Dealing with endometriosis

Approximately 10 per cent of women of childbearing age have some form endometriosis - a condition that affects the lining of the womb and can cause both pain and infertility.

What is it?
Endometriosis is a condition whereby the tissue that normally forms the lining of the womb (endometrium) is found outside the womb. This misplaced endometrial tissue is most commonly found in the pelvis, but more rarely it can be elsewhere in the abdominal cavity. Just like normal endometrium, this tissue thickens under the influence of ovarian hormones during the menstrual cycle, and then bleeds if a pregnancy does not occur.

The exact cause of this condition is not known, but the most popular theory is that the endometrial tissue gets into the pelvis by passing backwards along the fallopian tubes during a period.

How common is it?
It is estimated that about 10 per cent of women of childbearing age in the UK have some degree of endometriosis. It sometimes runs in families, so is more common in close blood relatives of affected women. It is also more common in women who had their first period at an earlier than average age. It is less common in women who have been taking oral contraceptive pills.

What are the symptoms?
Many women with endometriosis have no symptoms at all, and the diagnosis is made at the time of a laparoscopy for other reasons - sterilisation, for example. When symptoms do occur, they vary greatly in severity. Some relate to the shedding of blood around the time of the period, while others relate to the tendency for endometriosis patches to 'glue together' pelvic tissues. Patches of endometriosis on the ovaries can lead to the formation of ovarian cysts, which fill with blood.

Painful periods. The pain often begins a few days before the period starts and usually lasts for the entire period. The type of pain is different from regular period pain. Painful sex. This pain is felt deep inside and can last for several hours after sex. Lower abdominal and pelvic pain. This can occur at any time but is usually worse around the time of the period. Infertility. Even small pelvic deposits appear to reduce fertility, and the reason for this is unclear. Endometriosis can damage the fallopian tubes, leading to infertility. Pain on passing urine or pain when having a bowel movement may occur if there are endometrial deposits on the bladder or bowel.

How is it diagnosed?
The only reliable way to diagnose endometriosis is by a laparoscopy, a tiny instrument that enables the specialist to view the internal organs.

What treatments are available?
If there are no symptoms and fertility is not an issue then no treatment is necessary. Mild symptoms can be treated with simple measures such as paracetamol or anti-inflammatory tablets such as ibuprofen. In more severe cases there are a number of hormonal treatments available, the simplest being the oral contraceptive pill, which can be 'tricycled' to produce a light, three-monthly period.

Women with very severe symptoms may require more aggressive hormonal treatments, but their use can be limited by side effects such as weight gain and excessive hair growth. However, newer hormonal treatments have been developed that cause fewer side effects, but these can only be taken for six months at a time.

Sometimes, surgery is advisable to remove some of the larger patches of endometrium or to remove cysts. Hormone treatments are not suitable for women with fertility problems who wish to become pregnant, and surgery may be the best option for them.

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