Brinkmann Gynaecology

Endometriosis Awareness Week

4th March is Endometriosis awareness week so we want to share some information about an illness that affects 1½ million women in Britain.

Mistakenly stigmatised as merely "painful periods", endometriosis is far more than just simple "killer cramps" and can have a severely negative impact on life quality for the worst sufferers. Women are becoming more aware of the condition, but there is still much to be done. The number of women in the UK with endometriosis is equal to those with diabetes. But unlike diabetes, endometriosis is still relatively unknown and its symptoms are often mistaken for other conditions. The average time taken for a diagnosis of endometriosis in the UK is currently 8 years! Increased awareness of this condition will help reduce unnecessary suffering by quicker diagnosis and faster treatment.

What is endometriosis?

Endometriosis is a reproductive illness, which can appear at any age, but is most commonly diagnosed in women around the age of 30 when many start trying for a baby. While the cause is not clear, the condition is known to run in families.

Endometriosis occurs when cells that normally line the womb are found elsewhere in the body, such as the outside of the fallopian tubes, the ovaries and the bladder. These cells behave in the same way as those lining the womb. During a woman’s monthly cycle, her hormones stimulate the endometriosis, causing the cells to grow, then break down and bleed. This internal bleeding, unlike a period, has no way of leaving the body and leads to inflammation, pain and the formation of scar tissue.

The condition raises the risk of infertility, because the ovaries and fallopian tubes can become blocked or damaged, and because endometrial cells kill sperm.

Symptoms of endometriosis

Endometriosis can be a chronic and debilitating condition but many women with endometriosis don't get any symptoms at all and are not aware that they have it.

The quantity of endometriosis does not always correspond to the amount of pain or discomfort felt either – a small amount of endometrial cells can be more painful than severe disease. It largely depends on where the endometriosis is growing inside the body.

Symptoms may include painful, heavy, or irregular periods; pain during or after sex; infertility; difficulty opening bowels or fatigue. The cause of chronic or severe pelvic pain may be difficult to pinpoint. But discovering the problem early may help you avoid unnecessary complications and pain.

Diagnosing endometriosis

Because endometriosis manifests itself in a variety of ways, diagnosis can be difficult. Pelvic pain during a period; infertility; pain during intercourse or while opening the bladder or bowel are all symptoms shared with other conditions, such as irritable bowel syndrome, cystitis and fibroids. The average time taken for a diagnosis of endometriosis in the UK is currently 8 years! Correctly identifying the disease is often delayed because of a tendency to ‘normalise’ these common symptoms.

So whilst having a bit of period pain is normal, it’s not normal to have time off work and take strong painkillers each month. If you’re unhappy with your diagnosis, seek a second opinion.

Tests to check for physical clues of endometriosis include a pelvic exam or an ultrasound. But the only way to be certain that you have endometriosis is by having a diagnostic laparoscopy – a procedure to look inside your abdomen (direct visualisation) for signs of endometrial implants. This is a minor surgical procedure performed under general anaesthetic. Using a special needle, your surgeon expands your abdomen with carbon dioxide gas so that the reproductive organs are easier to see. A tiny incision is made near your navel, and a slender viewing instrument (laparoscope) is inserted. By moving the laparoscope around, your surgeon can view the pelvic and other abdominal organs, looking for signs of endometrial tissue outside the uterus.

Laparoscopy will provide you and your doctor with information about the location, size and extent of the endometrial implants and can help decide treatment options.

Diagnosing endometriosis

At present, there is no cure for endometriosis. Current treatments aim to reduce the severity of the symptoms and improve quality of life. You should discuss the best treatment options with your doctor considering factors such as your age, the severity of your symptoms or disease and your desire to have children.

Treatments can include relieving pain symptoms; shrinking or slowing the growth of endometriosis; preserving or improving fertility; or preventing recurrence of the disease. Evidence shows us that emotional support is very important.

Complications

The main complication of endometriosis is impaired fertility – about one-third to one-half of women who have endometriosis have difficulty falling pregnant.

However, many women with mild to moderate endometriosis are still able to conceive and carry a pregnancy to term. Doctors sometimes advise women with endometriosis not to delay having children because the condition may worsen with time. The longer you have endometriosis, the greater your chance of becoming infertile.

The other principal complication of endometriosis is pain to the degree where is impairs quality of life and the impact that can have with leading a normal life.