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Endometriosis

What is Endometriosis

Endometriosis is an inflammatory gynaecological disease, which impacts the lives of approximately 1 in 10 individuals assigned female at birth. Endometriosis is common - affecting 200 million people worldwide, yet there is still a general lack of awareness about what endometriosis actually is.

Endometriosis is tissue similar, but not identical, to the lining of the uterus that is found elsewhere in the body. Endometriosis lesions are different in both structure and behaviour from the normal endometrium which is shed during a period. Endometriosis lesions can produce their own estrogen, and have higher numbers of ERβ receptors, which can cause higher prostaglandin production (leading to pain).

Endometriosis tissue has the appearance of red, black, white or clear lesions, or cysts called endometriomas or chocolate cysts, which are generally found on the ovaries (a chocolate cyst is a dark fluid filled cyst).

Endometriosis is commonly found on the ovaries, fallopian tubes, uterine ligaments, the outer surfaces of the uterus, the pouch of Douglas, on the bladder wall, on the bowel wall, or on the intestines. It has also been less-commonly found, in remote locations such as the lungs, diaphragm, in the nose, and extremely rarely, on the brain.

 

Endometriosis lesions can cause pain, infertility, organ dysfunction due to inflammation, adhesions, and scar tissue. (Adhesions are bands of scar tissue which can stick/glue organs together). There are 4 stages of endometriosis: minimal, mild, moderate, severe. The stages were primarily developed to assess fertility and have no bearing on pain or symptoms.

Symptoms do vary between women. Endometriosis can cause extremely painful periods and painful sex for some women, while others hardly experience any pain at all. Symptoms can also occur at any time of the month. For some people pain can occur during urination or bowel movements. 

Globally on average, it currently takes around 8-10 years from the onset of symptoms, before diagnosis. Reportedly as many as 30-50% of women, of reproductive age with infertility, have endometriosis. The cause of endometriosis is still unknown and unfortunately there is no known cure available.

Currently the only way to diagnose endometriosis is by laparoscopic surgery. The gold-standard for treatment is excision surgery to remove the lesions, adhesions and cysts.

Possible Sites of Endometriosis

Endometriosis and Adenomyosis image
Pelvic Adhesions image
Pelvic Adhesions image

Most common symptoms of endometriosis: 

  • painful periods 

  • abdominal pain between periods

  • bloating 

  • abnormal bleeding 

  • heavy periods

  • lower back pain 

  • painful intercourse

  • ovulation pain

  • premenstrual syndrome (PMS)

  • low energy, tiredness, fatigue

  • sub-fertility or infertility

  • bowel pain, diarrhoea/constipation

  • bladder problems/urgency/frequency/interstitial cystitis (IC)

  • hip pain  

Endometriosis symptoms can have a huge impact on the persons physical, mental and social wellbeing, and it can really effect their quality of life. Many women plan their holidays to not coincide with their period, and social arrangements can end up cancelled at the last minute if the pain becomes too much. Many women are forced to take days off work or school each month in order to cope with their pain, and some women have had to give up work because their employers cannot deal with their frequent absences.

Endometriosis pain symptoms
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