What is endometriosis?
Endometriosis is a benign but chronic condition where tissue similar to the lining of the womb (endometrium) grows outside the womb. This can lead to superficial or deeply infiltrating growths (endometrial implants), ovarian cysts or thick bands of scar tissue (adhesions).
Endometriosis is influenced by the menstrual cycle
Like the uterine lining, this tissue builds up and sheds with the menstrual cycle. However, the blood can't drain away but must be broken down by inflammatory cells. This can lead to pain of all kinds and infertility. During menopause, hormonal stimulation gradually ceases and the symptoms mostly disappear.
How does endometriosis develop?
We’re not yet entirely sure. One likely theory is that endometrial cells, which normally drain through the vagina with the menstrual blood, migrate through the fallopian tubes into the pelvis. They can implant and, stimulated by the hormonal cycle, start to grow.
Preventing endometriosis? Because the exact cause of endometriosis is unknown, no preventive measures have been developed.
Does it only affect the genital area?
Endometrial implants can occur almost anywhere in the body, but are most commonly found in the lower abdomen. A distinction is made between endometriosis:
- In the genital area: endometriosis in the fallopian tubes, ovaries (in the form of cysts), wall of the uterus
- Endometriosis in the ligaments of the uterus
- Endometriosis in the vagina
- Endometriosis in the pelvic peritoneum
- Endometriosis in the bladder
- Endometriosis outside the genital area, e.g. in the gut or navel
In rare cases, the lungs, liver, skin (such as in an old scar) and other organs can be affected.
Endometriosis isn't necessarily associated with symptoms; some women don't experience any pain whatsoever. Others, however, find the pain practically unbearable. The symptoms are non-specific and depend on where the endometrial implants have grown.
Possible symptoms of endometriosis
- Pain in the abdomen just before your period
- Menstruation pain
- Abdominal pain independent of the menstrual cycle
- Pain during sex or gynaecological examinations
- Pain in the legs and/or back, during bowel movements or urination
- If the wall of the uterus is affected, heavy menstrual bleeding also occurs
- If the implants have grown in the bladder or gut, blood may appear in the urine or stools
- Fatigue, exhaustion
- Ectopic pregnancy, infertility
Does endometriosis make you infertile?
Every third to fourth woman who is unable to have children suffers from endometriosis. However, we still don't know exactly why this should be. One possible explanation: the inflammation leads to poor egg cell quality and can stop the sperm and fallopian tubes from functioning properly. This makes fertilisation more difficult.
Why does the condition often go undetected?
Many women consider a painful period to be normal or ascribe their inability to get pregnant to other causes. Reports on women's experiences additionally show that their symptoms are often not taken seriously and go undetected by their doctors. So it takes an average of 6 years for the condition to be discovered. A long time to suffer.
A thorough discussion of the symptoms, a physical exam and ultrasound can provide the first pointers. The only way to reach a clear diagnosis, however, is by laparoscopy. This means inserting a small instrument inside the abdomen to view the affected organs and remove tissue. It's even possible to remove the endometrial implant during this diagnostic procedure.
Why is a proper diagnosis needed?
According to specialists in this area, it's important to detect the disease at an early stage: on the one hand, to prevent infertility, and on the other, to stop the pain becoming chronic.
“Treatment is based on the individual patient's needs,” says gynaecologist Peter Martin Fehr. There are a number of treatments to choose from, and they can often be combined. Ideally, this will involve different specialists working together at specialised units.
Treating endometriosis with medication
Hormone treatment: this ensures that the implants no longer go through the cyclical changes, thus reducing the inflammation. Oestrogen-progesterone combinations, various progesterones or GnRH analogues are used to alleviate or suppress the monthly cycle.
Removing endometriosis by laparoscopy
Endometrial implants are removed by laparoscopy. The gynaecologist inserts special instruments into the abdomen through tiny cuts in the skin. The affected areas are either cut out or destroyed using heat or laser. A laparoscopy calls for expertise and practice. The procedure should only be carried out by trained specialists.
Success rates are good
Some 80% of women notice an improvement in their condition after the operation, providing they also take hormone preparations. While these alleviate the symptoms, they don’t improve fertility. Only surgery can increase the chance of getting pregnant. Every second woman who has the treatment is subsequently able to have a family. However, sometimes additional treatment such as artificial insemination is required.
Womb removal (hysterectomy) with endometriosis
If your family planning is complete and you experience very severe pain, you might consider a hysterectomy to remove the womb. Removing the ovaries and fallopian tubes at the same time is generally not recommended.
Is endometriosis curable?
Endometrial implants can come back after an operation. Without hormone treatment, 40% of women see a recurrence of the symptoms within two years. They usually don't disappear completely until menopause.
- At present, there is no clear evidence that endometriosis can be cured by natural means. Alternative treatment methods such as Traditional Chinese Medicine (TCM), exercise or a change of diet may help relieve the pain.
- If the pain is chronic, an interdisciplinary approach involving pain management, physiotherapy, psychotherapy and nutritional advice is recommended.
- If you are unable to work, or have work- or insurance-related problems, a social worker might help.
- It can also be a good idea for women with the condition to join a self-help group where they can talk to others
When to see a doctor?
If you have severely painful periods, cycle-related bleeding from the gut or bladder, persistent abdominal pain or difficulty getting pregnant, you should definitely see a doctor.