Understanding endometriosis, signs, diagnosed, how is it treated?

Endometriosis is a gynaecological condition that occurs when the lining of the womb, the endometrium, grows elsewhere in the body. It most commonly develops on the internal skin covering the pelvis (the pelvic peritoneum) and over the organs in the pelvic cavity, which include the uterus, ovaries, vagina, bladder and rectum.

The disease afects 10-15 per cent of women of childbearing age, some 2 million women in the UK, most commonly between the ages of 20-40. However, it can still afect a girl of 15 or a postmenopausal woman of 65.

During the menstrual cycle, the lining of the womb responds to hormonal changes in the body that cause it to thicken and shed. But in women with endometriosis, bleeding will occur wherever in the body this lining is present, leading to inflammation and pain. This inflammation results in scar tissue, which can fuse the pelvic organs together.

What are the signs?

Symptoms of endometriosis are wide-ranging and include lower abdominal/pelvic pain and infertility. Any such pain that lasts more than six months and doesn’t respond to painkillers should be investigated to rule out the possibility of endometriosis.

Getting a diagnosis

It takes an average of seven and a half years to get a diagnosis at present, with much unnecessary sufering, because women often assume pain is part of their ‘normal’ cycle. Endometriosis should be ruled out before treatment for IBS and recurrent cystitis is considered. The condition can’t be felt on examination until it’s advanced. Neither does it show up on ultrasound, MRI or CT scans. The best method is by visual inspection with a laparoscope, where a tiny camera is inserted into the pelvis.

How is it treated

Hormone therapy:
This aims to stop menstruation in the endometrial lesions, to reduce inflammation and pain. As women don’t menstruate during pregnancy, after menopause or if there are high levels of male hormones in the body, the drugs used usually mimic one of these situations. All drug treatment has various side efects, on occasion debilitating, so should not be used for more than six to nine months (except for the Pill and Mirena coil). Also, it should be avoided  if you’re trying to conceive, as it delays and does not improve chances of pregnancy. Nor does it reduce pain in all cases; those who do find relief can find themselves back to square one when treatment is stopped.

Surgical treatment:
This is more efective in terms of reducing pain and increasing fertility. Keyhole surgery should always be used, as the laparoscope magnifies the area, which allows the surgeon to survey the whole pelvis for patches of endometriosis, so it can be completely removed, which is impossible with open surgery. Two main methods are used: excision, where the endometriosis is cut away, and ablative surgery, which uses a laser to burn away the tissue. Ablative surgery is less efective, but it’s more often used, as it’s a quicker procedure and requires less expertise.
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