Endometriosis – Everything You Need to Know About it

By: Mariam El Naggar

Despite the slight achievements women have gained in issues regarding gender injustices, menstruation, ovulation pains, pre-menstrual syndrome (PMS), menstrual cramps all remain stigmatized private matters that are rarely – if ever – discussed. This has left women, especially teenagers, too shy to raise a flag when they feel something isn’t right and being almost completely uneducated on diseases like endometriosis. 

Endometriosis is a common gynaecological condition where tissue similar to the lining of the womb starts to grow in other places, such as the ovaries and fallopian tubes. You’d think that a disease affecting up to 10% of women would be commonly diagnosed, however, on average it takes 7.5 years to get a diagnosis of endometriosis. This is because pains in the pelvis are often associated with menstruation so women don’t normally report them, even when they’re extreme. Those who do decide to speak up are often told by their mothers or friends to just suck up the pain and are left unconsciously popping painkillers. 

Here’s everything you need to know about endometriosis: 

  1. Symptoms: 
  • Pain. This is the most common symptom. Women with endometriosis may have many different kinds of pain. These include:
    • Very painful menstrual cramps – this may get worse over time.
    • Chronic (long-term) pain in the lower back and pelvis
    • Pain during or after sex. This is usually described as a “deep” pain and is different from pain felt at the entrance to the vagina when penetration begins.
    • Intestinal pain
    • Painful bowel movements or pain when urinating during menstrual periods. In rare cases, you may also find blood in your stool or urine.
  • Bleeding or spotting between menstrual periods. This can be caused by something other than endometriosis. If it happens often, you should see your doctor.
  • Heavy periods
  • Infertility, or experiencing difficulty trying to get pregnant.
  • Stomach (digestive) problems. These include diarrhoea, constipation, bloating, or nausea, especially during menstrual periods.
  1. Causes:
  • Problems with menstrual period flow
  • Genetic factors: endometriosis runs in families so it may be inherited in the genes.
  • Immune system problems: a faulty immune system may fail to find and destroy endometrial tissue growing outside of the uterus. Immune system disorders and certain cancers are more common in women with endometriosis.
  • Hormones: the hormone estrogen appears to promote endometriosis. Research is looking at whether endometriosis is a problem with the body’s hormone system.
  • Surgery: during surgery in the abdominal area, such as a Cesarean (C-section) or hysterectomy, endometrial tissue could be picked up and moved by mistake. For instance, endometrial tissue has been found in abdominal scars.
  • How is endometriosis diagnosed?
  1. How is endometriosis diagnosed?

If you experience any of these symptoms it is recommended to go to a gynaecologist. While I know how hard it is to convince parents or guardians to take you to a gynaecologist it’s important to explain the irregularities you’re experiencing to help convince them, it may help to use this pain and symptoms diary (PDF, 238kb)

However just because you have some of these symptoms does not mean that you immediately assume that you have the condition. But nonetheless, if you are experiencing these symptoms you should go get it checked out so they can help you manage any irregular periods and extreme pain that could also point to other issues. 

If you do go see a doctor, they will talk to you about your symptoms and do or prescribe one or more of the following to find out if you have endometriosis:

  • Pelvic exam: your doctor will feel for large cysts or scars behind your uterus. Smaller areas of endometriosis are harder to feel.
  • Imaging test: your doctor may do an ultrasound to check for ovarian cysts from endometriosis. Magnetic resonance imaging (MRI) is another common imaging test that can make a picture of the inside of your body.
  • Medicine: if your doctor does not find signs of an ovarian cyst during an ultrasound, they may prescribe medicine such as:
    • Hormonal birth control; which can help lessen pelvic pain during your period.
    • Gonadotropin-releasing hormone (GnRH) agonists: which blocks the menstrual cycle and lower the amount of estrogen your body makes. GnRH agonists also may help pelvic pain.
  • Laparoscopy. Laparoscopy is a type of surgery that doctors can use to look inside your pelvic area to see endometriosis tissue. Surgery is the only way to be sure you have endometriosis. Sometimes doctors can diagnose endometriosis just by seeing the growths. Other times, they need to take a small sample of tissue and study it under a microscope to confirm this.
  1. Treatments:

There is currently no cure for endometriosis, but there are treatments that can help ease the symptoms which include:  

  • Painkillers: such as ibuprofen and paracetamol
  • Hormone medicines and contraceptives: including the combined pill, the contraceptive patch, an intrauterine system (IUS), and medicines called gonadotrophin-releasing hormone (GnRH) analogues
  • Surgery: to cut away patches of endometriosis tissue or an operation to remove part or all of the organs affected by endometriosis.
  • For some women, the painful symptoms of endometriosis improve after menopause. As the body stops making the hormone estrogen, the growths shrink slowly. However, some women who take menopausal hormone therapy may still have symptoms of endometriosis.
  1. Can I get pregnant if I have endometriosis?

Yes, many women with endometriosis get pregnant. But, you may find it harder to get pregnant. No one knows exactly how endometriosis might cause infertility. Some possible reasons include:

  • Patches of endometriosis block off or change the shape of the pelvis and reproductive organs. This can make it harder for the sperm to find the egg.
  • The immune system, which normally helps defend the body against disease, attacks the embryo.
  • The endometrium (the layer of the uterine lining where implantation happens) does not develop as it should.
  1. Prognosis:

Endometriosis may not currently have a cure but this doesn’t mean the condition has to impact your daily life. Effective treatments are available to manage pain and fertility issues, such as medications, hormone therapy, and surgery.

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