Endometriosis Awareness

Endometriosis has certainly been making the news recently, so we thought now was a good time to have a chat about this common but often hidden condition.

According to Endometriosis Australia, 14% of women, girls and those assigned female at birth will live with endometriosis at some point in their lives. Symptoms can be debilitating, and diagnosis is often delayed, on average around 7-8 years. Definitely time to do something about that!

What is endometriosis?

Endometriosis occurs when cells similar to the lining of the uterus are found in other parts of the body, mainly in the pelvis, such as the bowel, ovaries or bladder. These deposits tend to grow over time and are subject to the same hormonal sensitivities as the lining of the uterus – in other words they build up in the lead up to a menstrual period but are unable to shed like the lining of the uterus does. This tends to cause a lot of irritation and pain, particularly around period time and can also cause damage that might lead to fertility problems.

What causes it?

We don’t really know (yet), although there are a few associations such as:

• starting periods earlier, before age 11
• short cycles, less than 27 days
• heavy periods lasting longer than 7 days
• family history – mother, sister or daughter with endometriosis

Retrograde menstruation may play a role – this is when a bit of period blood flows backwards up the fallopian tubes, seeding endometrial cells into the pelvis.

What are the symptoms?

Endometriosis affects everyone differently. The most common symptom is pain, with the severity often linked to where the endometriosis is rather than the extent of it. It tends to get worse over time and the symptoms can change over time too.

The types of pain range from:

• painful periods
• pain during or after sex
• pain in the abdomen, pelvis or lower back
• often severe enough to interfere with daily life

Other symptoms can include:

• bladder or bowel problems
• bloating and fatigue around period time
• mood problems like anxiety and depression

Sometimes endometriosis causes no symptoms at all, or it pops up in investigations for infertility.

How is it diagnosed?

With the list of symptoms above, it’s not hard to see why diagnosis can be delayed for years. Unfortunately, many women & girls come to accept that painful periods are just a part of life. This is why raising awareness is so important – period problems or pain that is not responding to simple measures or is interfering with daily life should prompt a trip to the doctor.

The other problem with diagnosis is that there is no simple test to clinch it. There is no blood test for it and ultrasound or MRI scans may miss it (although these are improving).

The only way to definitively diagnose endometriosis is via a laparoscopy procedure – keyhole surgery where a camera is inserted into a tiny incision in the belly button to look for and biopsy any suspicious looking tissue. Even then, people with severe symptoms may have tiny or no visible patches of endometriosis and those with mild symptoms may have extensive disease. It’s a very weird condition!

How is it treated?

There is no cure for endometriosis (yet) but there are many management options. These hinge on the type of symptoms and how severe they are, and whether the woman is trying to fall pregnant or not. Options include:

• Pain management
  This can range from simple paracetamol or anti-inflammatories through to stronger pain medication.
• Hormonal treatment
  The contraceptive pill or progesterone via injection, implant or IUD aim to slow the growth of the endometriosis by reducing or stopping periods.
• Surgery
  As discussed above, a laparoscopy can make the diagnosis and whilst there, the surgeon may be able to remove any affected tissue or repair any damage, such as to the fallopian tubes (to increase the chance of pregnancy). It’s important to note that not everyone needs to have a laparoscopy so it’s important to discuss this with your doctor. Also of note (reassuringly), most women with endometriosis (70%) can fall pregnant without medical help.
• Lifestyle and other treatments
  Chronic pain can be a debilitating and draining condition to live with. Eating nutritious food, getting enough sleep, gentle daily movement and managing stress as best you can are an important part of managing any chronic condition. Other treatments that may help include physiotherapy (for bladder or bowel symptoms), acupuncture and counselling.

The bottom line is, if you are experiencing any of the symptoms above, especially if they are impacting your daily life, please come and talk to your GP, we are here to help.