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What is endometriosis?

Endometriosis is where the female pelvis is affected by lesions that appear similar to the “lining of the womb”. The lining of the womb is called “endometrium” hence the term endometriosis. Because periods are a result of shedding of the “endometrium”, periods in women with endometriosis can lead to swelling, stretching, inflammation and scarring of areas affected. However, endometriosis is not cancer or an infection, and therefore is not contagious.

Where is endometriosis found?

Endometriosis is most commonly found in the pelvis, i.e. the lower part of the abdomen. When it occurs on the ovaries the endometriosis can forms cysts (endometrioma). These are also called “chocolate cysts”. It can also be found on the walls of the pelvis, the Fallopian tubes, the bowel, on top of the vagina, the bladder, as well as several other places

What causes endometriosis?

In spite of extensive research, the cause of endometriosis is not known. No one knows for certain why some women are affected and others not. Some people believe it is caused by menstrual fluid flowing backwards up the Fallopian tubes towards the ovaries, instead of out of the body through the vagina. Endometriosis depends to some extent on the female hormones oestrogen to grow.

What problems can endometriosis cause?

The most common problems are painful periods, pain during intercourse, lower abdominal pain and infertility. Occasionally endometriosis can cause pain when moving your bowels.

Does endometriosis cause infertility?

Infertility and endometriosis are strongly linked. In some women, not getting pregnant is the first and only sign of endometriosis. Whilst many normal fertile women have endometriosis, it is more common in infertile women. Some women only have a little bit of endometriosis and it is not entirely clear how this causes infertility, but research has shown that surgical treatment can improve the chances of pregnancy. In women with more severe disease where there is presence of scar tissue, ovarian cysts or blocked tubes, fertility may be compromised by the inability to transport eggs, sperm and or embryos. In women with severe disease where pregnancy has not been achieved within a reasonable amount of time, IVF offers the best chances of success.

How is endometriosis diagnosed?

The symptoms caused by endometriosis can be caused by other conditions. So, tests are usually advised to find the cause of the symptoms. The only way to be sure that a woman has endometriosis is to look at the internal organs inside the pelvis and abdomen. This needs to be done by an operation in hospital using a “key hole” telescope known as laparoscopy. With you asleep under anaesthetic, the laparoscope is inserted through a small cut in the skin in the navel. Ultrasound scans cannot generally detect endometriosis unless cysts due to endometriosis affecting the ovary are present.

How is endometriosis treated?

Treatment for endometriosis depends on your symptoms. For example if infertility is a problem, then you should be fully assessed for this. The type of treatment will depend on the severity of her symptoms, whether she wants to have children and how extensive the endometriosis is. If pain is the main problem then pain killers, the oral contraceptive pill or hormonal treatment may help. Surgical treatment removing the endometriosis is also an option.

Surgery for endometriosis:  

Surgery can be used to remove or destroy patches of endometriosis, or cysts in the ovary and free any adhesions (scar tissue) found. This may alleviate symptoms of pain and increase the chance of pregnancy if infertility is a problem. If in the most severe cases and where other treatments have not worked, a hysterectomy (removal of the uterus) and removal of the ovaries may be an option. These days most surgery for endometriosis can be performed by key hole surgery (laparoscopy).

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Find out more about Endometriosis and Fertility prepared by Dr Oliver O’Donovan

Endometriosis and fertility