Endometriosis: what are the signs?

Endometriosis is a common yet often misunderstood condition affecting millions of women worldwide. Despite its prevalence, many women struggle for years without a proper diagnosis, enduring pain and other debilitating symptoms. Understanding what endometriosis is, its symptoms, and treatment options can help those affected seek timely medical advice and improve their quality of life.

We speak to a leading consultant gynaecologist who explores the key aspects of this condition to provide clearer insights.

What is endometriosis?

Endometriosis is a condition in which tissue resembling the uterine lining grows outside the uterus, frequently affecting the ovaries, fallopian tubes, or other pelvic organs.  During the menstrual cycle, this tissue thickens and breaks down, but it has no way to exit the body, causing inflammation, scar tissue, and cysts.

What symptoms should you look for?

The principal symptom of endometriosis is pelvic pain, which occurs frequently during menstruation. However, this pain often exceeds the typical menstrual cramps many women experience. It can be debilitating and may begin before the period starts and continue after it ends. Some women also experience pain during intercourse, bowel movements, or urination, especially during menstruation.

Other symptoms include excessive menstrual bleeding, either in the form of heavy periods (menorrhagia) or bleeding between periods (spotting). Additionally, many women with endometriosis report fatigue, diarrhoea, constipation, bloating, and nausea. The severity of symptoms does not always correlate with the extent of the condition. Some women with severe endometriosis may experience only mild symptoms, while others with a milder form may suffer from intense pain.

How is endometriosis diagnosed?

Diagnosing endometriosis can be challenging because its symptoms are often similar to other conditions such as irritable bowel syndrome (IBS) or pelvic inflammatory disease (PID). Doctors typically begin with a detailed medical history and pelvic examination. However, the only definitive way to diagnose endometriosis is through laparoscopy, a minimally invasive surgical procedure where a small camera is inserted into the pelvis to look for signs of endometrial tissue outside the uterus. During this procedure, a biopsy (small tissue sample) may also be taken for analysis. In some cases, imaging tests like ultrasound or MRI might help detect larger areas of endometriosis, such as ovarian cysts.

What causes endometriosis to develop?

Although the exact cause of endometriosis has not been determined, experts have several theories as to why it occurs. One popular explanation is retrograde menstruation, where menstrual blood flows backwards through the fallopian tubes and into the pelvic cavity instead of leaving the body. Other theories suggest that certain cells in the body may transform into endometrial-like cells outside the uterus, or that the immune system plays a role in the development of the condition. Genetics also appear to be a factor, as women with a family history of endometriosis are at a higher risk of developing the condition.

How does endometriosis affect fertility?

Yes, endometriosis can affect fertility. Between 30% and 50% of women with endometriosis may experience difficulties conceiving. The condition can cause damage to the ovaries and fallopian tubes, as well as lead to inflammation that affects the reproductive organs.

The condition can cause inflammation, scar tissue, and adhesions in the reproductive organs, which may block the fallopian tubes, interfere with egg release, or damage the ovaries. These issues can make it harder to conceive, though many women with endometriosis can still become pregnant, naturally or through fertility treatments.

What treatment options are available for endometriosis?

There is currently no cure for endometriosis, but treatments can help manage the symptoms. Pain relief medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), are often prescribed to manage discomfort. Hormonal treatments, including birth control pills or hormonal IUDs, can help control the hormonal fluctuations that trigger the growth of endometrial tissue.

In more severe cases, surgery may be recommended to remove as much of the endometrial tissue as possible. This can help alleviate pain and improve fertility. Laparoscopic surgery is the most common approach, and in some cases, women may require more extensive surgery.