There is no agreed theory to explain why endometriosis occurs however, there are claims that more than one million women suffer from it in the UK and the Endometriosis Society suggests that an average length of time to make a diagnosis is about seven years. The OXYGENE (Oxford Endometriosis Study) study has found that there does seem to be a genetic element to endometriosis. http://humupd.oxfordjournals.org/content/7/4/411.full.pdf
Endometriosis occurs when the cells of the endometrium (lining of the uterus) are found in other parts of the body. In the same way that the lining of the uterus swells and sheds each month as a period, these growths also swell and bleed, but as they are embedded in tissue, the blood cannot escape and so it forms blood blisters that will, in turn, irritate and scar the surrounding tissue which will then form a fibrous cyst around the blister.
This can also result in scarring on the ovaries, fallopian tubes and uterus which may then lead to infertility as they can make the transfer of an ovum(egg) from the ovary to the fallopian tube very difficult. They can also stop the passage of an egg down the fallopian tube to the uterus. Occasionally when the scarring is very bad, it can stick to the wall of the abdominal cavity and other organs which will be painful when it tears away and leaves scars.
It is believed to be caused by “retrograde menstruation” where fragments of the lining are shed backwards rather than through the vagina. Women may suffer no symptoms at all or they may be in great pain when they have a period or during sex and periods may be very heavy. Initial treatment will be with hormone drugs that either reduce or stop the periods altogether and which allow the blisters to heal, however, if the ovaries are affected then removal may be necessary.
• painful periods and pain/ache in the lower abdomen before or during your period
• pain in the lower back
• one of the most common symptoms is dull aches or sharp pains in the pelvis
• pain during or after sex
• pain with bowel movements
• painful urination
• more frequent or totally irregular periods
• spotting of blood before a period is due
In many cases, there may be no symptoms at all and the amount of pain experienced often bears no relationship to the amount of endometriosis found.
In all cases, it is necessary to perform a laparoscopy to confirm a diagnosis. In this case, two small incisions will be made in the abdomen under general anaesthetic, an amount of gas will be pumped into the abdominal cavity to enable a clearer site of the organs and a small camera will be inserted into the second incision so that the surgeon can see how clear the uterus is.
What Treatment is Available?
Consideration will be given to how severe the disease is, the woman’s age, her desire for children and how bad the symptoms are before a surgeon will make a recommendation about treatment.
Observation is often the first option, particularly for those who have no symptoms or whose symptoms are mild.
Pregnancy is thought to help reduce or clear endometriosis because of the increase in the ratio of progesterone to oestrogen.
Drug therapies may include pain relief only. They may involve the use of hormones to produce either a pseudo-pregnancy with contraceptives or a pseudo-menopause with gonadotrophinic drugs such as Danol, Decapeptyl, Dimentriose, Prostap, Suprecur, Synarel or Zoladex. Both of these drug regimes will reduce the amount of oestrogen produced by the ovaries. The hope is that as endometriosis reduces and often disappears when oestrogen is no longer produced (such as after menopause), then it will become dormant long enough for it to die off.
There are a number of side effects particularly linked to the pseudo-menopause regime which may include: menopausal symptoms as well as changes in bone density, weight gain, excess hair growth (due to the testosterone included in some). If you experience any such side effects you should discuss the treatment with your GP.
Progesterone may also be used to treat endometriosis and over a period of time, it can cause it to die off. However, side effects include oedema (water retention) weight gain, bloating, depression and spotting between periods.
Laser Surgery is used during laparoscopy to burn off the growths caused by endometriosis. Whilst it is reasonably successful, it is dependent upon the ability of the surgeon to remove even the smallest amount of endometriosis, as this can cause a re-growth to occur.