With an estimated 1 in 10 women affected, WUKA experts discuss what is Endometriosis, how it's diagnosed and what treatments are available.
What is Endometriosis?
For 10% of women between the ages of 15 to 49 approximately, Endometriosis is a painful yet difficult to diagnose condition. It’s estimated that around 2 million women in the UK suffer from it, wit numbers drastically falling once menopause occurs. But what exactly is Endometriosis, and why is it so hard for women to get a diagnosis and proper treatment?
Mr. Hemant Vakharia, consultant gynaecologist at London Gynaecology told us:
“Endometriosis is an oestrogen driven, chronic inflammatory condition that most commonly affects pelvic organs, but can also in some cases can occur at different areas of the body including the bowel, diaphragm (a muscle that sits at the base of the chest) and in the chest cavity. It can present in several ways. Whilst pain is a major feature, the impact it can have on those who suffer with it can be enormous, which is why prompt diagnosis and treatments are crucial.”
And although prompt diagnosis crucial, reports suggest that for most women it will take on average 7.5 years to get to that point. A 2003 study in Brazil found that younger women were less likely to report their symptoms, thus leading to a delay in diagnosis.
Overall this study found that more needs to be done to recognise the symptoms. NICE (the UK’s National Institute of Health and Care Excellence) has published guidelines to help doctors reduce this delay, but more awareness is still needed so that women who are suffering can recognise the disease too.
What causes Endometriosis?
The direct cause of Endometriosis is still unknown, but there are theories as to why it occurs. Mr Narendra Pisal, consultant gynaecologist at London Gynaecology explained,
“There is no trigger as such, but the condition can worsen with every period you have. With Endometriosis, there is growth of endometrium (lining of the uterus) outside the womb, often in the pelvic area or ovaries. During a menstrual period, this endometrial tissue is also shed and can lead to further growth and spread of Endometriosis.”
A common theory suggests that endometrial tissue is deposited in unusual locations by the retrograde flow of menstrual debris through the fallopian tubes, into the pelvic and abdominal cavities. With this theory in mind, it’s thought that menses is a major cause.
Another theory, summarised in this study, suggests that endometrial cells are moved to other parts of the body by the lymphatic system or bloodstream. More research is needed into this theory, with scientists recognising the need to develop new treatments for women suffering with the condition.
It’s also been suggested that Endometriosis could be genetic, with doctors believing that the disease has a ‘genetic basis’ (1999 study), while other research has found that a ‘dysfunctional immune clearance’ along with a genetic predisposition could provide the ideal circumstances for lesions to grow. This is commonly known as Peritoneal Cells Transformation, or the Induction Theory.
Some doctors have also theorised that puberty could be a potential cause, with embryonic cells potentially transforming into endometrial cell implants with the help of oestrogen. A final theory is that endometrial cells could potentially attach to a surgical incision made during surgeries such as a hysterectomy or caesarean section.
How do I know if I have Endometriosis?
Endometriosis can often be mistaken for other conditions such as Ovarian Cysts or Pelvic Inflammatory Disease (PID because they all cause pelvic pain. It can also be mistaken for Irritable Bowel Syndrome (IBS) too.
Because it’s notoriously difficult to diagnose, we always recommend you keep up to date with vaginal examinations and its a good idea to be aware of the signs and symptoms too.
Symptoms of Endometriosis
Symptoms can start during the early stages of adolescence or later on in adulthood. They can be cyclical, meaning that they occur each time you have your period, or they can be present at all times. For some women, the symptoms are very severe, impacting on daily life and in some cases affecting fertility.
- Extremely painful abdominal cramps and back pain, especially during your period - but for some women this can also occur before. Heat can help to soothe period pain - try the WUKA Wearable Hot Water Bottle.
- Pelvic pain that is difficult to ease with painkillers.
- Painful bowel movements (a major reason why many are incorrectly diagnosed with IBS).
- Painful urination, especially during your period.
- Bleeding between periods.
- Painful sex, or pain after sex.
- Difficulty becoming pregnant.
How is Endometriosis diagnosed?
As already mentioned, Endometriosis can be difficult to diagnose, because the symptoms can vary considerably. Many other conditions can cause similar symptoms, not to mention the fact that lots of women assume that painful periods are just a normal part of the menstrual cycle.
The first step is to make an appointment to see your doctor and discuss the symptoms you’re experiencing. Different examinations can be carried out to determine the cause for symptoms and to get the diagnosis you need for treatment.
Saurabh Phadnis, consultant gynaecologist & gynaecological oncologist at London Gynaecology told us that a laparoscopy is a commonly used diagnostic tool:
“A Laparoscopy is systematic examination of the abdominal cavity. When patient is complaining of pelvic pain, it is essential that all areas of the abdomen are inspected for evidence of endometriosis. These include – Ovarian fossas on both sides (this is the area of peritoneum under the ovary), Uterosacral ligament and pouch of douglas (area behind the uterus), bladder peritoneum (in front of the uterus), ovaries itself, appendix, liver and diaphragm.”
Your doctor will then perform a biopsy to determine diagnosis.
There are a variety of different treatments available to you. Mr Narendra Pisal, consultant gynaecologist at London Gynaecology told us,
“Endometriosis is known to get better during pregnancy and after menopause as there are no periods. Medical treatment is often based on mimicking these two physiological conditions through medication.”
This treatment is usually used when the symptoms are mild. The most common used medication includes painkillers such as ibuprofen, which are pain relieving drugs that interact directly with the nervous system.
Hormones also can be effective in treating the symptoms of endometriosis. Mr Hemant Vakharia, consultant gynaecologist at London Gynaecology explains,
“Sometimes we use medication that induces a temporary menopause by blocking hormonal signals to the ovary. This reduced stimulation of the endometrial tissue. This option is often used before surgery for severe disease.”
Hormone therapy can be utilised in the form of a pill, a shot or injection or a nasal spray.
Research shows that some surgical treatments can provide significant, although short-term, pain relief from Endometriosis. Saurabh Phadnis told us that sometimes surgery is carried out immediately after a diagnostic laparoscopy:
"Once the condition is identified, the surgeon may proceed to treating this at the same time. This depends on the severity. Minimal spots of Endometriosis may be ablated using diathermy. Gold standard treatment is excision of Endometriosis. In more severe stages of the condition, extensive surgery including large bowel resection and anastomosis may be needed.”
There are some natural remedies you can try too, and a great place to start is your diet. Laura Southern is a nutritional therapist at London Gynaecology and she told us that nutrition can play a vital role in supporting the immune system and inflammation.
“Ensure your diet is high in brightly-coloured, fresh vegetables to support both immunity and detoxification. Choose from the green ‘brassica’ family, such as broccoli, Brussel sprouts and kale, and add lots of deep red and purple vegetables; beetroots, purple ‘heritage’ carrots, red onions, red cabbage. Make soups and stir fries to maximize vegetable intake.
“Include lots of foods rich in ‘essential fat’ for their anti-inflammatory benefits. Eat small oily fish such as salmon, mackerel, trout, herring and sardines two to three times per week and have a handful of raw nuts and seeds daily; try almonds, pumpkin seeds, pine nuts, walnuts and chia seeds. Use a good quality olive oil or flax oil on salads.
“Minimise caffeine, tobacco and alcohol, which all place strain on the liver. Also to ensure you optimise your nutritional levels it’s worth asking your GP to test your Vitamin D and iron levels”
Alternative therapies such as meditation, acupuncture and acupressure may also be beneficial.
What happens if Endometriosis isn’t treated?
Endometriosis is a progressive condition, meaning that it worsens over time- so prompt diagnosis and treatment is vital. It can also recur after treatment, so keeping up with regular check-ups is a must too.
Endometriosis won’t make it impossible to conceive, but it can make it harder. In mild cases there are often no fertility issues at all. But as the severity of the condition increases. Scar tissue adhesions become more frequent and natural conception can be more difficult.
Generally, it is believed that fertility problems increase with the severity of the disease and with age – as with women who do not have the condition.
If you’re worried, and you’re having difficulties getting pregnant, you should go and talk to your doctor, sooner rather than later.
Raised risk of cancer
Endometriosis is not a form of cancer. However, there is some evidence suggesting that it can very slightly raise the risk of a woman developing ovarian cancer. This risk is very low.
When to see your doctor
If you’re experiencing symptoms and they’re impacting your daily life, speak to your doctor immediately. Keep a track of your symptoms and be ready for your doctor to refer you to a gynaecologist for tests.
The bottom line on Endometriosis
Endometriosis is a chronic condition that can often bring much discomfort both physically and emotionally with a huge negative impact on your daily life. Although there’s no permanent cure, there are effective treatments readily available to help you manage the pain to make sure it does not impact your daily life.
There are also many ways to address any fertility issues that you may experience. After menopause, the symptoms of the condition usually improve.
Apart from getting support from your doctor if you have this condition, it might also be helpful for you to contact support groups like Endometriosis UK, for more information and advice.