Endometriosis: what a bloody mess. It’s a condition as common as asthma and diabetes, but not as often discussed. It’s estimated that one in ten women suffer from endometriosis. The condition can be so debilitating that women often need to stay home, missing work or other important activities.
What are the symptoms of endometriosis?
While ramped-up period pain is often associated with endometriosis, it doesn’t end there. The most common signs are:
- Cramps — Common PMS cramps generally show up right before your period. Pelvic pain caused by endometriosis can show up days (even weeks) earlier than the expected PMS discomfort.
- Gastrointestinal or bladder issues — Sometimes the uterine lining can travel and attach itself to the bladder or bowels and can cause painful issues like constipation, diarrhoea, or the feeling that you’ve got a UTI.
- Painful sex — If you’re feeling pain during deep penetration (as opposed to say, the insertion of the penis) your gynae may suspect endometriosis.
- Backache — endometrial glands can travel along the back or frontal wall of the pelvic cavity, which can cause back pain or stomach aches.
- Fertility issues — When endometriosis is severe, it can damage or block the fallopian tubes or distort the pelvic cavity, lowering your odds of reproductive success. Around 70% of patients with endometriosis will have no fertility issues. According to the American Society of Reproductive Medicine, up to 30% of women with endometriosis struggle to get pregnant, doctors are unsure whether it’s to do with endometrium distorting the pelvic anatomy, altering the chemicals that affect egg quality or the implantation environment of the embryo, or whether another factor affects how sperm move up the fallopian tube.
If you suspect something’s not right, go see your doctor, stat.
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Women and girls of reproductive age, mostly between 15 and 49. There is a hereditary element, but scientists don’t know if one gene or a family of genes predispose women to endometriosis. There isn’t a known equivalent of the BRCA gene (which indicates if someone has a higher risk of developing breast cancer), but scientists are trying to determine if one exists, to then help identify people needing laparoscopic surgery for endometriosis diagnosis.
How it grows
Endometriosis is thought to be linked to oestrogen levels, with research indicating that sufferers show resistance to progesterone, the other female sex hormone. This is one possible explanation for associated infertility, as progesterone is necessary to thicken the uterus lining each month. Without it, the uterus may be an unfavourable habitat for an embryo to embed and form a pregnancy.
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Because scientists believe the growth of endometriosis lesions is driven by oestrogen, patients are prescribed drugs to stop ovaries producing the hormone, which subsequently reduces pain, stops the problem progressing and reduces adhesion size. Typical medication includes the combined pill, progestogens, a progestogen IUD (like the Mirena coil); or a GnRH (gonadotropin-releasing hormone) agonist, which causes temporary menopause.
The aim is to alleviate pain by removing the endometriosis, dividing adhesions or removing cysts. Conservative surgery is usually done via laparoscopy (keyhole surgery). The surgeon will either cut out the adhesions (known as excision) or destroy them using heat or laser (ablation). Complex surgery is required when the endometriosis adhesions are spread across multiple organs, like the bowel or bladder.
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Chronic pain affects many women with endometriosis. This can lead to central sensitisation, whereby the more exposure a person has to pain, the lower their threshold becomes. Brain imaging studies have shown that chronic pain patients have a reduced volume of grey matter in the area associated with muscle control and sensory perceptions, such as memory and self-control.
Hysterectomy is a radical surgery for endometriosis and, if guidelines are followed, should only be considered if a patient hasn’t responded to other treatments. Most experts agree that it should only be used in adenomyosis (where adhesions grow into the uterus wall).