Endometriosis

Reviewed by Dr Philip Owen, consultant obstetrician and gynaecologist

What is endometriosis?

Endometriosis is a condition in which the tissue (endometrium) normally lining the womb (or uterus) grows on different organs outside the uterus.

If the endometrium grows within the muscular layer of the womb it is called adenomyosis, which is just a different type of endometriosis.

The commonest areas to be affected are:

the ovaries where cysts might appear; these are called chocolate cysts because they contain brown material.

the area behind the womb and in front of the rectum (large bowel). This space is called the Pouch of Douglas and endometriosis here often causes deep pain and painful intercourse (dyspareunia).

less common sites include the bowel itself, the bladder and sites outside the pelvis including the navel or operation scars.

Like normal endometrium, the endometriosis tissue undergoes monthly changes according to the hormonal cycle and typically causes painful periods (dysmenorrhoea).

Treatment is usually required if it causes painful symptoms.

Who is at risk of endometriosis?

Endometriosis is a very common condition affecting up to 10 per cent of women between 16 and 50 years of age, often without producing any symptoms.

Endometriotic tissue is under hormonal influence so it is almost never seen in children or postmenopausal women. In extremely rare cases, the condition is seen in men.

What causes endometriosis?

This is still uncertain, but the main theory suggests that during a period, light 'backward' bleeding carries tissue from the uterus to the pelvic area via the Fallopian tubes. This is called retrograde menstruation.

What does endometriosis look like?

It appears as small blackish-blue nodules on the external lining of the ovaries or elsewhere in the pelvis. In some cases it may lead to the formation of cysts filled with altered blood, known as chocolate cysts.

Is endometriosis painful?

Endometriosis might cause discomfort or mild to severe pain during a period (dysmenorrhoea), with many sufferers experiencing chronic pain. Sexual intercourse can be painful, and women with chocolate cysts may have a feeling of fullness in the lower parts of their stomach.

Does endometriosis affect a woman's chances of becoming pregnant?

In severe cases, formation of connecting tissues around endometriosis near the Fallopian tubes or ovaries may reduce fertility.

Fortunately, most women with endometriosis have a mild form of disease and their fertility is not impaired. Once pregnant, most women's endometriosis gets better under the influence of the constant high levels of female hormones produced in pregnancy.

How is endometriosis diagnosed?

Although the doctor may suspect endometriosis and start treatment on the basis of symptoms alone, usually the diagnosis is made through direct inspection of the pelvis. This is most commonly via laparoscopy performed by a gynaecologist.

Adenomyosis, in which endometriotic tissue is formed within the muscle of the womb wall, is usually difficult if not impossible to diagnose without performing a hysterectomy because it cannot be seen.

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