Dr Dulcy advises on women’s health

Fortunately for sufferers, effective treatments are widely available.

Endometriosis is an often painful disorder in which tissue that normally lines the inside of your uterus, the endometrium, grows outside your uterus. Endometriosis most commonly involves your ovaries, fallopian tubes and the tissue lining your pelvis. Rarely, endometrial tissue may spread beyond pelvic organs. With endometriosis, displaced endometrial tissue continues to act as it normally would, it thickens and breaks down and bleeds with each menstrual cycle. Because this displaced tissue has no way to exit your body, it becomes trapped. When endometriosis involves the ovaries, cysts called endometriomas may form. Surrounding tissue can become irritated, eventually developing scar tissue and abnormal bands of fibrous tissue that can cause pelvic tissues and organs to stick to each other called adhesions. Endometriosis can cause pain, especially during your period. Fertility problems may also develop. Fortunately, effective treatments are available.

This condition is estimated to affect over 15% of women of reproductive age even though some may not have the symptoms. Estimates suggest that 20% to 50% of women being treated for infertility have endometriosis, and up to 80% of women with chronic pelvic pain or period pain may be affected.

CAUSES

The exact cause of endometriosis is not certain. The most likely cause for endometriosis is what is called retrograde menstruation, this is where menstrual blood, instead of flowing out the vagina, it flows back through the fallopian tubes and into the pelvic cavity. The endometrial cells then stick to the pelvic walls and surfaces of pelvic organs, where they grow and continue to thicken and bleed over the course of each menstrual cycle. The cause of this retrograde flow is not known. Another possible cause is that areas lining the pelvic organs possess primitive cells that are able to develop into other forms of tissue, such as endometrium. Occasionally endometriosis has been seen as a complication of surgery where there is accidental direct transfer of endometrial tissues at the time of surgery to other sites.

RISK FACTORS The following women are most at risk of developing endometriosis:

Women aged 25 to 35 years, even though some cases have been reported in girls as young as 12

Those who have never given birth, because of this many women who are homosexual report cases of endometriosis. Also in women who delay their first pregnancy

Early onset of menses or late menopause

One or more relatives (a mother, aunt or sister) with endometriosis

Any medical condition that prevents the normal passage of menstrual flow out of the body

History of pelvic infection or pelvic surgery

Any other abnormalities of the uterus (example fibroids)

It usually develops several years after the onset of menstruation and ends temporarily with pregnancy and then ends permanently with menopause. SIGNS AND SYMPTOMS

The primary symptom of endometriosis is pelvic pain, often associated with your menstrual period. Although many women experience cramping during their menstrual period, women with endometriosis typically describe menstrual pain that’s far worse than usual. They also tend to report that the pain increases over time.

Common signs and symptoms of endometriosis may include:

Painful periods (dysmenorrhea). Pelvic pain and cramping may begin before your period and extend several days into your period. You may also have lower back and abdominal pain.

Pain with intercourse. Pain during or after sex is common with endometriosis.

Pain with bowel movements or urination. You’re most likely to experience these symptoms during your period.

Excessive bleeding. You may experience occasional heavy periods (menorrhagia) or bleeding between periods (menometror-

rhagia).

Infertility. Endometriosis is first diagnosed in some women who are seeking treatment for infertility.

Other symptoms. You may also experience fatigue, diarrhoea, constipation, bloating or nausea, especially during menstrual periods.

The severity of your pain isn’t necessarily a reliable indicator of the extent of the condition. Some women with mild endometriosis have intense pain, while others with advanced endometriosis may have little or no pain. Some women need intervention while others can cope with the pain.

Endometriosis is sometimes mistaken for other conditions that cause pelvic pain, such as pelvic inflammatory disease (PID) or ovarian cysts. It may be confused with irritable bowel syndrome (IBS), a condition that causes bouts of diarrhoea, constipation and abdominal cramping. IBS can accompany endometriosis, which can complicate the diagnosis.

COMPLICATIONS

The main complication of endometriosis is infertility. About one-third to one-half of women with endometriosis have difficulty getting pregnant. Endometriosis may block the fallopian tubes.

Some studies suggest that women with endometriosis have an increased risk for development of certain types of ovarian cancer. This risk is highest in women with both endometriosis and primary infertility (those who have never conceived a pregnancy).

DIAGNOSIS

If you suspect based on the information above that you might have endometriosis, it is important that you see your doctor to get a definitive diagnosis. Your GP will conduct a pelvic examination and an ultrasound, and can refer you to a gynaecologist for a laparoscopy to be sure. Laparoscopy can provide information about the location, extent and size of the endometrial implants to help determine the best treatment options. Unfortunately sometimes these modes might miss the endometriosis, then tissue biopsy of the implants will be necessary, where bits of the tissue are taken for inspection under microscopes.