Endometriosis awareness (Part 1): Symptoms

Endometriosis is a complex medical condition, affecting 1.5 million women in the UK, that can manifest with diverse clinical presentations.

Mr George Goumalatsos is a renowned consultant gynaecologist and obstetrician in Basingstoke. In the first of two articles, Mr Goumalatsos offers an expert insight into the development and symptoms of endometriosis.

What is endometriosis?

Endometriosis is a condition that occurs when tissue lining the womb (called endometrium) grows in other organs within the body. Typically, this affects the ovaries, fallopian tubes, and pelvic lining. In some cases, it may extend to the bowel, which is then referred to as rectovaginal endometriosis. Occasionally, endometriosis can be detected in organs beyond the pelvic region, such as the diaphragm or lungs.

The displaced endometrial tissue retains the normal behaviour of endometrium; thickening and bleeding during each menstrual cycle. However, due to its inability to exit the body, it becomes trapped and continues to grow.

In the ovaries, the displaced endometrial tissue may lead to the development of cysts called endometriomas. This condition can cause inflammation in the surrounding tissues, as well as irritation and the formation of scar tissue, which results in the adhesion of pelvic organs to one another. Women who have endometriosis often experience pain and may encounter difficulties conceiving, although some women may remain asymptomatic.

Statistics indicate that approximately 10 per cent of women worldwide are affected by endometriosis. Among the women experiencing fertility challenges, 50 per cent have been found to have endometriosis, and about one-third of women who have pelvic pain have been found to have endometriosis as well.

What are the symptoms of endometriosis?

Endometriosis symptoms are often linked to the menstrual cycle, displaying a cyclical pattern. The primary symptom is pain, because the displaced endometrial tissue outside the womb also bleeds during the menstrual period, causing irritation to the pelvic organs and resulting in inflammation.

Other common symptoms include:

• Painful periods: Pain and cramping in the week before the menstrual period which may persist for several days. This pain may extend to the lower back and down to the legs.
• Pain during intercourse (dyspareunia): A commonly-reported symptom.
• Pain during bowel movements: If endometriosis affects the bowel, using the toilet can be painful, especially during the menstrual period.
• Subfertility: Endometriosis poses challenges to conception through two mechanisms:

1. Scar tissue blocks or traps fallopian tubes, making it difficult to pick up and transport the egg after ovulation.
2. Inflammation creates an unfavourable environment for the processes of ovulation, fertilisation, and implantation.

• Non-specific symptoms: Fatigue, bloating, and nausea are also frequently experienced.

It's important to note that the severity of symptoms doesn’t always correlate with the stage of the disease. In some instances, minimal endometriosis can cause more pronounced pain than severe endometriosis.

Furthermore, endometriosis may also coexist with other conditions, such as irritable bowel syndrome (IBS) originating from the bowel or interstitial cystitis from the bladder. These conditions share similar symptoms to endometriosis, adding complexity to the diagnosis.

Head on over to the second part of this series to find out about the diagnosis and treatment of endometriosis.

To schedule an appointment with Mr George Goumalatsos, head on over to his Top Doctors profile today.