Endometriosis occurs when cells similar to those found in the womb’s lining are found elsewhere in the body. It is usually found in the abdomen or pelvis but in rare cases can be found elsewhere. These cells react like womb cells during the menstrual cycle, meaning that they build and then bleed, but the blood they release has nowhere to go, causing inflammation and scarring inside the body. Sometimes these cells attach to the ovaries, causing cysts called endometrioma or more commonly, “chocolate cysts”, due to the thick, dark, chocolate-like fluid they contain.
Symptoms can vary, with some women experiencing very few symptoms while others are badly affected, including the possibility of having difficulty conceiving. It’s not unusual to feel fatigued; there can be pelvic pain which may be severe, and radiate towards the lower back and thighs. It may also be painful during and after sex as well as when going to the toilet. Sometimes there are symptoms related to your bowels, such as rectal bleeding, constipation, diarrhoea, nausea and bloating. Periods can become irregular and very heavy, with some light bleeding between periods. If an ovarian cyst has formed, the symptoms will be the same, but if the pain becomes sudden, sharp and severe, this could mean that the cyst has ruptured and may require urgent medical attention.
The exact cause is unknown, but in some cases, it is thought to be genetic or might indicate a problem with the immune system. It can also be caused by retrograde menstruation, when the cells released during menstruation travel back up the fallopian tubes rather than being released out of the body. These cells then attach to organs within the pelvis. Another potential cause is something called “metaplasia” which occurs when cells of one kind morph into different cell types, usually in response to inflammation.
There is currently no cure for endometriosis, but there are ways to control it and improve your quality of life. Painkillers can be used to suppress the pain to a more manageable level, while some patients find that the contraceptive pill can work to make periods shorter and lighter. Others have the Mirena coil fitted, which releases progestogen into the body over five years, thus reducing the impact of periods and sometimes stopping them altogether. Injections of progesterone work in a similar way by preventing ovulation, meaning that endometrial growth is suppressed.
In some cases, it is necessary to perform a laparoscopy which is the only way to definitively diagnose endometriosis. It also means that surgical removal of the lesions can be surgically removed by laser ablation. In extreme cases, it may be necessary to have a hysterectomy, but this is not a guaranteed cure. If an ovarian cyst has formed due to the endometriosis, surgery is required to remove it as it will not respond to hormone treatment.
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