Endometriosis

Endometriosis is a common condition where tissue that normally lines your womb starts to grow in other parts of your body.

It happens when endometrial cells escape outside the womb and implant themselves in the fallopian tubes, ovaries, bladder, bowel or vagina. 

Endometrial tissue can even appear in remote parts of the body such as your nasal cavity or lungs.

Like normal endometrial tissue in the uterus, endometrial tissue that escapes to other parts of the body builds up and sheds each time you have a period (menstruate). Because it can’t leave the body in the normal way this can lead to inflammation, scarring and cysts.

Endometriosis affects around two million women in the UK and a diagnosis is usually made between the ages of 25 and 40.

Endometriosis is a long term condition that can cause very painful, heavy periods. It can also lead to a lack of energy, depression and fertility problems.

The exact cause of endometriosis is unknown but there are several theories as to why endometriosis develops:

Retrograde menstruation 

One theory is that during menstruation cells and fluid from your uterus flow backwards up the fallopian tubes into your abdomen, instead of leaving your body. 

Genetics

Some research suggests the condition is hereditary so there’s a higher chance of you developing endometriosis if someone in your family has had it.

Bloodstream migration 

Some research suggests endometriosis occurs when endometrial cells escape into the bloodstream and lymphatic system, settling in other areas of the body such as the abdomen or lungs.

Endometriosis symptoms can vary from person to person. You may have mild to severe pain that can last for several days each time you menstruate, or you may have no symptoms at all (silent endometriosis). 

Research suggests that up to 25% of women have silent (asymptomatic) endometriosis that remains undiagnosed. You may have debilitating symptoms but hardly any endometrial tissue growing outside the womb.

Alternatively, you may have only mild symptoms of endometriosis, but a lot of endometrial tissue in areas other than the womb.

In the majority of cases if you have endometriosis you will have pain in the pelvis, lower back and lower abdomen.

Other symptoms can include:

• Painful or heavy periods
• Bleeding between periods
• Discomfort while urinating
• Pain during sexual intercourse
• Fatigue
• Depression
• Trouble falling pregnant
• Psychological problems relating to sex and relationships
• Symptoms will depend on where the endometrial tissue is in your body. 

If it’s in your intestines it can create a blockage, which causes pain and discomfort. If you have endometrial tissue in your lungs or nose, you may cough up blood or develop a nose bleed when you menstruate.

It can be difficult to diagnose endometriosis because individual symptoms can vary. The most effective way to diagnose endometriosis is by examination with ultrasound or through a laparoscopy.

A laparoscopy examination involves your gynaecologist making a very small incision (cut) near your tummy button. They then insert a thin camera (laparoscope) through the cut to examine your fallopian tubes and uterus.

Once the tip of the laparoscope is inside you it transmits images to a video screen which allows your gynaecologist to see if you have endometriosis. 

They may take a small tissue sample (biopsy) which is sent to the pathology lab for diagnosis.

At The London Clinic your gynaecologist will talk to you about your symptoms and explain any test results to you. 

They will tailor your treatment plan to suit you, your lifestyle and whether or not you are trying to get pregnant. 

Many women who become pregnant find their endometriosis improves because their body is making more progesterone which helps their symptoms, but this isn’t necessarily the case for all women.

Depending on your symptoms your gynaecologist may suggest you manage your endometriosis with pain relief, including non-steroidal anti-inflammatory drugs (ibuprofen or aspirin), paracetamol and codeine.

If you have deep infiltrating endometriosis (where organs such as your bowel and rectum are affected) they may suggest hormone treatment which can help shrink any displaced endometrial tissue.

At The London Clinic we have two main hormonal treatments including:

The Mirena intrauterine system (IUS)

A small coil-like device that your gynaecologist places inside your uterus. It releases a synthetic hormone progestogen that mimics natural progesterone. Progestogen prevents your eggs from ripening and your menstrual cycle will stop, allowing the endometrial tissue outside the uterus to shrink.

Gonadotropin-releasing hormone (GnRH)

This synthetic GnRH hormone will prevent your body producing oestrogen, which will reduce endometrial growth.

Another treatment option we offer at The London Clinic is keyhole surgery or abdominal surgery. 

Under a general anaesthetic your gynaecologist will carefully remove any displaced endometrial tissue including cysts (endometriomas) or lesions so that your symptoms improve. 

If you aren’t intending to get pregnant or your endometriosis is very advanced your gynaecologist may suggest a hysterectomy, where they remove your uterus. A hysterectomy is sometimes paired with an oophorectomy to remove one or both ovaries in the same procedure.

A hysterectomy or oophorectomy are major surgical procedures which your gynaecologist will discuss with you to assess your suitability.

At The London Clinic your gynaecologist will offer you the best and safest treatment option for long term relief from endometriosis.