Endometriosis - the facts

• Endometriosis is defined as the presence of endometrial tissue in sites away from the womb. Normally this tissue lines the womb (also called the uterus) only.

• Common sites of endometriosis include the ovaries, Fallopian tubes, lining of the pelvis, outside the uterus, rectum and bladder.

• The condition affects around 10% of women, with the average age of first diagnosis at 28 years old.

• Women with a family history of endometriosis have a 7-10% higher chance of being diagnosed with this disease.

• Around 30%-40% of women diagnosed with endometriosis will be termed "subfertile".

• The impact of women affected with endometriosis is so vast that GPs are fully aware of the significance of this condition. However, the average time to diagnosis is 8 years. If an earlier diagnosis can be made, the chances of some form of effective treatment can be offered.

CAUSES

The exact cause of endometriosis is not defined. However, accepted theories include:

• Retrograde menstruation – Backflow of menstrual blood containing endometrial cells through the Fallopian tube and into the pelvic cavity rather than out of the body

• Metaplasia – Transformation of cells lining the inner side of the abdomen (by hormones or immune factors) into endometrial-like cells

• Heredity – Studies have shown genetic predisposition to this disease in siblings

• Immune system disorder – Problems with the immune system can create an ineffective mechanism for the body to identify and destroy endometrial-like tissues growing outside of the womb

SYMPTOMS

• Pelvic pain

• Dysmenorrhea (painful periods)

• Pain during sexual intercourse

• Excessive bleeding

• Lower abdominal pain

• Back pain

• Pain when urinating

• Dyschezia (painful bowel movement)

• Fatigue, constipation, nausea, diarrhoea

DIAGNOSIS

During diagnosis, your doctor will go through your medical history as well as perform physical examinations. These include:

• Laparoscopy - This is the primary common diagnostic used for endometriosis as it has a sensitivity of 97% and can provide information about location, extent and size of endometrial implants

• Pelvic examination

• Transvaginal ultrasound

• MRI -Magnetic resonance imaging

TREATMENT

Treatment of endometriosis is dependent on the severity of the signs and symptoms. The treatment ranges from medication to surgery.

Pain medication - non-steroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen are recommended by doctors to help reduce the pain

• Laparoscopy – This procedure helps remove displaced endometrial cells without damaging vital organs

• Hormone therapy – This treatment method helps to lowers oestrogen production and this can be done using birth control pills, gonadotrophin-releasing hormone (GnRH) agonists and antagonists, progestin-only contraceptives and danazol (Danocrine)

Please see the video

Blog written by Caroline Lina Johnson-Mendy MMedSci