Endometriosis: What You Need to Know | Dr Semiya Aziz, Say GP

Endometriosis is a common condition that affects many women of reproductive age. It occurs when tissue similar to the lining of the uterus grows outside the uterus, causing pain, inflammation, and sometimes infertility. Endometriosis can be challenging to diagnose and treat, but there are options available to help women manage their symptoms and improve their quality of life.

In this blog post, Say GP will share some information about endometriosis, its causes, symptoms, diagnosis, and treatment options. Say GP will also provide some tips on how to cope with endometriosis and where to find support and resources.

What causes endometriosis?

The exact cause of endometriosis is not known, but there are several theories that may explain why it happens. Some of the possible causes are:

Retrograde menstruation. This is when some of the menstrual blood and tissue flows backwards through the fallopian tubes and into the pelvic cavity, where it implants and grows on other organs.
Immune system dysfunction. This is when the immune system fails to recognize and eliminate the endometrial tissue that grows outside the uterus, or even promotes its growth and survival.
Hormonal imbalance. This is when the levels of oestrogen and progesterone, the hormones that regulate the menstrual cycle, are abnormal or fluctuate too much, stimulating the growth of endometrial tissue.
Genetic factors. This is when a woman inherits a gene or genes that make her more susceptible to developing endometriosis.
Environmental factors. This is when a woman is exposed to certain chemicals or toxins that may affect her hormone levels or immune system, such as pesticides, dioxins, or phthalates.

What are the symptoms of endometriosis?

The symptoms of endometriosis vary from woman to woman, and may depend on the location and extent of the endometrial tissue. Some of the common symptoms are:

Pelvic pain. This is the most common symptom of endometriosis, and it can range from mild to severe. It may occur before, during, or after a menstrual period, or throughout the cycle. It may also be triggered by sexual activity, bowel movements, urination, or exercise.
Heavy or irregular bleeding. This is when a woman has longer, heavier, or more frequent periods than normal, or bleeding between periods or after menopause.
Infertility. This is when a woman has difficulty conceiving or carrying a pregnancy to term. Endometriosis may affect fertility by causing inflammation, scarring, or blockage of the fallopian tubes, ovaries, or uterus, or by altering the hormonal balance or the quality of the eggs or the embryos.
Other symptoms. These may include fatigue, nausea, bloating, constipation, diarrhoea, headaches, back pain, or mood changes.

How is endometriosis diagnosed?

Endometriosis can be difficult to diagnose, as its symptoms may be similar to other conditions, such as ovarian cysts, pelvic inflammatory disease, irritable bowel syndrome, or fibroids. To diagnose endometriosis, doctors tend to use the following methods:

Medical history and physical examination. This is when a doctor asks about the symptoms, menstrual cycle, sexual history, family history, and lifestyle factors, and performs a pelvic exam to check for any signs of endometriosis, such as tenderness, nodules, or masses.
Imaging tests. These are tests that use ultrasound, MRI or CT scans to create images of the pelvic organs and look for any abnormalities, such as cysts, adhesions, or lesions. However, some of these tests cannot confirm the presence of endometriosis, as some endometrial tissue may be too small or deep to be detected.
Laparoscopy. This is the only definitive way to diagnose endometriosis, and it involves a minor surgical procedure. The doctor makes a small incision in the abdomen and inserts a thin tube with a camera and a light, called a laparoscope, to view the pelvic organs and look for any endometrial tissue. The doctor may also take a biopsy, or a small sample of tissue, for further analysis.

How is endometriosis treated?

There is no cure for endometriosis, but there are treatments that can help reduce the pain, inflammation, and bleeding, and improve fertility. The choice of treatment depends on the severity of the symptoms, the age of the woman, the desire to have children, and the personal preference. The main types of treatment are as follows:

Pain medication. This includes over-the-counter or prescription drugs, such as nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, or opioids, that can help relieve the pain and discomfort caused by endometriosis. However, these drugs may have side effects, such as stomach irritation, liver damage, or addiction, and they do not address the underlying cause of endometriosis.
Hormone therapy. This includes oral contraceptives, progestins, Mirena IUD, gonadotropin-releasing hormone (GnRH) agonists or antagonists, or aromatase inhibitors, that can help regulate the hormone levels and suppress the growth of endometrial tissue. However, these drugs may have side effects, such as weight gain, mood swings, bone loss, or hot flashes, and they may not be suitable for women who want to get pregnant, as they prevent ovulation and menstruation.
Surgery. This includes laparoscopy, laparotomy, or hysterectomy, that can help remove or destroy the endometrial tissue, or in some cases, the entire uterus, ovaries, or fallopian tubes. Surgery can help relieve the pain, bleeding, and infertility caused by endometriosis, but it may also have risks, such as infection, bleeding, scarring, or damage to nearby organs, and it may not prevent the recurrence of endometriosis, unless the uterus and ovaries are removed.

How to cope with endometriosis?

Living with endometriosis can be challenging, both physically and emotionally, but there are ways to cope and improve the quality of life. Some of the tips are:

Seek support. This includes talking to a doctor, a therapist, a partner, a family member, or a friend, or joining a support group, either online or in person, where you can share your feelings, experiences, and advice with other women who have endometriosis.
Educate yourself. This includes learning more about endometriosis, its causes, symptoms, diagnosis, and treatment options, as well as staying updated on the latest research and developments. This can help you make informed decisions about your health.
Manage stress. This includes finding healthy ways to cope with stress, such as meditation, yoga, breathing exercises, massage, acupuncture, or aromatherapy, that can help relax your mind and body, and reduce the pain and inflammation caused by endometriosis.
Adopt a healthy lifestyle. This includes eating a balanced diet, rich in fruits, vegetables, whole grains, lean proteins, and healthy fats, and low in processed foods, sugar, caffeine, and alcohol, that can help nourish your body and reduce inflammation. It also includes exercising regularly, at least 30 minutes a day, three times a week, that can help improve your blood circulation, mood, and energy levels, and relieve the pain and cramps caused by endometriosis. It also includes getting enough sleep, at least seven to eight hours a night, that can help restore your body and mind, and boost your immune system.
Seek help. This includes consulting a doctor if your symptoms worsen, interfere with your daily activities, or affect your mental health, and asking for help from your partner, family, friends, or co-workers, when you need it. You do not have to suffer alone or in silence, and there are resources and treatments available to help you.

Where to find more information and support?

If you have endometriosis, or suspect that you may have it, you are not alone. There are millions of women around the world who have endometriosis, and many of them have overcome the challenges and achieved their goals. There are also many organisations and websites that can provide you with more information and support, such as:

Endometriosis UK: A charity that provides information, support, and advocacy for women with endometriosis in the UK.
Endometriosis.org: A global platform that connects women, doctors, researchers, and advocates for endometriosis.

Endometriosis is a complex and chronic condition that can affect every aspect of a woman’s life. But with proper diagnosis, treatment, and support, it is possible to manage the symptoms and live a fulfilling and productive life.

If you have any questions or concerns about endometriosis, please do not hesitate to contact Say GP and book an appointment. We are here to help you.

General information, written in January 2024. It isn't advice for your own situation: for that, book an appointment.