Endometriosis

This is a condition where tissue, similar to the tissue which lines the womb (endometrium), grows outside of the uterus. This tissue may be found in several different places, including the ovaries, the fallopian tubes, the bowel, the bladder and the stomach.

Each month when a woman gets her period, these growths will respond to the body’s hormones by shedding and bleeding in much the same way as normal womb tissue. Unlike the cells in the womb, which leave the body through the vagina (a normal period), this tissue has nowhere to escape, which often causes inflammation, scarring and intense pain.Diagram of endometriosis

Some women with endometriosis will have mild or no symptoms, while others complain of severe pain and difficulty in conceiving. Endometriosis is a chronic, long-term condition which currently has no cure. It can have a significant impact on the lives of its sufferers, though there are several treatment options available to help, depending on individual circumstances.

1 in 10 women are affected by endometriosis – that’s 176 million women worldwide. Despite it being a common gynaecological condition, unfortunately, the disease is still widely misunderstood, under-discussed and under-researched within the medical field. However, The London Women’s Centre have much expertise in diagnosing and helping manage the pain and other symptoms of endometriosis.

What are the symptoms?

Symptoms of the condition are wide-ranging and diverse, meaning the disease can present itself in many different ways, varying from woman to woman. Endometriosis also shares its symptoms with several other health problems, which gives an indication as to why it is often so difficult to diagnose.

Symptoms can include:

  • Painful periods
  • Heavy, irregular periods
  • Pelvic pain not related to the periods
  • Pain during or after sexual intercourse
  • Lower back pain
  • Abdominal pain
  • Pain when passing urine
  • Pain when opening bowels
  • Bleeding from the bowel or the bladder during menstruation
  • Fertility problems
  • Long-term fatigue
  • Constipation
  • Diarrhoea
  • Bloating
  • Migraines
  • Difficulty breathing

The condition usually affects girls and women during the reproductive years and the most common symptom is the pain, which may occur at regular intervals or all the time, often worsening before or during the regular period. Pain may improve once a woman falls pregnant, or can disappear itself without treatment.

For others, treatment may temporarily improve symptoms, but the disease can return at any point. The condition is less common in women who have already experienced the menopause.

Why is diagnosing endometriosis so difficult?

Endometriosis is a difficult condition to diagnose for a variety of reasons. The symptoms of the condition are wide, varied and differ from woman to woman. Symptoms of endometriosis share characteristics with other conditions, such as irritable bowel syndrome (IBS) and pelvic inflammatory disease (PID).

Symptoms are often atypical and many doctors may lack experience in diagnosing the condition. Moreover, the only way to give a conclusive diagnosis is through surgery.

A detailed medical history in combination with clinical examination will give us clues as to whether you have endometriosis. The gynaecologist will ask questions about your period, the location and severity of pain you experience, whether sex causes discomfort and whether you have bowel problems.

Laparoscopy

Traditional teaching states that endometriosis cannot be diagnosed via ultrasound, x-ray, or other non-invasive methods. However, when a transvaginal ultrasound is performed by a specialist gynaecologist, it can detect rectovaginal endometriotic nodules, endometriosis between the rectum and the uterus and also urinary tract endometriotic deposits.

Currently, the only way to reach a definitive diagnosis is through laparoscopic surgery, also known as keyhole surgery, which allows the doctor to see the abnormal tissue inside the body.

A laparoscopy will be carried out under general anaesthetic. Small cuts are made in the abdomen and then a telescope is inserted into the body, allowing the doctor to look at the pelvis. A small biopsy may be carried out to confirm an endometriosis diagnosis.

The magnitude of the disease is categorised as mild, moderate, or severe, depending on the location, extent and type of tissues affected. However, women with mild endometriosis can have severe symptoms, while women with severe endometriosis can have little or no symptoms.

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Mr. Athanasias is our consultant who specialises in the management of endometriosis.