ieExplains: The facts about endometriosis you shouldn’t ignore
Endometriosis affects one in 10 women worldwide. File picture: Alamy/PA
March marks the awareness month of endometriosis, a condition which can be debilitating. As common as diabetes, endometriosis affects one in 10 women worldwide.
It is estimated that 155,000 women are affected by the condition in Ireland.
Endometriosis is a condition where tissue similar to the lining of the womb starts to grow in other places, such as the ovaries, bladder and other places where it does not normally grow.
During menstruation, these cells react the same way as those lining the uterus. However, they have no way to escape, and can become "trapped".
Endometriosis is often perceived as a gynaecological condition, but it is a chronic and inflammatory illness. In some cases, it can grow into the ovaries, the rectovaginal space, bladder, intestines, and so on.
Symptoms can vary for everyone and some people can be asymptomatic.
However, a lot of people experience intense pain during menstruation or during sex, intense pelvic cramping, pain while urinating, bowel pain, constant fatigue, migraines, nausea, and irregular periods.
The pain does not necessarily occur during the menstrual cycle and some women are in pain outside their cycle, whether before or after.
In some cases, endometriosis can be the source of fertility problems.
The cause of endometriosis is not known.
There is currently no cure for endometriosis and it can be difficult to treat. However, there are several lines of treatment for pain management.
Firstly, anti-inflammatory drugs help treat menstrual cycle pain.
Secondly, a hormonal treatment, like a contraceptive pill, can be used to control the cycle and therefore control the endometrial tissue. As hormone treatments lower the levels of oestrogen in the body, it prevents the lining of the womb or any other endometrial tissue to grow quickly.
Surgery is advised by endometriosis specialists to alleviate the pain and remove the endometriosis adhesions or cysts. It is important to note that even though the surgery provides relief, symptoms can reoccur down the line.
To find the endometriosis lesions, a laparoscopy is often necessary as an MRI or endo-vaginal ultrasound does not always suffice. A laparoscopy is an inspection of the pelvic and abdominal cavity through a small incision.
With a laparoscopy, the surgeon either cuts the lesions (excision surgery) or they can destroy the endometrial tissue by using heat or a laser (ablation).
Depending on how advanced the endometriosis is or how a patient responds to drug treatments or the surgeries mentioned above, more radical options can be explored such as a hysterectomy. These are not to be taken lightly and should be thoroughly discussed with a gynaecologist.
A hysterectomy, which removes the womb (with or without removing the ovaries) is performed under general anaesthetic.
Oophorectomy is another procedure, which is the removal of the ovaries. Once both ovaries are removed, women go through menopause — which is irreversible.
There are four stages to the condition, from minimal (stage 1) to severe (stage 4). According to Johns Hopkins Medicine, the stages are based on where endometrial tissue occurs in the body, how far it has spread and how much tissue is in those areas.
Having a more advanced stage of endometriosis does not always mean you will have more severe symptoms or more pain. Some women with stage 4 endometriosis have few or no symptoms, while those with stage 1 can have severe symptoms.
- Stage 1 sees the condition manifest in small lesions on and around the pelvic cavity.
- Stage 2 can be more widespread, scarring can occur and is often found on the ovaries and uterosacral ligaments.
- Stage 3 affects the pelvic organs, and cysts can develop on one or both of the ovaries.
- Stage 4 endometriosis affects the majority of the pelvic organs, which causes deformation and adhesions. In some cases, endometriosis can evolve and spread to organs outside the pelvic region — such as the bowels, heart and lungs. At this stage, the chance of infertility is higher.
A similar (yet different) condition, called adenomyosis, can also co-exist with endometriosis. A chronic condition, adenomyosis occurs when the same tissue that lines the uterus is present within and grows into the muscular walls of the uterus — which causes an enlarged uterus.
The cause of the condition is unknown, and it usually resolves after menopause.
Adenomyosis causes severe pain during menstruation, heavy bleeding and vaginal bleeding in between periods. Most of the time, pain is located in the lower abdomen and can go up to the dorsal region.
The condition can be diagnosed with pelvic imaging, such as an ultrasound and MRI. Up until recently, it could only be diagnosed after a hysterectomy.
In terms of treatment, prescriptions and oral contraceptives can reduce pain and bleeding. Surgical treatment is also possible, and the surgeon can do a laparoscopic excision of the adenomyosis tissue. A hysterectomy is considered in severe cases, as a last option.
