November 23, 2008 12:50 Published by Gidon Lieberman 0 Comments

What is Endometriosis?

The endometrium is the medical term used to describe the lining of the womb. The biological role of the womb lining is to provide an environment where an early pregnancy can implant and subsequently grow.  The lining is lost every month when a woman has a period, and the loss occurs as normal cyclical hormones fall.

In most women this lining is confined only to the inside of the womb. However in woman with endometriosis the lining is found elsewhere. The most common places are on the inside walls of the pelvis and on/in the ovary.

This migrated endometrium will also be under hormonal control, so there will be “internal bleeding” associated with the period. This can then lead on to internal scar tissue formation.

Who does it affect?

Endometriosis is a common condition only affecting women. It can start at any age, from the teenage years onwards and can last through a woman’s entire reproductive life. The time taken for onset of symptoms to an eventual diagnosis is long as endometriosis can present with a wide variety of symptoms.

What symptoms does it give?

The main problems are very painful periods, pain during intercourse and a delay in falling pregnant. Other symptoms are chronic pelvic pain, painful ovulation and pain associated with the bladder or bowels. Irregular bleeding may also occur.

One of the main reasons that there maybe a delay in diagnosis is that many other disease processes have similar symptoms such as irritable bowel syndrome.

How can I be diagnosed?

Ultrasound is useful in identifying endometriosis cysts (called endometriomas), but the most proven way is for a gynaecologist to perform a “laparoscopy” or keyhole surgery where the endometriosis can be visualised and biopsied.

Is there treatment?

For women who are not currently concerned with fertility then treatment options are varied. I normally advise nutritional support together with medication.

Nutritional advice includes the use of vitamin B1, vitamin E and magnesium. The use of mega-greens has been suggested to be helpful, albeit with little evidence.

Different types of medication can be used ranging from simple analgesics, the contraceptive pill or a more powerful group called GnRH agonists.

Surgery is an option. Areas or deposits of endometriosis can be removed surgically, often at the time of the initial diagnostic surgery. This rarely involves an overnight hospital stay.

In those women who have a delay in falling pregnant as their main problem, then many of these medications are not suitable, as we do not want to inhibit ovulation.

The best management for such women is surgical removal of endometriosis followed by use of assisted reproductive technology (artifical insemination or IVF).

Most women who have sub fertility with endometriosis will fall pregnant.

Who can I talk to?

Endometriosis is a common condition, and I would hope that you would be able to discuss your problems with your GP or gynaecologist. There are many patient support groups e.g. (http://www.endometriosis.org/support.html).

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