A Guide to Understanding Endometriosis

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Endometriosis is a chronic and debilitating condition that affects approximately 11% of women in Australia.

Tissue, called the endometrium lines the inside of the uterus and regenerates after each menstrual cycle, but for women with endometriosis, this tissue also grows outside the uterus, and instead of shedding after each menstrual cycle, the tissue continues to build up, leading to inflammation, scarring and pain.

Endometriosis commonly affects not only the exterior of the uterus, but, ovaries, fallopian tubes, bowel, bladder and the space between the rectum and uterus, called the recto-uterine space. Whilst not all women will experience pain, when pain is present, it can be severe, particularly during the menstrual cycle.

For women who suffer from endometriosis it can lead to infertility or difficulty in conceiving, and the pain can negatively impact quality of life, private, social and professional. Continue reading to learn about the cause of endometriosis, its symptoms, diagnosis, treatment, and management options.

Cause of Endometriosis

The exact cause of endometriosis is unknown, but retrograde menstrual flow is considered a likely cause. This occurs when blood that would normally flow out of the body during the menstrual cycle, instead goes back along the fallopian tubes and sticks to pelvic organs where it can grow. Other possible causes include family history (genetics), the transport of endometrial cells via the lymphatic system, a metamorphosis of cells that transform into endometrial-like cells, and endometrial cells that may be transplanted during surgery.

Symptoms of Endometriosis

Endometriosis symptoms vary across women, however common symptoms include:

Extremely painful periods
Pelvic pain
Pain during sexual intercourse
Pain during bowel movements
Excessive menstrual bleeding or bleeding during periods
Fertility difficulties
Fatigue, especially during menstrual periods.

It is useful to note that pain severity is not necessarily an indicator of how advanced endometriosis is. Some women may experience no pain, but have an advanced stage of endometriosis, and conversely, other women may suffer from excruciating pain, but be at an early stage of endometriosis.

Diagnosis of Endometriosis

Endometriosis is a difficult condition to diagnose, as its symptoms may present as similar to other conditions. Unfortunately, due to this, it can go undiagnosed, but the Australian Government in 2018 launched the ‘National Action Plan for Endometriosis’ that includes investment in awareness and education of endometriosis, clinical management and care, and research. Through this initiative, and organisations, such as Endometriosis Australia, awareness of Endometriosis continues to improve throughout Australia.

When experiencing Endometriosis symptoms and presenting at a GP clinic for diagnosis, it is helpful to have a record of symptoms and lifestyle impact over the last six months. Endzone, funded by the Australian Government and Jean Hailes for Women’s Health, offers an online Endo Report that can be completed and brought to your GP appointment.

If Endometriosis is suspected, a thorough medical examination will be required to ensure an accurate diagnosis and this may include a pelvic exam, ultrasound or laparoscopy.

Treatment of Endometriosis

Whilst endometriosis can’t be cured, there are a range of treatment options to help women enjoy an improved quality of life. Treatment options include:

Pain medication
Hormone therapy to control menstrual cycles
Allied Health therapies, such as acupuncture and massage
Surgery: to remove endometrial tissue and adhesions

Treatment options will, generally speaking, consider aspects such as, endometriosis severity, a patient’s age, the desire to have children, and medical history.

Management of Endometriosis

For women who suffer from endometriosis, coping with endometriosis can be challenging and may feel isolating, but some things that may help manage the symptoms and reduce the feeling of isolation including:

Pain relief medication to reduce pain severity
Heat therapy to alleviate pelvic pain
Massage therapy to reduce menstrual pain
Yoga stretches (Endometriosis Australia Ambassador, Simone Skinner-Smith provides a 5 part YouTube series on Pelvic Yoga)
Joining endometriosis support groups,
Seeking support from family and friends

Whilst endometriosis does not have a cure, and affects many women in Australia, resulting in pain and infertility, it can be treated and managed, providing women with an improved quality of life. Seeking support from a GP to discuss symptoms is an important step in achieving this.