Endometriosis

Specialty of Obstetrics & gynaecology

What is endometriosis?

Endometriosis is a painful disorder where tissue that usually lines the womb (endometrium) is found outside of the uterus and in other parts of the body. The tissue appears in the abdomen on the ovaries, fallopian tubes, and ligaments that support the womb. Other areas for these growths may include the bladder, bowel, vagina, cervix and vulva. In more complex cases, they are found in the lung, arm, thigh or other locations.

What causes endometriosis?

The cause of endometriosis remains unknown. Some experts suggest that endometriosis occurs due to a process called retrograde menstruation. The menstrual blood flows back through the fallopian tubes into the pelvic cavity instead of leaving the body through the vagina. Another theory for the cause of endometriosis is that hormones transform cells outside of the womb into cells similar to those lining the inside of the uterus (endometrial cells).

What are the symptoms of endometriosis?

The symptoms of endometriosis can vary with some women are more affected than others. These can include:

  • Period pain that is not relieved by painkillers
  • Heavy periods
  • Infertility
  • Pelvic pain – this can occur just before the period or all of the time
  • Pain during and after sexual intercourse
  • Pain when going to the toilet
  • Blood in the stool
  • Fatigue
  • Gastrointestinal upsets - diarrhoea, constipation and feeling nauseous.

What is the treatment of endometriosis?

A laparoscopy can help to diagnose endometriosis, which usually shows the location, size and extent of the growths. There is no cure for endometriosis but there are treatments that ease the symptoms. These treatments include:

  • Anti-inflammatory painkillers
  • Hormone medicines and contraceptives – the combined pill, the contraceptive patch and the IUD.
  • Surgery
  • In some cases a hysterectomy is used to remove the womb.

Surgery and endometriosis

Surgery for endometriosis can alleviate pain. There are two options of surgery:

  • Conservative surgery – removes or destroys the deposits of endometriosis and is usually done using a laparoscopy. The endometriosis can be cut out by the surgeon or it can be destroyed using heat or laser. Surgery provides relief from symptoms but they can reoccur.
  • Complex surgery – this depends on the severity of the patient’s endometriosis. The surgery may involve different organs of the body that are affected by endometriosis, such as the bowel or the bladder.

The other option is radical surgery, which is considered if a woman has not responded to conservative surgery. This means either having a hysterectomy, which is the removal of the womb, or an oophorectomy, which is the removal of the ovaries.

Having either a hysterectomy or oophorectomy is a big decision as these procedures are irreversible and a woman might want to consider having a family.

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