Endometriosis: A Common yet misunderstood condition

Endometriosis is a chronic condition that affects many women, yet it often goes unrecognised for years. Its symptoms can range from mild discomfort to debilitating pain, significantly impacting daily life and, in some cases, fertility. For women experiencing persistent pelvic pain or other unexplained symptoms, understanding endometriosis is crucial. 

We speak to a revered consultant obstetrician and gynaecologist about the condition, including diagnosis, causes and treatment options.

What are the signs and symptoms of endometriosis?

The symptoms of endometriosis can differ widely between individuals. The most common symptom is pelvic pain, particularly during menstruation, which can sometimes be severe. However, other symptoms may include pain during intercourse, heavy menstrual bleeding, pain with bowel movements or urination, especially during periods, and fatigue. Endometriosis can also affect fertility, making it harder for some women to conceive.

It’s important to remember that the severity of pain doesn’t always correspond to the extent of the condition. Some women with advanced endometriosis may have little or no pain, while others with less extensive tissue growth may experience intense discomfort.

How is endometriosis diagnosed?

Diagnosing endometriosis can be tricky, as the symptoms often mimic those of other conditions like irritable bowel syndrome (IBS) or pelvic inflammatory disease (PID). Your doctor will start by taking a detailed medical history and performing a pelvic exam.

Imaging tests such as ultrasound or MRI may be used to detect cysts linked to endometriosis, though these methods can’t confirm the condition definitively. The most accurate way to diagnose endometriosis is through a minor surgical procedure called laparoscopy, in which a small camera is inserted into the abdomen to visually inspect the tissues and, if necessary, take samples (biopsies).

What causes endometriosis?

The cause of endometriosis is not fully understood, but several theories exist. One well-known theory is retrograde menstruation, where menstrual blood flows backwards through the fallopian tubes into the pelvic cavity rather than leaving the body. This backward flow may cause endometrial-like tissue to implant and grow outside the uterus.

Other possibilities include genetic factors (as the condition tends to run in families), immune system dysfunction, and hormonal imbalances. While none of these theories has been proven as the sole cause, research continues to explore how they contribute to the development of endometriosis.

What treatments are available for endometriosis?

Although endometriosis has no cure, various treatments are available to help manage the symptoms. Pain relief is often the first step, with nonsteroidal anti-inflammatory drugs (NSAIDs) commonly used to control discomfort. Hormonal therapies, including birth control pills or hormone-suppressing medications, can help reduce or eliminate menstrual periods, preventing the tissue from growing or shedding.

For more severe cases, surgery may be required to remove the endometrial-like tissue, which can provide pain relief and potentially improve fertility. However, endometriosis can sometimes recur after surgery, so ongoing management may be necessary.