Medical Guides - Endometriosis

What is Endometriosis?
Endometriosis is endometrium (the cells that line the womb) growing in abnormal places (ie places where it shouldn't!). You can therefore find these womb cells, that help nuture the fertilised egg during implantation, in abnormal places like the ovary, abdomen or the vagina.

How does it happen?
There is still debate about the exact cause but it may be caused by retrograde menstruation. That means instead of your period going out your vagina it is pushed up to the tubes, ovaries and abdomen. This is thought to "seed" these areas with cells from the womb. However, this explanation does not answer the very rare occurrance of endometriosis in distant sites.

Symptoms
Pain is the most common symptom reported in those that have symptoms. The pain can present in many different ways:

  • Painful periods and heavy periods (due to menstruation at other sites).
  • Constant or irregular pelvic pain (due to adhesions or scarring in the tummy and pelvis).
  • Painful intercourse (due to endometriosis in or surounding vagina).
  • Unexplained infertility (due to asymptomatic endometriosis and adhesions).


Diagnosis
The diagnosis can be made on history or symptoms but requires surgery to confirm. Laparoscopy is the surgical procedure prefered , that is the use of a tube-like telescope/video camera that goes into the body after it has been inflated with gas (CO2). This is allows your doctor to make the diagnosis and the same procedure can be used to treat the problem.

Treatment
Options include:

    Wait and See
    If endometriosis is present with mild or no symptoms then no treatment is needed.


    Hormonal
    Suppression of ovulation is the aim in this case and thus suppression of the endometrium. There are several differrent types of hormones that may be used:


    1. Oral contraceptives.
    2. Depo provera.
    3. Danazol, Gestrinone and GnRH analogues.

    These are in ascending order of affectiveness and ascending number of side affects. Looking at these hormonal or chemical forms of treatment:

      Oral contraceptives
      These are the most familiar medicine to most women. They are used in three month cycles so that there are no periods for the three months. This is done by avoiding the sugar pills or pill free days. It is an affective method in mild or moderate endometriosis. The usual contraceptive side affects apply. See our section on Contraception(The Pill).


      Depo Provera
      This contraceptive stops ovulation or eggs developing at the level of the brain. It is more affective than oral contraceptives but still has a failure rate. The side affects are the same as if it were to be used for contraceptive purposes. See our section on Contraception(Depo Provera).


      The Rest
      These medications will inhibit the womb tissue growth and effectively produce a kind of chemical menopause or masculine changes. The side affects are thus generally quite bad such as acne, excess hair growth, hot flushes and dry vagina. They are however very affective at controling the endometriosis. One other side affect they can have is bone mineral loss or mild osteoporosis. For this reason they can only be used for a certain amount of time. They also must be prescribed by a specialist only and be followed very closely by that specialist.



    Surgery
    As stated earlier the preferred surgery is laparoscopy. The surgeon may diathermy (electrically burn) or surgically remove the areas that are involved or in extreme cases remove the pelvic organs. This radical procedure is a last resort only. Surgery is also used to try to increase fertility if endometriosis is thought to be the cause of unexplained infertility.