Endometriosis

The endometrium is the name for the cells that line your uterus (womb). These cells respond to the hormones released from the ovary.

Endometriosis is a common disease in which the tissue that is similar to the lining of the womb grows outside it in other parts of the body. 

When pregnancy doesn’t occur each month, the tissue comes away from the body with bleeding - this is known as a menstrual period.

Endometriosis occurs when these cells move to other parts of your body. Although they can move to almost any part of the body, most commonly endometriosis occurs in the pelvis.

Even though this tissue (the endometriosis) is outside the womb, it still responds to the messages from the ovary - it gets filled, and then when you have a period it bleeds.

Common symptoms include pelvic pain that puts life on hold around or during a woman’s period. It can damage fertility. Whilst endometriosis most often affects the reproductive organs it is frequently found in the bowel and bladder and has been found in muscle, joints, the lungs and the brain.

Endometriosis is:

• Common - at least 1 in 10 women have endometriosis

• Chronic - because endometriosis rarely goes away without treatment before menopause, the goals of treatment are to control the symptoms of endometriosis, not to cure it

• Estrogen dependent - endometriosis is dependent on the hormone estrogen. Estrogen is produced by the ovary throughout the ‘reproductive years’; this means from the time you start having periods (puberty) to the time your ovaries shut down (menopause).

As long as you still have functioning ovaries you can still be affected by endometriosis. Once you go through menopause, your endometriosis will not be able to grow anymore.

Signs & symptoms of endometriosis:

The symptoms of endometriosis vary from one person to another.

Some women with endometriosis have no symptoms at all.

The 2 main symptoms that endometriosis causes are:

1. Pain - the pain occurs in the places that the endometriosis has grown. It is mostly in the pelvis. It happens with your period (cyclical). For a lot of women the first pain they notice is with their periods. Some women with endometriosis also have pain with sex.

2. Trouble getting pregnant (sub-fertility or infertility) - endometriosis can make it difficult to get pregnant. Because some women have no symptoms of endometriosis they might only get diagnosed once they start trying to get pregnant.

Other symptoms include:

• Fatigue.

• Pain that stops you on or around your period.

• Pain on or around ovulation.

• Pain during or after sex.

• Pain with bowel movements.

• Pain when you urinate.

• Pain in your pelvic region, lower back or legs.

• Having trouble holding on when you have a full bladder or having to go frequently.

• Heavy bleeding or irregular bleeding.
  
  

What causes endometriosis?

The cause of endometriosis are not fully understood. Women with a mother or sister with endometriosis are more likely to get it.

How is endometriosis diagnosed?

Worsening painful periods is a symptom that may prompt your doctor to believe you have endometriosis. An ultrasound can sometimes help with the diagnosis. However the only way to know for sure is to undergo a laparoscopy.
This is a surgical procedure where your gynaecologist uses a small telescope inserted through your belly button to look at the organs on the inside of your pelvis. Your surgeon will take photos and often take samples of the endometriosis to confirm the disease.

How is endometriosis treated?

The treatment of endometriosis often involves both medication and surgery. 

Most women who have endometriosis will require both of these treatments at different stags of their lives.

The choice of treatments depends on how bad the pain is, where the pain is, and if you are trying to get pregnant.

1. Medicines
   Pain relief medication like naproxen or ponstan

2. Hormone-based treatments
   - The oral contraceptive pill - using the pill to stop ovulation, the levels of estrogen on the pelvis are reduced and this can help settle the activity of endometriosis.
   - Mirena - this small device is placed int he uterus and it releases a progesterone-like hormone. It has been shown to reduce the acitivy and pain of endometriosis over time for many women.
   - Other types of progesterone-like hormones - these medications can help settle the activity of endometriosis when used over time.
   - GnRG-agoniosts - some implants and sprays can switch off the release of reproductive hormones in women. However, this can can induce a state like menopause that women may find unpleasant. It is unusual to use such medications alone for more than a few months, as there can be long-term side effects.

3. Surgery
   The surgery depends on the symptoms and location of the endometriosis.

4. Complementary treatments (physiotherapy, psychology, etc.)
   Using other health professionals such as physiotherapists, acupuncturists, nutritionists and psychologists can be very helpful for women with endometriosis. You should always discuss these treatments with your doctor before commencing them, or if you are on any of these treatments and are having surgery, then it is also important to tell your doctor as some treatments can interfere with surgery.

There is not one type of treatment to suit all women that have endometriosis. Each treatment is specific to that woman and her symptoms and condition of the endometriosis. You should always be well informed and educated of the different types of treatments available to you, as well as the possible side-effects and complications. Keep in mind you may require more than just 1 type of treatment for your endometriosis.

For more information please seek independent medical assessment from a doctor. 
This is general advise only.

For more great info head to Endometriosis Australia website.