Endometriosis
Many women experience painful periods. In a minority of cases, this can be caused by endometriosis, a condition in which small pieces of the womb lining (the endometrium) grow outside the womb. Endometriosis occurs in between 1-15% of women of childbearing age. In many women it causes no symptoms, but in others it can cause severe pain and may reduce the chances of becoming pregnant.
This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.
Normally, as part of the menstrual cycle, your womb lining thickens every month to receive a fertilised egg. If an egg doesn’t get fertilised (if you don’t get pregnant), the lining of your womb breaks down. This lining leaves your body as menstrual blood (a period). This process is controlled by your body’s hormones.
In endometriosis, you have cells like those that would normally line your womb (endometrial tissue) elsewhere in your body. This tissue will also thicken, break down and bleed with your menstrual cycle, but this tissue and blood has no way of leaving your body. This can lead to pain, swelling and scarring. Rubbery bands of scar tissue, called adhesions, may form. These can tie organs and tissues together and affect the normal working of organs.
Endometriosis most commonly occurs on the ovaries, on the tubes that carry eggs from the ovaries to the womb (Fallopian tubes), and on the tissues that hold the womb in place. When it occurs on the ovaries the endometriosis can form cysts (endometrioma). These are also called chocolate cysts because of the brown fluid they contain. They may not cause any pain and may only be found during an internal examination to check fertility. However, if they burst, their contents spill into the body cavity where they can cause severe pain and result in adhesions. Endometriosis can affect other parts of your body, such as your lungs, but this is rare.
Endometriosis is not a form of cancer, and it isn’t contagious (doesn’t spread from person to person).
One of the most common symptoms of endometriosis is pelvic pain which is usually worse just before, and during your period but in some women the pelvic pain can be constant. The pain may get worse over time and you may find that it’s not eased by taking over-the-counter painkillers such as ibuprofen.
Other typical symptoms include pain during sex, small loss of blood before your periods (spotting) and heavy or irregular periods. If you’re trying for a baby you may find that you have difficulties becoming pregnant. You may feel extremely tired. Some women become depressed because of the long-term pain they have.
Symptoms of endometriosis often disappear during pregnancy or after the menopause.
None of the symptoms of endometriosis are unique to the condition, so the only way to be sure that a woman has endometriosis is to look inside the abdomen.
Your GP will ask you about your symptoms. Don’t be embarrassed to tell them about the problems you’re having – including pain during sex, or seeing blood when going to the toilet. It’s important that they know about these.
Your GP may offer you the following tests:
- A vaginal or rectal examination. A vaginal examination involves your GP inserting gloved, lubricated fingers into your vagina to gently feel for any abnormalities in and around your uterus (womb). At the same time, they’ll use their other hand to lightly press on your abdomen (tummy). A rectal examination involves your GP inserting a gloved, lubricated finger into your anus (back passage). This may feel uncomfortable but shouldn’t be painful. Let your GP know if anything hurts. You can ask to have someone stay with you while your GP does these tests, if you prefer.
- An ultrasound scan. Ultrasound uses sound waves to produce an image of the inside of the body. To look for endometriosis, an ultrasound scan may be done using a sensor placed in your vagina. An ultrasound scan may be helpful in picking up other causes of your symptoms. It doesn’t always pick up endometriosis, even if you have it.
Your GP may refer you to a gynaecologist (a doctor that specialises in women’s reproductive health) for further tests.
It may take some time for you to get a diagnosis of endometriosis because the symptoms are similar to some other health conditions. The only way doctors can be sure that you have endometriosis is to check through a procedure called a laparoscopy. This is carried out under general anaesthetic so you’ll be asleep. Your gynaecologist will look inside your abdomen using a narrow tube-like telescopic camera (laparoscope) that they insert through a small cut. They may take a biopsy – a small sample of tissue to send to the lab for examination under a microscope. If you have a laparoscopy to diagnose your endometriosis, your gynaecologist may remove the endometriosis during that procedure. Or they may recommend having surgery to remove the endometriosis at a later time. See our section on treatment below.
Sometimes, rather than you having this procedure right away, your doctor may suggest trying treatments for endometriosis first, to see if they help. You might also be offered an MRI scan. An MRI scan uses magnets and radio waves to produce images of the inside of the body.
Doctors don’t really know yet why people get endometriosis. There are lots of different ideas about how it develops.
Endometriosis is probably caused by a combination of factors. For example, your immune system or hormones might play a role. Endometriosis may also run in families, as you’re more likely to get it if your mother or sister has it. It is also more common in white people rather than in other ethnic groups, in women who give birth for the first time after the age of 30, and in infertile women.
About one in three women get better on their own over 6 to 12 months. Other women may need to have treatment to reduce their symptoms. Your treatment will depend on factors such as how bad your symptoms are and whether or not you want to have children.
A number of treatments can help to manage your symptoms, but they don’t always work in the long-term. About half of women find that their symptoms come back. You may choose to have another course of medication or more surgery if this happens.
Your doctor will discuss the various options with you, and help you decide which treatment is best for you.
Medicines
Pain medicines
Your doctor will probably suggest that you try analgesics (such as paracetamol, anti-inflammatories and codeine) to ease pain and discomfort. Complementary medicines (such as acupuncture, aromatherapy, herbal remedies, homeopathy etc) may also help.
Hormonal treatments
Hormone treatments can help to shrink or suppress endometriosis and therefore lessen your pain. However, they aren’t suitable for treating endometriosis in women who are trying to become pregnant. There are several hormonal medicines that can be used:
- combined oral contraceptives (the pill)
- progestogens
- danazol
- gestrinone
- gonadotropin-releasing hormone (GnRH) analogues
All of these hormonal medicines work equally well overall but have different side effects. The doctor may suggest trying several medicines to find one that works and causes fewest side effects.
Treatment with medicines won’t cure endometriosis and symptoms usually return when the medicine is stopped. Pain returns in about 2 in 5 women 12 months after stopping treatment, and in about half after 5 years.
Surgery
Surgery can remove areas of endometriosis. This can help to improve your chance of getting pregnant if your endometriosis is affecting your fertility, and can also reduce your pain. Surgery for endometriosis is done under a general anaesthetic so you’ll be asleep. Endometriosis can come back after surgery, so you may need to have surgery again in the future.
Laparoscopy (keyhole surgery)
Surgery can often be done by laparoscopy – a type of keyhole surgery. This involves a gynaecologist looking inside your abdomen (tummy) using a narrow, tube-like telescopic camera (laparoscope) inserted through a small cut. They can then remove or destroy any patches of endometriosis.
Laparotomy (open surgery)
If you have severe endometriosis, keyhole surgery may not be suitable. You may need an operation called a laparotomy where a larger cut is made in your abdomen, usually along the bikini line. If your gynaecologist recommends this, they will explain the procedure and why it’s best for you.
Hysterectomy
If you don’t want to have children in the future, your gynaecologist may offer you a hysterectomy. This is a larger operation to remove your womb and sometimes your ovaries. This operation can also be done by keyhole surgery. Talk to your gynaecologist about the pros and cons of this type of surgery, and see our FAQ on hysterectomy.
Some complications of endometriosis are listed below:
- Scar tissue can attach to organs in your pelvis and abdomen (tummy). These scars are known as adhesions and can cause pain. They may also cause your bowel to become blocked.
- You may have difficulty getting pregnant (reduced fertility). This may affect up to a half of those women who have endometriosis.
- Endometriosis increases your risk of getting ovarian cysts. These can rupture and cause pain and reduced fertility.
- You may have a slightly increased risk of ovarian cancer if you have endometriosis.
Speak to your GP or doctor if you have any questions about the complications of endometriosis.
1. Can treatment for endometriosis help me get pregnant?
The good news is that around seven out of 10 women with endometriosis will eventually get pregnant without medical help. However, some women with endometriosis do have problems with reduced fertility.
Having hormonal treatment for endometriosis can help ease your pain symptoms (see our treatment section above). However, doctors don’t think it increases your chance of getting pregnant.
There are treatments that can help improve your chance of getting pregnant if you have endometriosis. However, there isn’t yet one, agreed ‘best option’. This is something you should discuss with your gynaecologist. What treatment you may have will depend upon several factors including the type and severity of endometriosis and your preferences.
Having laparoscopic surgery to remove or destroy patches of endometriosis may improve your fertility. This is more likely to help if you have mild endometriosis, rather than moderate to severe disease.
After discussion with your gynaecologist, you may decide to opt for one of the forms of medically-assisted reproduction (assisted conception, fertility treatments). These include intrauterine insemination and in vitro fertilisation (IVF). See our topic on female infertility for more information.
2. I have endometriosis – am I more likely to get cancer?
Endometriosis is a benign condition, which means it isn’t a type of cancer.
However, having endometriosis does seem to slightly increase your chance of getting some types of ovarian cancer. Doctors aren’t sure why this is. So there’s lots of research going on to try and find out more about the link between endometriosis and ovarian cancer.
If you’re concerned about your risk of ovarian cancer, talk to your GP or gynaecologist.
3. Will a hysterectomy cure my endometriosis?
If other treatments haven’t worked, and you’re sure that you don’t want to become pregnant in the future, then a hysterectomy may be an option. This is an operation to remove your uterus (womb).
Your gynaecologist may recommend you have your ovaries removed at the same time, as this gives you a better chance of your symptoms ending. Removing your ovaries removes the hormones they produce. It’s these hormones which cause the areas of endometriosis to swell and bleed.
Having your womb and ovaries removed, along with areas of endometriosis, may make your symptoms go away for good. It doesn’t always work though – some women still have symptoms of endometriosis after the operation.
If you have your ovaries removed, this may cause you to have symptoms similar to the menopause, such as hot flushes and mood changes. Your doctor may recommend that you take hormone replacement therapy (HRT) to deal with these. They’ll discuss with you how soon after your hysterectomy you can start HRT.
For more information about your treatment options, or if you have any questions, speak to your doctor. They’ll explain the options available to you, as well as their benefits and risks.
This information was published by Bupa Group's Health Content Team and has been reviewed by appropriate medical or clinical professionals. To the best of their knowledge the information is current and based on reputable sources of medical evidence, however Bupa (Asia) Limited makes no representation or warranty as to the completeness or accuracy of the Content.
The information on this page, and any information on third party websites referred to on this page, is provided as a guide only. It should not be relied upon as a substitute for professional medical advice, nor is it intended to be used for medical diagnosis or treatment. Bupa (Asia) Limited is not liable for any loss or damage you suffer arising out of the use of, or reliance on, the information.
Third party websites are not owned or controlled by Bupa and any individual may be able to access and post messages on them. Bupa is not responsible for the content or availability of these third party websites.
The National Endometriosis Society (UK)
http://www.endo.org.uk
Website written by a patient:
http://www.endometriosis.org.uk
Website written by a doctor:
http://www.womens-health.co.uk
National Womens Health Information Center (US)
http://www.4woman.gov/faq/endomet.htm
Endometriosis Association
http://www.endometriosisassn.org/
Endometriosis Research Center
http://www.endocenter.org/
The Endometrosis Association (Victoria)
http://www.endometriosis.org.au
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