometriosis?
Clinical history and examination often make the diagnosis of endometriosis obvious. If the endometriosis involves the ovaries, these cysts can be diagnosed during an ultrasound scan.
A laparoscopy (look inside the abdomen with a telescope) is the best way to confirm endometriosis. This procedure is carried out under general anaesthetic and often treatment can be performed at the same time.
What is the treatment for endometriosis?
Endometriosis can be treated by medical or surgical means. Tri-cycling the contraceptive pill (taking 3 packs together without a break) is the easiest way of treating endometriosis. This way you achieve a longer gap between periods giving your body a window of opportunity to heal the endometriosis.
Laparoscopic (key-hole) surgery is often the best way to cure endometriosis. Endometriosis can be either excised or ablated during key-hole surgery.
If you are trying for a pregnancy, pregnancy itself can act as treatment for endometriosis as you don’t get periods for up to 12 months if pregnant!
How can you prevent recurrence of endometriosis?
Recurrence of endometriosis occurs in 15% of cases. Your surgeon may recommend either taking hormone injections or tri-cycling the pill after your procedure. Mirena IUD is also associated with reduction in risk of recurrence.
Can endometriosis affect fertility?
Endometriosis can make it more difficult for you to get pregnant depending on the degree of involvement. Surgical treatment of endometriosis is associated with increase in the chances of spontaneous conception and also of IVF pregnancy rates.
If you have endometriosis and are pregnant it is unlikely to cause pregnancy complications. In fact pregnancy can sometimes reduce the symptoms, although these can return after birth and breast feeding when the cycle returns to normal.