Endometriosis

AGE Most common between the ages of 30 and 45	GENDER
LIFESTYLE Not having had children is a risk factor	GENETICS Sometimes runs in families

Endometriosis is a condition in which endometrial tissue, which normally lines the uterus, is attached to other organs in the abdomen.

The lining of the uterus, known as the endometrium, is normally shed once a month during menstruation and then regrows. In endometriosis, some pieces of the lining are attached to organs in the pelvic cavity, such as the ovaries and the lower intestine. These pieces of endometrial tissue react to the hormones of the menstrual cycle and bleed during menstruation. The blood cannot leave the body through the vagina and this causes irritation of the surrounding tissues, which leads to pain in the abdomen and eventually scarring. Irritation of the ovaries may lead to painful cysts.

Endometriosis is a common condition, affecting as many as 1 in 5 women of childbearing age. Women who do not have children until they are in their 30s and those who remain childless are more likely to develop the condition. Severe endometriosis can often cause problems with fertility (see Female infertility).

The exact cause of endometriosis is not known, but there are many theories. One theory is that fragments of endometrium shed during menstruation do not leave the body in the usual way through the vagina. Instead, they travel along the fallopian tubes, from where they may pass into the pelvic cavity and become attached to the surfaces of nearby organs.

What are the symptoms of endometriosis?

Endometriosis may not produce symptoms. If symptoms do develop, their severity varies from woman to woman. Symptoms may also vary depending on which organs are affected by the condition. They may include:

Pain in the lower abdomen, which often becomes more severe just before and during menstrual periods (see Dysmenorrhoea).
Irregular periods or very heavy menstrual bleeding.
Pain during sexual intercourse.
Lower abdominal pain on urination.

If the endometrium grows on the lower intestine, you may develop diarrhoea or constipation, pain during bowel movements, and, in rare cases, bleeding from the rectum during menstruation.

What might be done about endometriosis?

In women who do not have symptoms, endometriosis may only be suspected following investigations for infertility. To help make a diagnosis, your doctor will carry out a pelvic examination. The diagnosis may be confirmed with a laparoscopy, in which the organs in the pelvic and abdominal cavities are examined using a viewing instrument.

There are many different treatments for endometriosis, and the one chosen depends on your age, which organs are affected, the severity of symptoms, and whether you wish to have children in the future. You may be offered hormonal or surgical treatment. In mild cases, treatment may not be necessary.

If your symptoms are troublesome, your doctor may prescribe one of several different hormonal treatments that stop menstruation for several months. These drugs may include the synthetic hormone gonadorelin, gonadorelin analogues, and danazol (see Sex hormones and related drugs), all of which suppress production of the female sex hormone oestrogen and have the effect of stopping menstruation. Alternatively, you may be given the combined oral contraceptive pill. This treatment is usually given for approximately 6-12 months, during which time the endometriosis should improve. If the condition does recur, it may be milder than before.

Small fragments of endometrial tissue that do not respond to a period of hormonal treatment may be destroyed by laser surgery during a laparoscopy. However, endometriosis sometimes recurs after this treatment, and further operations may be necessary.

If you have severe endometriosis and you do not plan to have children, your doctor may suggest that you have a hysterectomy to remove the uterus. Both ovaries will also be removed, together with other areas that are affected by endometriosis. If the ovaries are removed before you have reached the menopause naturally, you will develop menopausal symptoms. To alleviate these symptoms, your doctor may recommend hormone replacement therapy.

What is the prognosis?

Although treatment is usually successful, endometriosis may recur until the menopause occurs and menstrual cycles end. Endometriosis is unlikely to recur if the ovaries are removed.

Posted 09.09.2010

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