What is endometriosis?
The endometrium is the lining of the uterus. It thickens each cycle under hormonal influence and is shed as a period if pregnancy does not occur. In endometriosis, similar cells grow outside the uterus, most often on the ovaries, the back of the uterus, its supporting ligaments and the pelvic lining (peritoneum).
This tissue also responds to hormones, which can cause inflammation, adhesions and pain over time. Deposits on the ovary may form cysts filled with thick dark fluid, called endometriomas or "chocolate cysts".
What are the symptoms?
The severity of symptoms does not always match the extent of disease. Common symptoms include:
- Painful periods that worsen over the years and affect daily life
- Pelvic and lower back pain outside periods
- Deep pain during or after intercourse
- Painful bowel movements or urination during periods
- Difficulty conceiving
- Fatigue, bloating and changes in bowel habits
What causes endometriosis?
The exact cause is unknown. The most widely accepted explanation is retrograde menstruation, where some menstrual blood flows back through the tubes into the pelvis and cells attach there. Because this happens in most women but only some develop the disease, the immune system, hormones and genetic predisposition are thought to play a role. Having a mother or sister with endometriosis increases the risk.
How is it diagnosed?
Diagnosis begins with a detailed history and examination. Transvaginal ultrasound is useful for showing endometriomas and some deep deposits, and MRI may be used when needed. Small superficial deposits may not be visible on imaging, so laparoscopy may be needed for a definitive diagnosis. Current guidelines state that medical treatment can be started without laparoscopy in women with symptoms.
Treatment
Treatment is tailored to symptoms, age, fertility wishes and the extent of disease. The aim is to relieve pain, slow progression and protect fertility.
Pain relief
Non-steroidal anti-inflammatory drugs are the first step for period pain. They ease symptoms but do not treat the disease itself.
Hormonal treatment
Combined pills, progestogens and the hormonal intrauterine system reduce hormonal stimulation of the deposits and help control pain. GnRH analogues or antagonists may be considered in resistant cases. Hormonal treatments are not used while trying to conceive.
Surgery
Laparoscopic surgery is considered for pain that does not respond to medication, large endometriomas or deep disease affecting other organs. Surgery on ovarian cysts is decided carefully in women who want to conceive because of its possible effect on ovarian reserve.
Does endometriosis affect fertility?
Endometriosis is common in women with difficulty conceiving. Adhesions can impair tubal function, and cysts and inflammation can affect egg quality and implantation. Even so, many women with endometriosis conceive naturally. Assessment considers age, ovarian reserve, tubal status and the partner's semen analysis, and follow-up, insemination, surgery or IVF may be planned.
When should you see a doctor?
- Period pain stops you from going to school or work despite painkillers
- You have recurrent pelvic pain outside periods
- You have pain during intercourse
- You have not conceived after one year (six months if 35 or over) of regular intercourse
Frequently Asked Questions
Does endometriosis cause infertility?
Does endometriosis go away on its own?
Must a chocolate cyst always be operated on?
Can endometriosis turn into cancer?
Does diet help endometriosis?
Sources
The information on this website is for general information only and does not replace a medical consultation.
