Endometriosis pain and other signs of Endometriosis are important aspects to explore in understanding the chronic health condition, Endometriosis. Learn more about this condition in our feature post below.

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What Is Endometriosis

• Endometriosis is a chronic or lifelong disease where tissue that looks like (or is similar to) the womb’s inner lining grows in other body parts.
  • These tissues can form cysts in the ovary or patches in other areas. The womb’s inner lining is also known as the endometrium.
  • Under the influence of hormones oestrogen and progesterone, the lining changes at different stages of a woman’s cycle.
  • For example, before ovulation, the lining thickens to prepare to receive a fertilised egg. If no egg is implanted, the womb lining breaks down and is shed along with the egg during menstrual. Therefore if you have misplaced womb lining in other parts of the body, it will also be under the influence of hormones, growing and shedding with each menstrual cycle. 

How Endometriosis is Diagnosed?

Endometriosis diagnosis involves a direct look at a woman’s reproductive organs. Usually, this happens through a procedure known as laparoscopy.

Here, a camera on the end of a thin telescope is passed through the small cuts in the abdomen to explore the internal organs of the abdomen and pelvis, looking for abnormal womb tissue.

What about an ultrasound scan?

An abdominal or transvaginal scan is very useful, especially as the first line before a laparoscopy. It can help us rule out other causes of pelvic pain or painful, heavy periods that look similar to Endometriosis, like Fibroids or PID (Pelvic Inflammatory Disease) and ovarian cysts (check out this video). Also, problems like IBS (Irritable bowel syndrome), IBD (Inflammatory Bowel Disease) or bladder abnormalities.

You may also have MRI or CT scans that can pick up anything that looks structurally abnormal around the abdomen/pelvis. The best test, known as the gold standard, is laparoscopy. 

Symptoms and Signs of Endometriosis

What endometriosis symptoms mean. The womb lining present in parts of the body outside the womb causes Endometriosis symptoms. Blood and the menstrual product are trapped and cannot leave the body, unlike the usual womb lining, which is shed through the vagina as menstrual blood.

Bleeding irritates the tissues, causing inflammation and pain. Endometriosis pain is a big issue:

• It can be pelvic pain that comes and goes throughout the menstrual cycle.
• Pain in the lower abdomen/ back, painful periods or painful cramps that worsen during a menstrual cycle.
• Deep pain during sex, pain urinating, pain exercising.

In addition, having endometriosis in unusual sites can affect the menstrual pattern leading to abnormal bleeding – irregular/ heavy, prolonged and so on.

It can also cause troublesome bowels – constipation, bloating, pain when stooling during your period, nausea/vomiting.

Also, endometriosis patches are sticky, so organs can get stuck together, scar tissue forms in the areas, or organs like the fallopian tube get blocked.

These adhesions (scar tissue) is can lead to infertility (affects 30-40% of women with Endometriosis). Endometriosis can lead to abnormal cysts from endometrial tissue developing in the ovary – known as endometriomas. They will disrupt how well the ovaries work – affecting ovulation and fertility.

Women with Endometriosis may also become fatigued due to chronic blood loss leading to anaemia.

What Endometriosis Means or Feels like 

We’ve explained what it is, and here I want to address which parts of the body are most often affected by Endometriosis.

The ovaries and the tissues around them support the womb, the fallopian tube, the bladder, the large bowel, and the kidney tubes. Away from the lower trunk area, the chest is a popular location for endometriosis to grow.

Endometriosis affects 1 in 6 to 10 women, so it’s much more common than we often realise.

It also affects women differently, so they do not all have the same symptoms. They can spread to different locations, and laparoscopy is best to help see these organs and locate any abnormal tissues/cysts. 

It can take a long time for endometriosis diagnosis because people still believe that period pain or having heavy periods is normal.

Fertility and Endometriosis’ Relationship

How endometriosis causes infertility or why endometriosis causes infertility

Up to 1 in 3 women with Endometriosis have problems with fertility.

In most cases, we don’t know why it is harder for women with endometriosis to become pregnant. This is unless a woman’s disease is severe enough to damage her organs.

If the ovary has scars because of endometriosis patches or contains cysts, it may not be able to release eggs.

Or if the fallopian tube is stuck and the egg cannot travel through it toward the sperm for fertilisation. Such can happen in women with moderate/severe disease. 

However, there may be other causes for infertility occurring:

• 1. poor quality of eggs,
• 2. travel of the egg in the tube affected by chemicals produced,
• 3. inflammation in the pelvis caused by endometriosis stimulates the production of cells that attack the sperm and shorten their life span,
• 4. eggs are not released from the ovaries each month (also known as anovulation, a problem which may also occur in women without endometriosis) 

How Women Develop Endometriosis

Why endometriosis occurs? We don’t know what causes this condition.

However, there are some suggestions about how these womb-like tissues get to where they should not be:

• #1. One of the most popular theories is that the disease starts during early life menstruation when blood and material are shed through the vagina. Instead of being shed, some tissue escapes back to other locations where they settle. (retrograde menstruation).
• #2. Another theory is that the blood vessels that supply the womb may carry bits of the womb lining to other body parts, where they settle.
• #3. The next theory is that these are not cells of the womb initially. Still, they are cells that will usually develop into abdominal tissue, which transforms into womb-lining cells. However, they are doing so outside the womb.
• #4 There is also a theory that endometriosis may arise from an impaired immune system. Scientists who propose this theory suggest that within the pelvis and abdomen, there are certain immune cells that behave like killers and scavengers.
  • They explain that these cells target and destroy others when they enter areas they do not belong. When the body fails (for unknown reasons) to develop these killer cells, it may allow the development of endometriosis cells.

Will Endometriosis Go Away (Endometriosis Treatment)

Endometriosis affects 10 -15% of women of childbearing age. It is comparable to fibroids that affect over 30% of women in that same range.

One notable difference may be in racial trends – fibroids seem to occur more in people of African background.

But in terms of development, we think the growth of endometriosis cysts and tissues is under the effect of hormones – particularly Oestrogen.

We currently do not have a cure for endometriosis, but there are treatments which usually address a woman’s troublesome symptoms, such as painful cramps, periods or fertility issues.

These treatments try to prevent menstruation, i.e. mimic pregnancy or create an artificial menopause, to remove the effect of hormones on endometriotic tissues.

But, even after menopause, women may still have endometriosis and require treatment, so there may be more to it than Oestrogen alone.

Options for treatment include:

• Hormones to regulate symptoms like bleeding and painful periods, for instance, the combined birth control pill.
  • This needs to be carefully monitored, though, as while it may control bleeding for some women, it could make it worse in others.
• Another option which suppresses the oestrogen hormone and makes the endometriosis tissues inactive is using other forms of birth control like Mirena or the Depo Shot.
• Other hormone-like medicines can also modify the behaviour of the tissues and reduce symptoms.
  •  Depo Provera Endometriosis treatment – Depo Provera (depo shot) is a treatment option for Endometriosis. It controls the growth/prevents the growth of the cysts while you are on the shot but will not cure it, so when you stop the Depo, the cysts will start growing again. 
• Surgery is yet another option to remove the abnormally sited tissues from different parts of the body.

Having the Conversation about Abnormal Periods

Many women with heavy, painful periods and other symptoms still experience significant delays before endometriosis diagnosis and treatment. It’s important to move forward from enduring (or accepting) the symptoms of this condition in order to seek medical attention sooner than later.

Doctors are also increasingly more aware that troublesome periods should not be ignored – rather examined or treated.

More Reading

• The Right Treatments for Endometriosis.
• Video – What are the Symptoms of Endometriosis?
• Video – Endometriosis – “Who” gets it and Why?
• DIY Diagnosis: Self Diagnosis and Self Medication
• 5 Reasons You Didn’t Know For Vaginal Bleeding After Sex

Editing By AskAwayHealth Team

Disclaimer

All AskAwayHealth articles are written by practising  Medical Practitioners on various healthcare conditions to provide evidence-based guidance and to help promote quality healthcare. 

The advice in our material is not meant to replace the management of your specific condition by a qualified healthcare practitioner.
To discuss your condition, please contact a health practitioner here.