Endometriosis is a chronic and debilitating condition that causes painful and heavy periods. It is believed that 1 in 10 women in the UK are affected by the condition.
To mark National Endometriosis Awareness Week, we spoke with Mr Ertan Saridogan, Consultant Gynaecologist at The Portland Hospital, about the causes of endometriosis and treatment options.
What is endometriosis?
Endometriosis is a condition in which there is tissue from the lining of the womb (uterus) but outside the womb. This tissue outside the womb (endometriosis) behaves in a similar way to the lining of the womb (endometrium), in other words there is monthly bleeding from this tissue at the time of periods. This bleeding is thought to cause irritation, inflammation and pain. The irritation and inflammation result in tissues or organs sticking to each other (adhesions) and this can distort the pelvic anatomy. Presence of endometriosis in the ovaries can cause formation of cysts which are usually filled with old blood. Old blood has a brown colour, hence these cysts are frequently known as chocolate cysts (endometrioma).
What causes endometriosis?
The exact cause of endometriosis is not known. It is probably due to a number of causes including genetic, environmental and anatomical factors. If there is a close family member with endometriosis, the risk of endometriosis is higher and this suggests a genetic contribution. There are reports that exposure to environmental toxins such as dioxins can increase risk of endometriosis. Girls who are born with lower genital tract (cervix, vagina) anatomical defects which cause obstruction to the flow of menstrual blood are more likely to develop endometriosis.
Endometriosis is thought to be more common in women who have never been pregnant; hence it is thought that pregnancy may have a protective effect. Current use of the contraceptive pill also has a protective effect.
What are symptoms of endometriosis?
Common symptoms of endometriosis are painful periods, pelvic pain, pain with sexual intercourse, pain with bowel motions and infertility. However, many women with endometriosis may have few or no symptoms.
How does endometriosis affect the ability to have children?
In advanced forms of endometriosis there may be significant distortion to the pelvic anatomy, due to adherence of the pelvic organs to each other. This may affect function of the fallopian tubes which may not be able to capture the released egg and transport it to the site of fertilisation. Presence of cysts in the ovaries may interfere with ovulation and interfere with egg capture.
In earlier forms of endometriosis when the pelvic anatomy is not affected, the cause of infertility is not clearly known. It is thought that the chemical substances released from the endometriosis tissue affect the normal reproductive process and reduce chances of getting pregnant.
What treatment options are available?
The treatment options include painkillers, hormonal treatment and surgery. Many women with endometriosis related pain take painkillers that can be purchased over the counter. When these are not sufficient additional painkillers (analgesics) may be prescribed. Hormonal treatments include the contraceptive pill, synthetic progesterone containing intrauterine contraceptive device (Mirena Intrauterine System), high dose synthetic progesterones and gonadotrophin releasing hormone analogues which switch off the ovaries and cause temporary menopause. The hormonal treatment is usually used to treat symptoms and reduce risk of recurrence. They do not eliminate endometriosis; hence the symptoms tend to return when they are discontinued.
Surgery aims to eliminate endometriosis by removing or destroying it. Surgical treatment is most commonly carried out as keyhole surgery (laparoscopy). The extent of surgery will depend on how extensive endometriosis is and can vary from a very minor procedure to a very extensive operation.
Women with endometriosis and infertility may benefit from surgery, but some patients will need additional fertility treatment (insemination or IVF treatment). Sometimes fertility treatment may be carried out without surgery.
Will I have to have surgery?
The decision as to whether you will need surgery will depend on the severity of your symptoms, whether you are trying for pregnancy, your age, your fertility plans and past treatment history. In appropriately selected patients surgery may be helpful in improving the pain symptom and chances of pregnancy. However, there is a significant risk of recurrence after surgery as well.
Will endometriosis affect my sex life?
Endometriosis may affect the sex life by causing pain during sexual intercourse. In addition, tiredness due to pain and fear of pain may lower the sex drive. These symptoms can be improved with appropriate treatment as described above.
If I have any more questions, whom should I speak to?
The leading patient support organisation in the United Kingdom is Endometriosis UK, they provide a helpline and their website (www.endometriosis-uk.org) provides high quality information on endometriosis. You can also speak to your general practitioner or a gynaecologist who is experienced in management of endometriosis. The European Society of Human Reproduction and Embryology also has a detailed guideline for patients (www.eshre.eu).