What is endometriosis?
Endometriosis is a common condition which affects around 1 in 10 women across the world. Endometriosis occurs when tissue grows in places outside of the uterus where it does not belong and acts in the same way as the tissue which naturally lines the womb (endometrium).
This means that whenever a woman gets her period, that tissue sheds and bleeds much in the same way as normal womb tissue. However, unlike a normal period, this tissue cannot escape from the vagina and, because it grows in places like the ovaries, fallopian tubes, bladder, bowel and pelvic wall, it frequently causes intense pain, inflammation and sometimes scarring.
What are the symptoms of endometriosis?
The symptoms of endometriosis are diverse and wide-ranging (which often makes it difficult to diagnose), but the most common complaints are:
- Intense period pains which often cannot be relieved by normal painkillers
- Heavy periods – many women find they use a lot of sanitary products or bleed through their clothing
- Pelvic pain and abdominal pain
- Pain during or after sexual intercourse
- Sickness, diarrhoea, or constipation
- Fertility problems
How do I cope with endometriosis pain?
The most common symptom associated with endometriosis is that of chronic pain. For some of its sufferers, pain is debilitating, constant and essentially controls their life. As such, pain medication is often used to help try to alleviate some of the pain.
Non-steroidal anti-inflammatories (NSAIDs) such as Ibuprofen are recommended since they also help in minimising inflammation caused by endometrial growths. Taking the pain relief for a few days before your period is normally due can sometimes help.
For many endometriosis sufferers, pain is severe and so stronger medication, like Codeine, can be prescribed. However, this medication is known to cause constipation which can, in many people, worsen endometriosis symptoms.
For milder cases, applying heat, such as a hot bath or using a hot water bottle, can help soothe pain. Getting as comfortable as possible and keeping stress levels to a minimum is important.
Some women also find using a Transcutaneous Electrical Nerve Stimulator (TENS) machine helpful, as an alternative to pain medication. These are small electronic machines that can be attached to the skin and send electric pulses to the body. They will not hurt but may feel a little strange at first. They work to block the pain messages in the nerves and release endorphins. Check with your doctor before using this type of machine, as some women may be unsuitable.
What treatment options exist for endometriosis?
Endometriosis is a chronic, long-term condition which can seriously affect the lives of its sufferers. Although endometriosis is a challenging condition to cure, there are several treatment options, which aim to help relieve the symptoms and make life manageable, including pain medication, contraceptives and hormone medication, and surgery.
After you have been diagnosed with endometriosis via a laparoscopy (the ideal way to diagnose the condition), your GP or gynaecologist will discuss treatment options with you. They should outline the benefits and risks associated with each option so that you can determine which is right for you. Factors to consider include medical history, age, the severity of symptoms, whether you want to have children and any past treatments.
There are several reasons for undergoing endometriosis treatment, including pain relief, to slow down the growth of endometrial tissue, to help improve fertility and to prevent the endometriosis from returning.
What are the hormonal treatments for endometriosis?
Hormone treatments are used to try and stop the production of oestrogen, which encourages the growth of endometrial tissue. Some evidence suggests that each hormone treatment can be just as effective as the other at treating endometriosis symptoms, though side effects and individual suitability differ (for example, with cases of persistent severe pain).
Several hormone-based treatments exist, including:
Combined oral pill or contraceptive patch
This treatment is referred to as the combined pill because it contains both oestrogen and progestogen hormones. Many of us will know this as “the pill” and will associate it with an effective contraceptive birth control method.
However, in cases of mild endometriosis, the combined pill can be used to help relieve symptoms, by acting to stop ovulation and therefore hopefully make periods lighter and less painful.
Women with endometriosis are often advised to take the contraceptive pill continuously for three or more months, allowing for fewer periods and therefore less pain and bleeding.
Levonorgestrel-releasing intrauterine system (LNG-IUS)
This may also be known as The Mirena coil. It is a T-shaped contraceptive device which is fitted inside a woman’s womb by a doctor or nurse and is then effective for up to five years. It releases levonorgestrel, a progestogen hormone and works to prevent the womb lining from rapidly growing, thus also decreasing pain and periods; sometimes even stopping them altogether.
Side effects can include irregular bleeding for over six months, tender breasts and skin acne.
Gonadotrophin-releasing hormone (GnRH) analogues
GnRH analogues are synthetic hormones which work to cause a temporary menopause, by decreasing the production of oestrogen from the ovaries and therefore shrinking endometrial tissue as a result.
According to reports, this treatment reduces pain in over 80% of women, including those with severe pain.
There are several common side effects of using GnRH analogues and these are generally the same symptoms of normal menopause, such as hot flushes, night sweats, vaginal dryness, decreased libido, mood swings and insomnia. However, your doctor may prescribe you with Hormone Replacement Therapy (HRT) to help combat menopause symptoms.
Adult women can take a GnRH analogue for up to 6-12 months, meaning this is only a short-term solution. There are concerns over-using GnRH analogues for more than 12 months, such as bone density loss. One way to minimise bone density loss and treat the side effects is to take hormonal “add-back” treatment (adding very small amounts of either oestrogen or a synthetic progestin) in addition to the GnRH analogue.
These are synthetic forms of a natural hormone called progesterone and work to prevent the womb lining and endometrial tissue from rapidly growing.
Progestogens are recommended for women have not managed to get pain relief from the contraceptive options above, or who have been advised against taking hormonal contraception which contains oestrogen (such as smokers). However, there are several common side effects including bloating, weight gain, mood swings and irregular bleeding.
What are the surgical treatment options for endometriosis?
While laparoscopic surgery, also known as keyhole surgery, is the only way to reach a definitive endometriosis diagnosis, it can also be used to help treat the condition, by removing or destroying as much of the endometrial tissue as possible.
A doctor might recommend that laparoscopic surgery is the best option in cases where a woman has severe and constant pain which cannot be lessened by pain medications, or where they are having trouble getting pregnant and it is suspected that endometriosis is the cause. Additionally, if they have a growth or mass in the pelvic area, then surgery may be necessary to remove it and again determine if endometriosis is causing it.
The goal of laparoscopic surgery is to remove the troublesome endometriosis tissue. More than 80% of women who have surgery have reported a decrease in pain for several months after surgery. However, since endometriosis is a chronic condition there is a good chance that the pain will come back. The best way to reduce the likelihood of this happening is to ensure you continue with some form of treatment after surgery, such as hormone treatment.
This surgery is minimally invasive and carried out under general anaesthetic. Many people can go home the same day following a laparoscopy, though some could be asked to stay overnight.
This surgery is recommended rarely and only when laparoscopy is contraindicated. It involves a larger scar.
As this is a major surgery, the recovery time is longer than that of a laparoscopy.
Hysterectomy and removal of ovaries
This is a major surgery which cannot be reversed. It should be used as a last resort option.
It involves the removal of the uterus or ovaries. This type of treatment will usually only be carried out as a last resort, in very severe endometriosis cases and where all other treatment options have been exhausted. A woman will no longer be able to have children following a hysterectomy, so future children will be a deciding factor when deciding whether it is right for you.
Your doctor might recommend surgery to remove your uterus or ovaries, or both if:
- You have tried other treatments but continue to suffer severe symptoms
- You do not want to become pregnant in the future
- You want a permanent treatment
It is important to note that even after a hysterectomy there is no guarantee that endometriosis will not return, though this is unlikely.
Can endometriosis be cured?
Endometriosis is a chronic and challenging condition. However, treatment options exist which can ease symptoms and manage pain. A combination of long-term treatments generally helps to improve the lives of people with endometriosis.
To discuss endometriosis treatment in London, book a consultation today with our consultant gynaecologist who specialises in endometriosis.