Endometriosis is a condition where tissue similar to the endometrium (that lines the inside of the uterus) also grows outside the uterus. These growths or “patches” occur most often in the pelvis and lower abdomen.
The most common sites for patches are the:
- Ovaries, uterus and fallopian tubes
- Uterosacral ligaments
- Inside the walls of the pelvis over the ureters (the tubes running from the kidneys to the bladder
- Pouch of Douglas
- Surface of the rectum and, less commonly the large and small intestine and appendix
Rarely patches occur in the upper abdomen, diaphragm, lungs, nasal passages, pharynx, caesarean section scar, umbilicus or elsewhere in the body.
The body’s reaction to patches can vary from no reaction at all to the growth of scar tissue around them. More extensive scar tissue, called adhesions, can also develop around the pelvic organs.
Endometriosis is common, occurring in about one in 10 women between the ages 12-50. However, not all have symptoms. A woman is more likely to develop endometriosis is her mother or sister has it. Endometriosis usually becomes inactive or less active after menopause. Patches of endometriosis can be found in women who have no pain and are fertile.
Types of Endometriosis
Endometrial implants – these are small patches, usually one to two millimetres across, or smaller.
Endometrial Nodules –These are of various sizes but usually are at least two to three millimetres across. Uncommonly, one may grow to four centimetres across.
Endometriomas – These are cysts in an ovary that can grow to 10 centimetres or more across. They are typically dark brown due to the presence of old blood in them and are often called chocolate cysts.
Adenomyosis – Endometriosis in the wall of the uterus is called adenomyosis. A troublesome non-cancerous tumour (adenomyoma) maybe present.
There are 3 degrees of endometriosis –
Mild – mild endometriosis appears as small patches scattered around the pelvic cavity, with no scarring.
Moderate – Moderate endometriosis appears as larger patches or patches that are more widely spread. They may be attached to other organs with cysts present and are often associated with significant scarring.
Severe – In severe endometriosis, most of the organs in the pelvic cavity are affected by numerous and large patches and severe scarring.
Symptoms of Endometriosis
Pain in the most common symptom, it may occur on one side or both sides of the abdomen, around the abdomen, deep inside the pelvic cavity, in the lower back or in the rectum. Pain is often different during menstruation. Endometriosis may be indicated by pain that is prolonged or gets worse as menstruation continues. The pain can be severe enough to interfere with work and social activities for one or more days during a period.
Pain during and after intercourse is a common symptom of endometriosis. If patches have attached to the bladder it may cause pain when passing urine, a frequent need to urinate, blood in the urine or aching in the bladder area.
Although mild endometriosis is not a major cause of infertility, about 3 or 4 women in 10 who have Endometriosis have difficulty in becoming pregnant. Endometriosis appears to cause infertility because the patches may release substances that:
- Decrease sperm movement
- Affect normal embryo development
- Adversely affect the development of the placenta
- Decrease the ability of the fallopian tube to capture the egg from the ovary after ovulation.
Moderate or severe endometriosis may also cause adhesions to form around a fallopian tube and ovary. Patches and adhesions can cause fallopian tubes to become narrowed, blocked or damaged. If the fallopian tubes do not work properly, then fertilisation is difficult.
Treatment for Endometriosis
Treatment for endometriosis may stop the progress of the disease. Several treatments are available. Choice of treatments will depend on:
- Severity of the symptoms
- How much endometriosis was found during diagnostic laparoscopy
- The age of the women
- The women’s planes to become pregnant
Some women with mild endometriosis are not greatly troubled by symptoms, and treatment may not be needed. If symptoms are chronic or severe, then a variety of treatments may be required including:
- Laparoscopy: Surgery can be effective for women who have mild, moderate or severe endometriosis. The aim of laparoscopic surgery is to remove patches, cysts and adhesions. It may be helpful in reducing pain and improving fertility.
- Laparotomy (open surgery): in cases of severe endometriosis, a laparotomy may be necessary.
- Hysterectomy: In severe cases of long term and painful endometriosis in older patients, the patient may choose to have her uterus removed. One or both ovaries and fallopian tubes may also have to be removed as well.
Hormonal treatment therapies are particularly effective in treating the pain associated with endometriosis. In cases of severe endometriosis, hormonal therapies usually do not work as well. Hormones have the advantage of treating small lesions that surgery may miss.
The contraceptive pill can help to relieve the pain of endometriosis. This is especially so if the tablets are taken continually for several months so that a period does not occur. This method is not suitable for women who are trying to become pregnant, as the contraceptive pill prevents pregnancy.
Treatment with progestagen taken every day, usually helps to relieve symptoms. Side effects are usually minor. Progestagens can also be given as an injection once every 12 weeks. As with the contraceptive pill, progestagens are not suitable for women who want to become pregnant.