Endometriosis is when the tissue that normally lines the uterus (womb) also grows on the outside of the uterus, and on the other pelvic organs. It most commonly effects the ovaries, fallopian tubes and uterine tissue. It is non-cancerous and is diagnosed through a hysteroscopy, where a hysteroscope (a light and camera on the end of a long, thin tube) is inserted through the vagina and into the womb.

Endometriosis is one of the most common conditions that results in pelvic pain, being the cause in 30% of chronic pelvic pain cases. It effects 1 in 10 women of reproductive age, peaking at 40 years of age. The pain is caused by inflamed endometrial tissue on the outside of the uterus, bleeding during menstruation. The bleeding can cause scarring and act as a glue, sticking the pelvic organs and tissue together, resulting in further pain. Not all women experience pain with endometriosis, however. Although most do, on average spending 18 days in bed each year as a result. Some women may even be admitted to hospital for pain relief.

On average it takes 7.5 years for a women suffering from pelvic pain to be diagnosed with endometriosis. If left untreated for a long period of time, it can lead to fertility problems such as a difficulty conceiving and an increased risk of miscarriages. Therefore it is important that you raise concerns with your GP as soon as you experience any symptoms, and arm yourself with knowledge on the subject. To receive a positive diagnosis of endometriosis you will require a sample to be taken for your doctor to observe.

Effective treatment for endometriosis usually begins with hormone therapy through taking a contraceptive pill. If it worsens, and you have finished having children, you may elect to have surgery to remove the invasive tissue, alongside your uterus and ovaries.

What are the Symptoms of Endometriosis?

As with most conditions, everyone experiences endometriosis slightly differently. Some women may not experience any obvious symptoms, and may not even be aware that they are suffering from endometriosis. Others will have constant pain and very heavy periods, that result in them spending time in hospital.

Other symptoms include:

  • Pain described as a constant period pain
  • Pain in the lower abdomen, pelvis and lower back
  • Pain that gets worse during or after sex, and a reduced sexual satisfaction
  • Pain that gets worse during or after urination and defecation
  • Very heavy periods (menorrhagia)
  • Very painful periods (dysmenorrhea)
  • Miscarriages, difficulty getting pregnant or even infertility
  • Social isolation
  • Iron deficiency anaemia making you feel tired and breathless

Similar symptoms are experienced with other gastrointestinal, urinary, musculoskeletal and psychological conditions. These will need to be ruled out during your diagnosis of endometriosis, for an effective and lasting relief from pelvic pain.

What Causes Endometriosis?

The cause of endometriosis is mostly unknown. Studies suggest that it is hereditary and is passed through the women in a family. Other studies suggest oestrogen promotes the growth of endometriosis, as the condition usually begins after a girl begins to have periods, and it can resolve as you go through the menopause.

Your risk of developing endometriosis increases if you:

  • have a maternal family member which suffers - It may be passed from your mother, or her mother as it is thought to be hereditary.
  • are of reproductive age - Studies link oestrogen with the growth of endometriosis. As a result, having a late menopause increases your risk.
  • smoke - An association has been made between smoking cigarettes and endometriosis being more painful. More studies are needed to confirm this however.
  • have a poor diet - Studies show eating a healthy diet results in less pain from endometriosis.More studies are needed to confirm this however.

To read about other causes of pelvic pain, visit the Causes and Diagnosis of Pelvic Pain page.

How to Treat Endometriosis

The treatment for endometriosis depends on its severity, and whether you wish to have children in the future. The symptoms often naturally resolve as you go through the menopause. Therefore endometriosis is usually considered as a life-long disease which can be successfully managed without the need for a permanent cure.

Treatment for endometriosis begins with a prescription of hormone treatments and painkillers, with the aim of improving control over the menstrual cycle. Surgery may be offered if you are looking for a permanent cure, no longer wish to have children, and are wiling to accept the risks of undergoing pelvic surgery.

  • Painkillers - If you have mild pain, ibuprofen may be enough to manage it.
  • Hormone treatments - Hormone treatments are not a cure, but can help manage the symptoms of endometriosis by; reducing menstrual flow, the growth of endometrial tissue, and pain during the menstrual cycle.
    • Combined oral contraceptive pill - To be taken orally each day for 3-4 months, followed by a week break when you will have a light period. This pill contains oestrogen and progestogen which add to the levels that are naturally produced. The aim is to suppress ovulation, and thin the uterus lining to make periods shorter and lighter. This pill has an 80% success in managing pelvic pain from endometriosis. Oral contraceptives have even been proven to reduce the risk of endometriosis developing in the first place. Even for a year after the last time they were taken.
    • Progestogen only LARC contraceptive pill - Often referred to as POP or mini-pill. This pill is a long-acting reversible contraception (LARC), meaning it can be delivered to the body through several methods which have lasting effects (3 months - 5 years) but are not permanent. This pill can be given through; an intrauterine system (IUS), which is a small plastic device fitted inside your womb for up to 5 years. Injections, which are delivered to the muscles in the bottom every 3 months. Or an implant, under the skin of you arm for 3 years. Progestogen aims to reverse the growth of endometrial tissue, and stop it from getting any worse.
    • Testosterone derivatives - These drugs are now less commonly used due to their negative side effects; including swollen breasts, headaches, anxiety and an increased growth of body hair. The male hormone testosterone aims to decrease the natural production of oestrogen and progesterone to reduce endometriosis from spreading. It is commonly taken within the drugs Danazol and Gestrinone (Dimestriose) which aim to create conditions similar to menopause.
  • Surgery - Surgeries aim to remove the invasive endometrial tissue from affected organs as a permanent cure. Depending on the severity of pain and wishes of the patient, during surgery you may also have your uterus and ovaries removed as well, meaning you will no longer have periods or be able to fall pregnant.
    • Laparoscopy - Also known as a laparotomy, during a keyhole surgery the growths will be removed through multiple incisions, or by burning them off.
    • Hysterectomy - The removal of the uterus may be required if the endometriosis has caused severe damage, or if not all of the invasive tissue can be removed during a laparoscopy.
    • Oophorectomy - The removal of the ovaries to remove all invasive tissue.

To read about other treatments available for pelvic pain, visit our pelvic pain treatment page.

Sources

Bedaiwy, M. A. Falcone, T. (2007) General Gynecology. Chapter 13 – Endometriosis and Adenomyosis. [online] Mosby, p321-345 [viewed 08/05/18]. Available from: https://www.sciencedirect.com/science/article/pii/B9780323032476100139

Bennis, S. (2017). Endometriosis & Pelvic Pain: The Basics. [online] The International Pelvic Pain Society, 2017. [viewed 03/05/18].

Blanks, L. (2018). Endometrial ablation. [online] BUPA, 2018. [viewed 28/06/18]. Available from: https://www.bupa.co.uk/health-information/directory/e/endometrial-ablation

Ferrero, S. Remorgida, V. Venturini, P. L. (2010). BMJ Clinical Evidence. Endometriosis. [online] 0802. [viewed 28/06/18]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3217755/

Endometriosis UK. (2018). Hormone Treatments. [online] Endometriosis UK, 2018. [viewed 04/05/18].

International Pelvic Pain Society. (2018). Endometriosis. [online] The International Pelvic Pain Society, 2018. [viewed 02/05/18].

NHS Trust. (2016). Hysteroscopy: The hysteroscopy procedure. [online] NHS Trust, 2016. [viewed 02/05/18]. Available from: https://www.nhs.uk/conditions/hysteroscopy/what-happens/#the-hysteroscopy-procedure

NICE. (2017a). Endometriosis: diagnosis and management. [online] National Institute for Health and Care Excellence, 2017. [viewed 04/05/18]. Available from: https://www.nice.org.uk/guidance/ng73/informationforpublic

NICE. (2017b). Patient decision aid: Hormone treatment for endometriosis symptoms – what are my options? [online] National Institute for Health and Care Excellence, 2017. [viewed 04/05/18]. Available from: https://www.nice.org.uk/guidance/ng73/resources/patient-decision-aid-hormone-treatment-for-endometriosis-symptoms-what-are-my-options-pdf-4595573197

NICE. (2017c). Suspect endometriosis in women with chronic pelvic pain, says NICE. [online] National Institute for Health and Care Excellence, 2017. [viewed 04/05/18]. Available from: https://www.nice.org.uk/news/article/suspect-endometriosis-in-women-with-chronic-pelvic-pain-says-nice

Ortiz, D. D. (2008). American Family Physician. Chronic Pelvic Pain in Women. [online] 77(11), p 1535-1542. [viewed 01/05/18]. Available from: https://www.aafp.org/afp/2008/0601/p1535.pdf

The Practice Committee of the American Society for Reproductive Medicine. (2008). Fertility and Sterility. Treatment of pelvic pain associated with endometriosis. [90(5), p S260-S269. [viewed 04/05/18]. Available from: https://www.fertstert.org/article/S0015-0282(08)03474-2/fulltext

UChicago Medicine. (2018). Frequently Asked Questions About Pelvic Floor Disorders [online] UChicago Medicine, 2018 [viewed 01/05/2018]. Available from: http://www.uchospitals.edu/specialties/pelvic/faq/pelvic-floor-disorders.html

Vercellini, P. Frontino, G. De Giorgi, O. Pietropaolo, G. Pasin, R. Crosignani, P. G. (2003). Fertility and Sterility. Continuous use of an oral contraceptive for endometriosis-associated recurrent dysmenorrhea that does not respond to a cyclic pill regimen. [online] 80(3), p560-563. [viewed 04/05/18]. Available from: https://www.fertstert.org/article/S0015-0282(03)00794-5/fulltext

Wong, W. S. F. Lim, C. E. D. (2011). Iranian Journal of Reproductive Medicine. Hormonal treatment for endometriosis associated pelvic pain. [online] 9(3), p 163-170. [viewed 01/05/2018]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4575749/#!po=6.25000