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How much do you know about endometriosis?

15 December 2017

According to the charity Endometriosis UK one in ten women – almost two million - will suffer from endometriosis.

Mainly affecting girls and women of childbearing age endometriosis is a common condition where tissue that behaves like the lining of the womb (endometrium) is found in other parts of the body. 

It can appear in many different places, including the ovaries, fallopian tubes, inside the tummy, and in or around the bladder or bowel.

Mr Chris Mann,  a Consultant Gynaecological Oncologist and Laparoscopic Surgeon at Spire Parkway Hospital in Solihull, answers some of the most-asked questions about the condition, how it develops and to treat it.

What is endometriosis?

It is when womb lining tissue (endometrium) is found outside the womb. It is a long-term condition that can cause severe pain and discomfort. It is most found in women aged between 16 and 50 although it can be found in women who have been through the menopause as well as in girls who are yet to start having periods.

Some women will have a mild form of the condition, whilst others will experience extreme pain often related to their period. However it can also occur on a daily basis, when they have sexual intercourse, go to the toilet, either to open their bowels or urinate.  Some of these patients will also have difficulty becoming pregnant.

How does it affect the body?

Each month, at the end of the menstrual cycle, hormones cause the lining of the womb to break down and bleed. This is then released from the body as a period.

Endometriosis cells growing outside the womb will also break apart and bleed. However, the blood will have nowhere to go. This internal bleeding can lead to irritation, inflammation, pain and scar formation.

What causes endometriosis?

No-one knows for sure but the most widely accepted theory is that during a period not all the womb lining leaves the body properly. Instead some passes back into the pelvic cavity and attaches to the reproductive organs. This is known as retrograde menstruation. However, this doesn't explain all cases of endometriosis and there are several other theories about its causes. This does not affect the treatment of the condition.

What are the usual symptoms?

There are a vast array of symptoms but some of the most common are very painful abdominal cramps or back pain during menstruation; painful bowel movements; pain when urinating - especially during periods; bleeding between periods; painful sex and general tiredness. There is obviously the problem that sufferers will find it difficult to get pregnant.

Can it be cured?

Yes. In a large proportion of patients who have a complete excision of the endometriosis there is no recurrence of the disease.  In some cases however there may be a recurrence which can require repeat excision.

What kind of medical treatments are available?

Painkillers and hormone medication can help reduce symptoms and stop them interfering with daily life while anti-inflammatory over-the-counter drugs can help to reduce painful cramps.

For mild cases your GP may recommend hormone treatment to limit the production of oestrogen and control tissue growth size. Hormones can also reduce the amount of blood produced during periods so giving tissues time to heal. However, once hormone treatment stops the growths will usually return to their original size and cause the same symptoms as no drug-based treatment is able to get rid of the endometriosis – hence the symptoms return after treatment with drugs finishes.

What about surgery?

Patches of endometriosis tissue can be surgically removed (excised) to improve symptoms and fertility. Available surgeries include:

Laparoscopy - also called keyhole surgery. It is commonly used and is the least invasive surgical option. It improves pain symptoms and increases the chances of pregnancy. Problems can return if any endometriosis tissue is left behind so this surgery should be performed by experienced surgeons who specialise in excisional surgery.

Laparotomy - a more invasive operation for more severe endometriosis. A wide cut is made along the bikini line or mid-line to access the affected organs.

Hysterectomy - this is a major operation where the womb is removed, and is only recommended if other treatments haven't worked and if you have decided not to have any more children.

Remember - The severity of symptoms depends on where the abnormal endometrial tissue is not on how much you have. A small amount in one place could be more painful than a larger amount somewhere else in the body.

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