The tissue which lines the inside of the uterus is called the endometrium. In women of reproductive age (12 years – menopause) the tissue is broken down each month and shed as menstrual blood.
Endometriosis is a condition where the endometrium tissue is located in other sites of the body outside the uterus instead of being confined to the inside lining.
It is thought that this may happen for two reasons:
- Instead of the menstrual fluid flowing outside the body in the usual way, it flows back through the fallopian tubes.
- Patches of endometrium tissue may be deposited during the very early development of the reproductive organs.
Sites of Endometriosis
- Behind the uterus (called the Pouch of Douglas)
- The tissue below the ovaries (called the broad ligament)
- The bladder
- The bowel
- The vagina
- Rarely, it may occur in surgical scars, the navel or elsewhere
- Endometriosis affects 1 in 10 women
- It is commonly associated with infertility
- 3 out of 10 infertile women have endometriosis
- The surgical removal of endometriosis can help infertility
- Untreated endometriosis is associated with an increased miscarriage rate
- Women may have symptoms for many years before a diagnosis is made
- A laparoscopy is the most reliable diagnostic method
- Endometriosis can occur at any time between puberty and menopause
- Endometriosis frequently occurs during teenage years
The diagnosis of endometriosis is first suspected by taking a history of the woman’s symptoms.
Many women have been led to believe that pelvic pain, period pain and sexual discomfort are a woman’s ‘lot in life’ or are exaggerated Despite adequate information and knowledge of endometriosis some doctors still have this attitude and the final diagnosis can be delayed for many years while the woman continues to suffer.
The diagnosis relies on a doctor taking a thorough history, performing an appropriate examination and suspecting endometriosis. The only sure way to diagnose it is to actually see the endometriosis through a laparoscope.
The examination for endometriosis is best done by a gynaecologist who performs a vaginal ultrasound at the same examination. This allows the gynaecologist to see the most painful spots. Ultrasound cannot show most types of endometriosis but it will detect the ‘chocolate cysts’ of endometriosis inside the ovary. This is crucial information.
Blood tests for endometriosis are not reliable.
Symptoms of Endometriosis
- Painful periods. The pain usually starts several days before the period begins, but can sometimes occur during the period only
- Painful bowel motions
- Pain during or after sexual intercourse
- Other pain:
- Abdominal pain
- Leg/thigh pain
- Back pain
- Heavy bleeding
- Bleeding in between periods
- Irregular cycles
- Bleeding from the bowel
- Painful bowel motions
- Diarrhoea and/or constipation
- The need to pass urine frequently
- Pain on passing urine
- Poor performance at work because of pain
- Absenteeism because of pain
- Delay in getting pregnant