Endometriosis: Understanding the symptoms, causes, and treatment options

Endometriosis is a chronic, often painful condition that affects an estimated 5–10% of women of reproductive age worldwide. This complex disorder occurs when tissue similar to the lining of the uterus, known as the endometrium, grows outside the uterine cavity. These endometrial-like tissues can attach to the ovaries, fallopian tubes, pelvic lining, and even, in rare cases, organs beyond the pelvic area. Despite its prevalence, endometriosis often goes undiagnosed for years due to its varied symptoms and the lack of awareness surrounding the condition.

What is Endometriosis?

At its core, endometriosis involves the abnormal growth of tissue resembling the uterine lining outside the uterus. During a typical menstrual cycle, the endometrium thickens in response to oestrogen, preparing for potential pregnancy. If pregnancy doesn’t occur, the lining sheds, resulting in menstruation. However, in women with endometriosis, the endometrial-like tissue outside the uterus responds to these hormonal changes but has no natural way to exit the body. This leads to internal bleeding, inflammation, scar tissue formation, and the development of cysts, commonly referred to as endometriomas.

One of the theories explaining the cause of endometriosis is retrograde menstruation, where menstrual blood flows backward through the fallopian tubes into the pelvic cavity instead of leaving the body. This backward flow carries endometrial cells that attach to pelvic organs and tissues, growing over time. However, retrograde menstruation alone doesn’t fully explain the condition, as many women experience it without developing endometriosis. Researchers believe a combination of genetic, hormonal, and immune system factors contribute to its development.

Recognising the Symptoms of Endometriosis

The symptoms of endometriosis can vary significantly, with some women experiencing severe pain and others having little to no symptoms. The condition is often mistaken for other disorders like irritable bowel syndrome (IBS) or ovarian cysts, making diagnosis challenging.

One of the hallmark symptoms is chronic pelvic pain, especially during menstruation. This pain can be debilitating and is often more intense than typical menstrual cramps. Many women also experience pain during intercourse, known as dyspareunia, which can affect relationships and emotional well-being. Additionally, endometriosis can cause painful urination and bowel movements, particularly during menstrual periods, due to the proximity of the endometrial tissue to the bladder and intestines.

Other common symptoms include:

• Heavy or irregular menstrual bleeding, sometimes with clotting.
• Digestive issues, such as diarrhoea, constipation, bloating, and nausea, often mistaken for gastrointestinal disorders.
• Fatigue, which can result from chronic inflammation and the body’s constant battle against misplaced tissue.

Infertility, affecting up to 50% of women with endometriosis, as the condition can cause adhesions and blockages that interfere with conception.

How is Endometriosis Diagnosed?

Diagnosing endometriosis often requires a combination of medical history, physical examinations, and imaging tests. However, the only definitive way to confirm the diagnosis is through laparoscopy, a minimally invasive surgical procedure where a small camera is inserted into the pelvic cavity to look for endometrial growths, scar tissue, and cysts. During this procedure, tissue samples may be collected for biopsy to rule out other conditions.

While imaging techniques like ultrasound and MRI can identify ovarian cysts associated with endometriosis, they cannot detect smaller lesions or adhesions. This limitation contributes to delays in diagnosis, with many women waiting years before receiving an accurate assessment.

What Are the Treatment Options for Endometriosis?

Although there is no cure for endometriosis, several treatments can help manage symptoms and improve quality of life. Treatment plans are often personalised, depending on the severity of symptoms, the extent of the disease, and whether the patient wishes to become pregnant.

Hormonal therapy is one of the first-line treatments. Hormones like gonadotropin-releasing hormone (GnRH) analogues help suppress oestrogen production, reducing the growth of endometrial tissue. Medications like Danazol can induce a pseudo-menopausal state, alleviating symptoms but with potential side effects. Oral contraceptives are also commonly prescribed to regulate the menstrual cycle, reduce bleeding, and relieve pain. Additionally, progestins can help shrink endometrial tissue and prevent its regrowth.

For women who do not respond to medication or those with severe symptoms, surgical intervention may be necessary. Laparoscopic surgery allows surgeons to remove or destroy endometrial implants, scar tissue, and cysts while preserving reproductive organs. In extreme cases where other treatments fail, a hysterectomy, sometimes with the removal of the ovaries, may be considered, though this is often a last resort due to its irreversible nature.

For women struggling with infertility, assisted reproductive technologies (ART) such as in vitro fertilisation (IVF) can offer hope. ART bypasses many of the physical barriers caused by endometriosis, increasing the chances of conception.

Living with Endometriosis: Long-Term Outlook

Endometriosis is a chronic condition, meaning symptoms can persist even after treatment. Recurrence is common, particularly after surgical removal of endometrial tissue. However, with early diagnosis and a comprehensive treatment plan, many women find effective ways to manage their symptoms.

Ongoing research into endometriosis is uncovering new insights into its causes and potential treatments. Advances in understanding the role of the immune system, genetics, and inflammation in the disease are paving the way for more targeted therapies. Additionally, support networks and advocacy groups play a crucial role in raising awareness, reducing stigma, and helping women find the resources they need to cope with this challenging condition.