Everything you need to know about endometriosis

Endometriosis is a gynaecological disease that concerns about one woman out of ten but is rarely diagnosed.

What is it?


Endometriosis is the migration of pieces of endometrium (superficial layer of the uterus) towards places where it should not be: ovaries, myometrium, bowel, bladder, etc.
These ectopic implants are influenced by the hormonal cycle and so behave like the normal endometrium. Therefore, they grow and bleed every month.


Why and how does it appear?


One possible explanation is that at some point the menstrual blood flows back through the tubal the tubal towards the pelvic cavity rather than through the cervix towards the vagina as it should. Endometrial celles then settle on peritoneum and pelvic organs.
Nevertheless, not everybody is affected by this pathology and it seems that an immunity deficiency would be involved. This remains all uncertain and quite mysterious still.




Schema of the uterus explaining endometriosis

Source: Wikimedia



How can it be diagnosed?


The main symptom is pelvic pain, especially during periods but also during sexual intercourse. Sometimes it is found out to be bowel or bladder disorders but the relapse of pain when the period occurs is often a sign of endometriosis. If you suffer intolerable periodic pain, think of consulting a gynaecologist who could diagnose endometriosis and confirm if needed with a MRI.
Endometriosis can appear at an early age, as early as teenage years.
Sometimes, there can be no symptom but be diagnosed during a check-up for infertility.


What consequences can endometriosis have?


The main consequence of endometriosis is infertility. Endometriosis is involved in half the cases of infertility and a lot of women affected by endometriosis have to consider an IVF (In vitro fertilisation) especially after 35 years old.


What are the existing treatments and how efficient are they?


The treatment depends on your main concern and what you want to treat first.
If the main complaint is the pain, it is possible to take contraceptive and hormonal treatments which stop the natural influence of hormones and stop the painful menstrual bleeding. It is however sometimes inefficient and, in case of infertility, the treatment is surgical. 
Thus, when the pain becomes intolerable or the infertility may not be resolved by IVF, surgery is essential and the only tool to be efficient. However, the procedures can sometimes be heavy and risky, especially if the depth of the implants is significant. Relapse occurs in 30% to 50% of the cases.

This is why it is essential to diagnose this disease as early as possible to enable doctors to deliver the most efficient treatment. If you feel any symptom such anormal periodic pain, book an appointment with your gynaecologist now.



By Dr Christine Frayret, Gynaecological surgeon at the Harley Street Clinic. 



Christine FRAYRET