Endometriosis is a common, long-term condition where tissue similar to the lining of the uterus (womb), known as the endometrium, grows outside the uterus. These abnormal growths, called endometrial implants, are most commonly found in areas such as the ovaries, fallopian tubes, the surface of the uterus, bowel, and the pelvic lining (peritoneum).
Around 10% of women of reproductive age (typically between puberty and menopause) globally suffer from endometriosis, making it one of the most widespread gynaecological conditions [1]. This translates into approximately 190 million women affected worldwide, impacting their quality of life significantly [2]. Despite its prevalence, endometriosis remains poorly understood and often misdiagnosed, delaying appropriate treatment.
Anatomical and Physiological Details
In endometriosis, endometrial-like tissue behaves similarly to the tissue within the uterus: it thickens, breaks down, and bleeds during each menstrual cycle. Unlike the tissue inside the uterus, however, these implants outside the uterus have no natural exit route. This trapped blood and tissue cause inflammation, irritation, and the formation of scar tissue (adhesions).
Common sites affected by endometriosis include:
- Ovaries (where cysts called endometriomas or “chocolate cysts” often form).
- Fallopian tubes.
- Outer surfaces of the uterus.
- Peritoneum (lining of the pelvic cavity).
- Bowel and bladder.
In rare cases, endometrial tissue can be found in distant sites like the lungs, diaphragm (muscle below the lungs), and even the brain, although this is uncommon.
Symptoms and Clinical Features
Symptoms of endometriosis vary significantly between individuals, ranging from mild discomfort to severe, debilitating pain. Common symptoms include:
- Painful menstrual cramps (dysmenorrhoea) that worsen over time.
- Chronic pelvic pain not confined to menstrual cycles.
- Pain during or after sexual intercourse (dyspareunia).
- Painful bowel movements or urination, especially during periods.
- Excessive menstrual bleeding (menorrhagia).
- Spotting or bleeding between menstrual periods.
- Digestive issues, such as diarrhoea, constipation, or nausea, particularly during periods.
- Fatigue and exhaustion, often related to chronic pain and inflammation.
Notably, the severity of symptoms does not always correlate with the extent of the condition. Some individuals with mild endometriosis experience severe symptoms, while others with advanced endometriosis may have minimal or no symptoms.
Potential Complications
If left untreated, endometriosis can lead to several serious complications, including:
- Infertility: Approximately 30–50% of women with endometriosis experience difficulty conceiving [3]. Endometriosis can distort reproductive anatomy, block fallopian tubes, and create inflammatory environments detrimental to fertility.
- Adhesions: Scar tissue formation can bind organs together, causing chronic pain and disrupting normal organ function.
- Ovarian cysts (endometriomas): These cysts can lead to severe pelvic pain and potential damage to ovarian tissue, impacting fertility.
- Chronic pain and psychological impacts: Persistent pain can significantly impact mental health, causing anxiety, depression, and reduced quality of life.
Common Misconceptions
- Myth: Severe pain during periods is normal.
- Fact: While mild menstrual cramps are common, severe or worsening pain is not normal and could indicate endometriosis or other medical conditions.
- Myth: Pregnancy cures endometriosis.
- Fact: Pregnancy can temporarily alleviate symptoms for some, but it is not a cure. Symptoms often return postpartum.
- Myth: Endometriosis can be diagnosed via blood tests.
- Fact: Currently, there is no blood test for endometriosis. Diagnosis typically involves a detailed medical history, clinical examination, imaging tests (ultrasound or MRI), and often surgical confirmation via laparoscopy (a minimally invasive surgical procedure using a camera).
Management and Seeking Medical Advice
Early diagnosis and treatment can significantly improve quality of life for individuals with endometriosis. If you experience symptoms suggestive of endometriosis, it’s important to seek medical attention from a healthcare provider, ideally a specialist gynaecologist familiar with endometriosis.
Management strategies include:
- Pain management: Use of painkillers (analgesics) such as ibuprofen or stronger prescribed medications.
- Hormonal therapies: Oral contraceptives, progestins, GnRH agonists, or antagonists can help control the growth of endometrial tissue.
- Surgical interventions: Laparoscopic surgery may be recommended to remove or reduce endometrial implants, cysts, and adhesions.
- Lifestyle adjustments: Healthy diet, regular physical activity, stress reduction techniques, and supportive therapies such as physiotherapy or counselling can help manage symptoms.
It is essential to approach endometriosis as a chronic condition, often requiring ongoing management and support.
For personalised guidance and treatment, always consult a healthcare professional experienced in diagnosing and managing endometriosis.
References
[1] Zondervan KT, Becker CM, Missmer SA. Endometriosis: Science and Practice.
[2] World Health Organization (WHO), Endometriosis Fact Sheet.
[3] Giudice LC. Endometriosis. New England Journal of Medicine.
