All about Endometriosis

1 in 10 of everyone assigned female at birth suffers from endometriosis, a common chronic inflammatory condition where tissue, similar to the tissue that normally grows inside the uterus, grows outside of the uterus. The most common places where endometriosis occurs are the ovaries, the fallopian tubes, the bowel, and the areas in front, on the back, and to the sides of the uterus. It can also be found on the bladder and bowel. In some rare cases, it is found outside the pelvis (lung, skin, brain, diaphragm).

With endometriosis, the endometrial-like tissue acts as endometrial tissue would — it thickens, breaks down and bleeds with each menstrual cycle. But because this tissue has no way to exit your body, it becomes trapped. When endometriosis involves the ovaries, cysts called endometriomas may form. Surrounding tissue can become irritated, eventually developing scar tissue and adhesions — bands of fibrous tissue that can cause pelvic tissues and organs to stick to each other.

 

painful periods

Each woman with endometriosis will experience different symptoms, and the severity of the symptoms does not necessarily correlate with the seriousness of the disease. Common signs and symptoms of endometriosis include:

Painful periods (dysmenorrhea)
Pelvic pain and cramping may begin before and extend several days into a menstrual period. You may also have lower back and abdominal pain.

Pain with intercourse
Pain during or after sex is common with endometriosis.

Pain with bowel movements or urination
Most commonly experienced during a menstrual period.

Excessive bleeding
Heavy menstrual periods or bleeding between periods (intermenstrual bleeding).

Sometimes, endometriosis is first diagnosed in those seeking treatment for infertility.

Other signs and symptoms
You may experience fatigue, diarrhea, constipation, bloating or nausea, especially during menstrual periods.

The anticipation of recurrent pain or discomfort each month may also lead to feelings of anxiety, stress and depression. It is important to acknowledge these emotional difficulties that may arise from endometriosis.

 

 

The causes of endometriosis are not known, but there are some things that put women at greater risk.

Retrograde menstruation
Instead of menstrual blood flowing out of the body as usual, some travels backwards along the fallopian tubes and into the pelvis.

Metaplasia
When normal pelvic tissue turns into endometriosis.

Family history
Women who have a close relative with endometriosis are up to 7 to 10 times more likely to develop the condition.

Endometriosis family history
Diagnosing Endometriosis

A diagnosis of endometriosis is made based on the description of symptoms (symptom diary), plus additional investigations such as:

Clinical examination
When a doctor feels for abnormalities

Ultrasound
An imaging test using high-frequency sound waves

Laparoscopy
A surgical procedure to examine the inside of the abdomen via a thin telescope inserted through a small incision in the wall of the abdomen. If areas of possible endometriosis are seen, samples are taken to confirm the disease.  At present, laparoscopy with biopsy is the only definitive way to diagnose endometriosis.  Australian data indicate a prevalence of endometriosis of 11.4%, with people aged 30–34 years most likely to receive the diagnosis.

 

There are 4 stages or grades of endometriosis, depending how severe the disease is:

Stage/grade I (mild)
Small patches of endometriosis scattered around inside the pelvis.

Stage/grade 2 and 3 (moderate)
The disease is more widespread and can be found on the ovaries and other parts of the pelvis. There may also be significant scarring and adhesions.

Stage/grade 4 (severe)
The disease has spread to most of the pelvic organs.

stages of endometriosis

When you first present to your general practitioner with painful symptoms that may be caused by endometriosis, empirical treatment may be given that includes analgesia, hormonal contraceptives or progestagens. Empirical means you’re receiving treatment without a “definitive diagnosis”, but it is a good place to start.  If the symptoms are relieved, you may not need further investigation at that time. If these treatments do not resolve the pain and other symptoms, you should be referred to a gynaecologist who specialises in endometriosis.  It is a complex disease and not all gynaecologists have a speciality in this field, so make sure you seek guidance from your GP.

On average it takes 7 years for a woman to be diagnosed with endometriosis.  This is partly because doctors are not familiar with this complex illness, but also because women put up with the pain instead of seeking help. If you have a gynaecologist who specialises in endometriosis you will be diagnosed and treated quickly to relieve your symptoms.

Dr Swift has over 30 years’ experience in this specialised field as well as a finger on the pulse when it comes to the latest technology and advances.  He trains up and coming gynaecology students of talent and also has hundreds (if not thousands) of success cases demonstrating his authority in this field.

It is not normal to have severe period pain. If your pain is so severe that you are missing school, work and other activities, please seek help.