|Many women experience painful
periods. In a minority of cases, this can be caused by endometriosis,
a condition in which small pieces of the womb lining (the endometrium)
grow outside the womb. Endometriosis occurs in between 1-15% of
women of childbearing age. In many women it causes no symptoms,
but in others it can cause severe pain and may reduce the chances
of becoming pregnant.
|What is endometriosis?
|During the menstrual cycle
the lining of the womb, known as the endometrium, gradually thickens
and fills with blood as it prepares for the arrival of a fertilised
egg. If the egg is not fertilised, the womb lining breaks down
and is lost as the monthly 'period'. Sometimes small pieces of
endometrium grow on organs outside the uterus. This is called
endometriosis. The endometriosis goes through the same monthly
changes as the womb lining; sometimes swelling and bleeding into
the body cavity, which can cause inflammation and pain. Rubbery
bands of scar tissue, called adhesions, may form. These can tie
organs and tissues together and affect the normal working of organs.
Endometriosis most commonly occurs on the ovaries, on the tubes
that carry eggs from the ovaries to the womb (Fallopian tubes),
and on the tissues that hold the womb in place. When it occurs
on the ovaries the endometriosis can forms cysts (endometrioma).
These are also called 'chocolate cysts' because of the brown fluid
they contain. They may not cause any pain and may only be found
during an internal examination to check fertility. However if
they burst, their contents spill into the body cavity where they
can cause severe pain and result in adhesions. Less commonly endometriosis
can occur on the bladder or bowel or on other organs.
|What causes endometriosis?
|No one knows for certain
what causes endometriosis or why some women get endometriosis
and others do not. Some people believe it is caused by some menstrual
fluid flowing backwards up the Fallopian tubes towards the ovaries,
instead of flowing out of the body through the vagina.
|Which women get endometriosis?
|Endometriosis can occur
in any woman of childbearing age. Endometriosis can run in families.
It is more common in white people than in other ethnic groups,
in women who give birth for the first time after the age of 30,
and in infertile women.
|Symptoms of endometriosis
|Pelvic pain, which feels
like 'period pain', is the most common symptom of endometriosis.
The symptoms can vary, with some women who have endometriosis
having no symptoms at all, while others have severe pain. The
pain usually occurs around the time of a period, but in some women
the pelvic pain can be constant. It may be felt on one side of
the body, in the middle or both sides. Some women find that sexual
intercourse before or during a period is painful. There may also
be changes to periods, such as a small loss of blood before the
period is due (spotting), irregular or heavy periods. Endometriosis
on the bowel or bladder may cause swelling of the lower abdomen
and pain when going to the toilet, or blood in the stools during
a period. Symptoms of endometriosis often disappear during pregnancy
or after the menopause. In some women, difficulty becoming pregnant
is the first sign of endometriosis.
|None of the symptoms of
endometriosis are unique to the condition so the only way to be
sure that a woman has endometriosis is to look inside the abdomen.
This needs to be done in hospital using a laparoscope, a thin
metal viewing tube that is inserted through the skin just below
the belly button. The examination of the internal organs is generally
done under general anaesthetic by a gynaecologist. Sometimes a
small piece of the endometriosis will be removed for testing.
The examination takes about 30 minutes and can usually be done
without an overnight stay.
|Treatments for endometriosis
- relieve pain
- shrink endometriosis or slow its growth
- remove the endometriosis
- keep or bring back fertility
The type of treatment will depend on the woman's age, the severity
of her symptoms, whether she wants to have children, and the severity
of the endometriosis. Without treatment, endometriosis stays the
same or gets better in most women, but in about one in three women
it gets worse. It is important to discuss the condition with a
doctor and agree a plan. If the endometriosis is mild, then drug
treatment may be effective. In more severe endometriosis, surgery
may be required. Sometimes it is necessary to remove the womb
or one or both ovaries.
Analgesics (such as paracetamol, anti-inflammatories and codeine
may help to control the pain if the symptoms are mild. Complementary
medicines (such as acupuncture, aromatherapy, herbal remedies,
homeopathy etc) may also help.
Hormonal treatment to shrink the endometriosis
Just like the normal endometrium, endometrial cells need the hormone
oestrogen to survive and grow. Hormonal medicines that reduce
the amount of oestrogen in the body will reduce the size of the
endometriosis. There are several hormonal medicines that can be
- combined oral contraceptives (the 'pill')
- gonadotropin-releasing hormone (GnRH) analogues
All of these hormonal medicines work equally well overall but
have different side effects. The doctor may suggest trying several
medicines to find one that works and causes fewest side effects.
A barrier method of contraception (such as condoms) should be
used while taking hormonal medicines (except oral contraceptives)
because they can damage a developing baby.
Treatment with medicines won't cure endometriosis and symptoms
usually return when the medicine is stopped. Pain returns in about
2 in 5 women 12 months after stopping treatment, and in about
half after 5 years.
The aim of surgery is to remove as much of the endometriosis as
possible while keeping the woman's ability to have children. Surgery
- if the pieces of endometriosis are larger than
4 - 5cm (1.5 - 2 inches)
- if there are many adhesions or they are interfering
with the normal workings of internal organs such as the bowel
- if the endometriosis is blocking the Fallopian
tubes and causing infertility
- if there is severe pain which cannot be controlled
with analgesics or hormones. The endometriosis may be cut
away, or destroyed with heat produced by an electrical device
or by using a laser. This can often be done through small
cuts in the belly, using a laparoscope (keyhole surgery),
but may require an open operation. Endometriosis returns in
about 1 in 5 women five years after having surgery. Hormonal
medicines are sometimes given after surgery to try to delay
this return. However, the only sure way to prevent endometriosis
returning is to remove the ovaries. This is only considered
for women with severe symptoms as a last option, or in women
who are not planning to have a baby
|Tests that may be done
|Ultrasound, X-ray and MRI
(magnetic resonance imaging) may be used to see how the endometriosis
is responding to treatment.
|Endometriosis and fertility
|Endometriosis may reduce
the chances of a woman being able to get pregnant. In severe cases
this may be due to blockage of the Fallopian tubes, but even mild
endometriosis can reduce fertility. Medicines used to treat endometriosis
do not improve fertility, but surgery can if the endometriosis
is interfering with the normal workings of the womb and ovaries.
Some women with endometriosis who want to have a baby may need
|The National Endometriosis
Website written by a patient:
Website written by a doctor:
National Women's Health Information Center (US)
Endometriosis Research Center
The Endometrosis Association (Victoria)
|Healthwise (Health Information Resource
Tel : (852) 2849 2400
Fax : (852) 2849 2900
Email : firstname.lastname@example.org
Homepage : http://www.healthwise.org.hk/
This leaflet is for information only. For a detailed
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