Have you heard?
Endometriosis is a condition that affects a woman's reproductive organs. It occurs when the tissue that lines the uterus grows outside of it. Often women have questions about the effect of endometriosis on their bladder and bowel, fertility, emotional health and relationships. Knowing where to go for advice and support is important, and reading and listening to the personal stories of women who have endometriosis is helpful too, particularly the importance of not giving up hope.
Causes of endometriosis
We don't really know what causes endometriosis, and possible causes or factors may be different from person to person.
Family history : women who have a close relative with the condition are up to 7-10 times more likely to get endometriosis. Also, it is common with twins that both may get endometriosis, particularly if they are identical twins.
Retrograde (backwards) menstruation : When a woman has a period, the blood flows out of the vagina, but also backwards along the Fallopian tubes into the pelvis. In 90% of women, the blood, which will contain endometrial cells is absorbed or broken down and causes no symptoms; however, in women with endometriosis this endometrial tissue starts to grow.
Metaplasia: the conversion of the normal pelvic tissue into endometriosis.
Other possible factors that may have a role in causing endometriosis are:
having first pregnancy at an older age
heavy bleeding during periods and periods lasting longer than five days
first period before 11 years of age
regularly having less than 27 days between periods, or having shorter regular cycles
changes in the immune cells
low body weight
alcohol use
Factors that may lower the risk of getting endometriosis are:
how many children you have – the chance of getting endometriosis may lower with each pregnancy (this may be related to the hormone progesterone during pregnancy)
younger age of first pregnancy
breastfeeding for a longer period
regular exercise of more than four hours per week (this may also help with pelvic pain for endometriosis)
Superficial peritoneal patches (surface lining patches or plaques)
Deep infiltrating endometriosis, in which endometriosis causes scarring and nodules which can grow into nearby organs, such as the bladder, bowel and ovary. In the ovary it causes a 'chocolate cyst' or endometriom
Adolescent endometriosis, which may have different causes
The symptoms vary from woman to woman. Some women have many symptoms and severe pain, whereas others have no symptoms. About a third of women with endometriosis discover they have it because they have not been able to become pregnant, or because endometriosis is found during an operation for another reason.
The type of symptoms and their severity are likely to be related to the location of the endometrial tissue rather than the amount of endometrial cells growing.
About three out of four women with endometriosis have pelvic pain and/or painful periods.
In the early stages of the disease, one or two mild symptoms may be felt for the first day or two of a period. Later, as the condition continues, symptoms may get worse for more days of the month, both during and before the period.
In women over the age of 25, endometriosis can make it difficult to get pregnant. This may be because the endometrial cells release chemicals that cause inflammation that:
*interfere with the ability to get pregnant
*affect the development of the embryo in its early stages
In moderate to severe cases, the scarring caused by the endometrial cells may interfere with the release of an egg (ovulation), due to damage or blockage. The damage can also prevent the journey of an egg along the Fallopian tube and/or the sperm from reaching the egg, causing problem
Pain is a key symptom of this condition and is not related to how severe the disease is, but to the location of endometrial tissue.
Pain immediately before and during a period
Pain during or after sex
Abdominal, back and/or pelvic pain
Pain on going to the toilet, passing urine, opening bowels
Ovulation pain, including pain in the thigh or leg (this can also happen normally in some women)
Bleeding Heavy bleeding, with or without clots
Irregular bleeding, with or without a regular cycle
Bleeding longer than normal
Bleeding before a period is due
Bladder and bowel problems
Bleeding from the bladder or bowel
Change in pattern of bowel habit, such as constipation, diarrhoea
The need to urinate more frequently or some other change from the normal habit
Bloating Increase abdominal bloating, with or without pain at the time of the period
Tiredness or lack of energy, especially around the time of the period
Mood changes
Anxiety and depression due to ongoing pain
Reduced quality of life
Taking days off work, study or school because of an inability to function normally
Vagina Pelvic floor muscle spasm or tightening occurring because of fear of pain previously experienced with intercourse of tampon use
In many cases, the symptoms of endometriosis appear to go away with pregnancy. This is thought to be because pregnancy hormones cause the endometriosis to reduce. After the baby is born the effects of endometriosis are unclear. In a small study of 23 women, the endometrial lesions worsened in the first three months of pregnancy, but improved as the pregnancy continued. Complications of endometriosis during pregnancy are rare.
Usually, endometriosis does go away after menopause. It may return with the use of hormone replacement therapy (HRT), but this is rare. Even more rarely, it can return for no reason.
The information above is based on current medical knowledge, evidence and practice as at October 2016.
