Endometriosis is a long-term condition caused by the presence of tissue that is similar to the lining of the womb (endometrium), growing in places outside the womb. These tissues react to the naturally circulating female hormones, just like the womb lining, leading to inflammation of the surrounding tissue and subsequent pain.
Endometriosis tissues are usually found in the pelvis and around the womb, commonly involving the ovaries and fallopian tubes. In some cases, organs local to the pelvis such as the bladder and bowel, or organs distant from the pelvis such as the liver and lungs may also be involved.
Endometriosis affects 1 in 10 women in the UK and is recognised as one of the most common gynaecological conditions affecting women. It mostly occurs in women of childbearing age and usually disappears after menopause.
Symptoms of endometriosis
Women with endometriosis can be affected by the condition in a variety of ways. The most commonly reported and often the most debilitating symptom is pelvic pain. The pain may be cyclical (in sync with the bleeding phase of the menstrual cycle), or it may be continuous (chronic, persistent pelvic pain). It may also cause irregular or heavy periods. Some women report deep pain during or after sexual intercourse. If the endometriosis involves the bladder or bowel, women may report pain or bleeding when passing urine or opening their bowels. In contrast to this, some women report no pain or related symptoms at all, but have the diagnosis made during investigation for other gynaecological issues such as fertility problems.
The classification system that doctors commonly use to categorise the severity of endometriosis does not always correlate with the severity of symptoms or the magnitude of its effect on a woman’s quality of life.
Diagnosis and treatment of endometriosis
Endometriosis is one of the most challenging gynaecological conditions to diagnose and treat, due to the wide spectrum in which it manifests, and the often quite non-specific symptoms. Depending on the location and size of the lesions, endometriosis tissue may not always be visible on imaging (Ultrasound, MRI) and in some cases can be difficult to spot during keyhole surgery (laparoscopy).
Since endometriosis tissue itself is benign (i.e. not cancerous) not all women with endometriosis will require treatment. Treatment options should be tailored to the individual - taking into account their symptoms, the effects of their symptoms on lifestyle and quality of life, and their family planning wishes. Treatments for endometriosis include painkillers, hormone medicines and surgery to remove the endometriosis tissue.