Endometriosis can affect up to 10 in every 100 women, but a confirmed diagnosis is often elusive. One could characterise it as a Nomadic condition, as endometrial cells, which make up the lining of the womb, travel outside of the uterus and take up home elsewhere and behave in exactly the same way as if they were inside in the womb.
When the lining of the womb thickens as the cycle progresses and then sheds, causing a menstrual period, so too do the cells outside of the womb. These fully functioning nomadic cells can settle on the ovaries, fallopian tubes, outside surface of the womb and even other organs. In severe cases, where the cells settle together in communities, they can act like glue, sticking different internal surfaces together (adhesions). Quite how these cells escape the womb and embark on their travels is not fully understood, but it is widely believed menstrual blood flows backwards (retrograde flow) through the fallopian tubes instead of the normal route during menstruation.
Unfortunately, this can be a profoundly painful condition. Pain often occurs before the period starts, as the cells outside the womb build up pre-period and then shed when you have your actual period. The blood from the errant cells has nowhere to go, so remain within the abdominal cavity, causing further pain and bloating. Depending on where the cells are located, you may experience pain in the lower back, abdomen and ovaries, or with intercourse or even sometimes when you go to have your bowels open or urinate. One further indignity of endometriosis is difficulty in conceiving. This can be caused by the cells locating in the ovaries causing cysts sometimes called chocolate cysts. This term is coined because of the appearance of liquid chocolate (old blood) when these cysts are opened. Also the adhesions caused can cause the tubes to be affected or blocked, effectively stopping the sperm and egg from meeting.
Having looked at the symptoms, the next step is diagnosis. Rather shockingly, according to national statistics, a diagnosis can take an average of 71/2 years to achieve. Factors causing this delay include women ‘putting up with symptoms and not complaining, or all too often accepting GPs only treating the painful symptoms without verifying the cause or referring for expert diagnosis. If you are planning a family, this can be very frustrating as with a proper diagnosis, a fertility pathway should be possible.
If you suspect endometriosis, you should seek the opinion of a specialist gynaecologist, who will elicit your relevant medical and family history and a detailed record of all of your symptoms. This, together with an ultrasound scan, could confirm or deny the possibility of a diagnosis. However, in some cases the gynaecologist may advise you to undergo a laparoscopy, (key hole surgery) to take a look inside. This is performed as a day case procedure in hospital under anaesthetic. The gynaecologist makes a tiny incision in your abdomen and then guides a very small scope (camera) around the abdominal cavity. In this way, a record of where the endometriosis is located can be confirmed and some can even be physically removed. As the condition is known to be chronic, the gynaecologist, after confirming the diagnosis, can prescribe you suitable long term pain relief and or hormone treatment. Once your pain symptoms are under control, you can get back to the lifestyle you deserve and if your fertility has been affected, here too a treatment plan can be designed around the specific problems caused by the endometriosis.
At the Women’s Wellness Centre, are Specialist Gynaecologists who can diagnose endometriosis and offer a treatment plan tailored for your circumstances and lifestyle.