What is endometriosis and are you a sufferer?

It is more likely to present in your 30s or 40s, and is more likely to strike if you've never had children, says Dr Michelle O'Driscoll
What is endometriosis and are you a sufferer?

Endometriosis cannot be prevented, but management of it involves reducing the levels of oestrogen in the body where possible to keep the tissue lining thinner.

ENDOMETRIOSIS affects about 10% of women, and the cause is often unknown.

It is thought to be potentially attributable to genetics, the immune system, issues with menstrual flow that directs the tissue to the wrong areas of the body, or a hormonal issue.

But what actually is it? The lining of the womb is made up of very specific type of tissue, that is designed to nourish a growing embryo, and shed if you haven’t become pregnant, in the form of a period. Endometriosis is a painful and debilitating condition where the lining of the womb grows in places outside of the uterus. This could be in the intestines, on the fallopian tubes, or elsewhere.

Around the time that this tissue should shed in the womb, these growths outside of the womb can swell and bleed, and they’re usually located in areas where it cannot easily get out. While they are not cancerous, they do have negative impacts, and cause issues with fertility, as well as quality of life.

Endometriosis is more likely to present in your 30s or 40s, although it can occur at any age once menstruating. Symptoms often improve after the menopause due to the decrease in oestrogen levels. Endometriosis is more likely if you’ve never had children, have short menstrual cycles or long menstrual bleeds.

The pain experienced by women with endometriosis varies, and often extends further than just period pain, although menstrual cramps can be very severe.

It can also include lower back pain and pelvic pain that is chronic or ongoing, a pain during intercourse that is deeper and more severe than just pain at the entrance to the vagina, pain in the intestines, and pain when movement of bowels or passing of urine occurs, all depending on the location of where this tissue has grown. Stomach issues are also possible, especially during menstruation, with diarrhoea, bloating, nausea or constipation all potential issues to contend with.

Endometriosis cannot be prevented, but management of it involves reducing the levels of oestrogen in the body where possible to keep the tissue lining thinner. 

Options include going on hormonal contraception with oestrogen in it (as the levels of oestrogen in these are quite low), and increasing exercise to keep a low percentage of body fat and as a result, a lower level of oestrogen. Research also suggests that reducing alcohol and caffeine to one drink a day each has a positive effect on oestrogen levels for those suffering from endometriosis.

The types of examinations that can be done in the diagnosis of endometriosis include pelvic exams, ultrasounds, MRIs and laparoscopy. This procedure involves checking internally to definitively confirm the presence of endometriosis. Sometimes the visual is enough, and sometimes a tissue sample must be taken to be examined in the lab to confirm the diagnosis.

Treatment can involve hormonal contraception to reduce or regulate periods and the pain associated with them, or if trying to get pregnant you may be prescribed a gonadotropin-releasing GnRH agonist, which stops all ovulation and menstruation and the growth of endometriosis. When you come off it you have a better chance of becoming pregnant.

Pregnancy can be difficult to achieve with endometriosis if the shape of the pelvis or womb is altered, if the immune system attacks the embryo, or if the lining doesn’t develop as it should. Removal of the growths can also be helpful in supporting efforts to become pregnant, or other fertility treatments may be discussed.

Other treatments for endometriosis involve controlling the pain associated with it, so pain relief medication as well as some complimentary therapies such as acupuncture or the chiropractor can be helpful.

Women can go many years with a variety of the above symptoms, and/or issues conceiving, with no diagnosis presenting. This can have huge psychological impacts, with sufferers of the condition not feeling understood or heard. It’s very important to recognise when symptoms are more than just severe period pain, and to request further investigation to guide appropriate treatment and management.

It is very important to recognise when symptoms are more than just severe period pain and to request further investigation.

management.

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