What is Endometriosis?

The endometrium is the layer of cells that lines the inside of the uterus. This lining sheds away each month and causes your period. Endometriosis is a condition where there are endometrial cells are in abnormal places. The most common sites for endometriosis to be found are around the outside of the uterus, and in the ovaries. The deposits of endometriosis respond to your cycle, just like the lining of the uterus. When the endometriotic deposits bleed they cause inflammation and scarring leading to pain. This may also lead to fertility problems in some people. Endometriosis is very common and may affect 10-20% of women. In the past there symptoms were put down as period pain. In the modern era of minimal access surgery we can now diagnose and treat endometriosis accurately by looking in the pelvis with the laparoscope.

Signs and symptoms

The most common symptom of endometriosis is severe pain with periods. Women with endometriosis may also have heavy periods and bleeding between periods. Other common symptoms of endometriosis are pain with intercourse and pain on passing bowel motions. Occasionally women with endometriosis may have no symptoms and sometimes the disease is found incidentally , or in the process of fertility investigations.

What causes endometriosis?

There are two main theories for the developement of endometriosis:

• Genetic theory - Endometriosis is implanted in the tissues during fetal developement. The deposits are then activated at the time of puberty when estrogen levels rise.
• Implantation theory - Endometrial cells flow into the abdomen from the ends of the fallopian tubes during menstruation. These cells then implant in the abdominal cavity. Immune factors may be important in determining why some women's bodies allow these cells to implant and others do not.

No one is really 100% sure as to the cause of endometriosis. It may not be just one disease and there may be multiple mechanisms for the disease to occur.

Treatment of endometriosis

Treatment with medications or hormones has been generally disappointing in the treatment of endometriosis. Hormones that suppress the menstrual cycle are often quite effective at controlling symptoms, but they do not permanently eliminate endometriosis and do not improve fertility. Keyhole or laparoscopic surgery is now the cornerstone of endometriosis treatment. Endometriotic deposits, particularly those causing severe pain are often deep seated and invasive. The most effective treatment for these deposits is surgical excision. This surgery is more precise when carried out with the magnification of the laparoscope, which also affords a more rapid recovery. Surgical treatment has also been shown in randomised studies to improve fertilty.

Effective treatment of endometriosis may involve a multidisciplinary team, and as wll as surgery, other therapies may be very important in treating the overall effects of endometriosis. Therapies may include:

• Pain management
• Stress management
• Dietary advice
• Counselling
• Physiotherapy

Some women who have severe symptoms of endometriosis, and have completed their family, may require a hysterectomy to completely relieve their symptoms. In most cases this can be carried out through keyhole surgery.

Futher information about endometriosis can be found at www.endometriosiszone.org