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Could Your Pain Be Endometriosis?

Endometriosis is a medical disorder of the endometrial tissue that lines the inside of the uterus.

Who could be affected by Endometriosis?

Endometriosis is a condition that primarily affects individuals assigned female at birth. While endometriosis can affect anyone with a uterus, they are most commonly found in women of reproductive age. It is possible, although rare, for transgender men who have not undergone hysterectomy to develop endometriosis if they have a uterus.

Higher risk for endometriosis is associated with:

  • earlier onset of menstruation
  • shorter menstrual cycle (less than the typical 28-day cycle)
  • heavy menstrual bleeding
  • obstruction of menstrual flow
  • taller height
  • higher alcohol and caffeine consumption
  • a blood relative with endometriosis (this increases your risk sevenfold)
  • late menopause

What is Endometriosis?

Endometriosis is a medical condition where the tissue that normally lines the inside of the uterus, known as the endometrium, grows outside the uterus. This tissue can implant and grow on organs such as the ovaries, fallopian tubes, and pelvic lining, as well as in other areas of the body. Endometriosis can cause a range of symptoms, including pelvic pain, painful periods, heavy menstrual bleeding, pain during intercourse and infertility.

The displaced endometrial tissue continues to act as it would within the uterus, thickening and breaking down during each menstrual cycle. However, because it is located outside the uterus, the blood and tissue shed during menstruation have no way to exit the body, leading to inflammation, scarring, and pain.

Endometriosis can be diagnosed through a combination of medical history evaluation, pelvic examinations, imaging tests (such as ultrasound or MRI), and sometimes laparoscopic surgery for visual confirmation and tissue biopsy. Treatment options for endometriosis depend on the severity of symptoms and may include pain medication, hormonal therapies (such as birth control pills or GnRH agonists), and in more severe cases, surgical intervention to remove the endometrial growths.

When could Endometriosis conditions affect you?

Endometriosis can affect individuals during their reproductive years, typically starting in their late teens or early twenties. It is most commonly diagnosed in individuals between the ages of 25 and 40, although it can occur at any age after puberty. However, endometriosis can persist beyond the reproductive years as well.

Where could Endometriosis Affect You Physically And Mentally?

Physically, endometriosis involves the growth of endometrial-like tissue outside the uterus, which can lead to various symptoms and affect different areas of the body.

Pelvic pain:

Endometriosis commonly causes chronic pelvic pain that may be constant or cyclical, worsening during menstruation. The pain can extend to the lower back and may be accompanied by cramping or stabbing sensations.

Painful periods:

Dysmenorrhea, or severe menstrual pain, is a hallmark symptom of endometriosis. Menstrual cramps may be significantly more intense and debilitating than typical period pain.

Painful intercourse:

Deep pelvic pain during or after sexual intercourse, known as dyspareunia, can be a symptom of endometriosis.

Gastrointestinal symptoms:

Endometriosis lesions can affect the gastrointestinal tract, leading to symptoms such as bloating, diarrhoea, constipation, or pain during bowel movements.

Mentally, the physical symptoms of endometriosis can also have psychological and emotional effects on individuals.

Emotional distress:

Living with chronic pain and the challenges of managing endometriosis can lead to emotional distress, including feelings of frustration, anxiety, or depression.

Impact on daily activities:

Severe pain and fatigue associated with endometriosis can limit one’s ability to engage in regular daily activities, work, or social interactions, potentially causing feelings of frustration and isolation.

Impact on fertility and family planning:

Endometriosis can be associated with infertility or difficulties in conceiving, which can cause significant emotional stress for individuals or couples desiring to have children.

But some people with endometriosis have no symptoms.

Why does it matter to deal with this condition?

Alleviating pain and symptoms:

Endometriosis can cause severe pelvic pain, painful periods, and pain during intercourse. By addressing and managing endometriosis, individuals can find relief from these debilitating symptoms and improve their overall quality of life.

Preserving fertility and family planning:

Endometriosis can be associated with infertility or difficulties in conceiving. By seeking appropriate treatment and support, individuals can explore fertility options, receive guidance on family planning, and potentially improve their chances of conceiving if desired.

Preventing disease progression and complications:

Without proper management, endometriosis can progress and lead to further complications. These may include the formation of scar tissue, ovarian cysts (endometriomas), adhesions that bind organs together, and potential damage to reproductive organs. Early intervention and treatment can help prevent or minimise these complications.

Improving mental well-being:

Living with chronic pain, infertility concerns, and the challenges of managing endometriosis can significantly impact an individual’s mental health. By addressing endometriosis, individuals can seek appropriate support, counselling, and resources to manage the emotional and psychological aspects of the condition.

Long-term health implications:

Endometriosis has been associated with an increased risk of certain health conditions, such as certain types of ovarian cancer. By managing endometriosis, individuals can potentially reduce the long-term health risks associated with the condition.

If you suspect you may be experiencing symptoms related to endometriosis, such as pelvic pain, painful periods, or difficulty conceiving, it is important to consult with a healthcare professional. They can provide an accurate diagnosis and guide you through appropriate treatment options based on your specific circumstances. Early detection and management can help in alleviating symptoms and minimising the impact of endometriosis on your daily life.

Diagnosis

If you don’t have symptoms, your first diagnosis may occur when your doctor is treating you for another problem.

If you have symptoms, such as pelvic pain, your doctor will take your medical history and ask you about your symptoms:

  • When did they start?
  • How long do they last?
  • How do you rate your pain?

The doctor will examine you physically and likely order imaging tests.

To rule out other possible causes of pelvic pain, your doctor may order a urine test, pregnancy test, smear/pap test or vaginal swabs.

Your doctor will take your medical history. They’ll also ask about others in your family who may have had endometriosis.

Your doctor will examine your pelvic area to feel for cysts or other abnormalities. They’ll likely order imaging tests, including a sonogram and possibly an MRI.

The sonogram may be done with a wand type of scanner across your abdomen or inserted into your vagina.

Your doctor may also use laparoscopic surgery to look for endometrial-like tissue outside of the uterus. If a diagnosis isn’t clear, a tissue sample can be taken during surgery to confirm the diagnosis or to be examined under the microscope.

Research is ongoing into noninvasive ways to diagnose endometriosis using blood tests. But so far, no accurate biomarker (indicator that you have the condition) has been found.

Treatment

Treatment ranges from minimal (over-the-counter medications) to more invasive (hysterectomy).

Treatment options in between these extremes vary. This is because of the differences in where the misplaced endometrial-like tissue is located.

Discuss your treatment options with your doctor. Some of the questions to consider are:

  • Do you want to have children?
  • Is your pain intermittent, just around your periods?
  • Does chronic pain prevent you from carrying out your daily activities?
  • Are you near menopause, when adenomyosis related symptoms may go away?

For mild symptoms, over-the-counter anti-inflammatory drugs may help. For more severe symptoms, there are other options.

Anti-inflammatory drugs may be combined with hormonal treatments. Hormone supplements may help:

  • regulate your periods
  • reduce endometrial-like tissue growth
  • relieve pain

These can be prescribed in a staged fashion, starting with a low dose of oral contraceptives and seeing how you respond.

The first line of treatment is usually low-dose combined oral contraceptive pills.

A second-tier of treatment includes progestins, androgens and GnRH. These have been shown to reduce endometriosis pain. The progestins may be taken orally, injected or as an intrauterine device.

The hormonal contraceptive treatments may stop your periods and relieve symptoms as long as you’re taking them. When you stop taking them, your periods will return.

If you want to get pregnant, there’s evidence that taking and then stopping hormonal treatments may improve chances of fertility with in vitro fertilisation.

Conservative surgery can remove endometriosis laparoscopically while keeping your uterus intact. This may relieve symptoms, but the endometriosis can return.

Laparoscopy can also be used with heat, current, or laser treatments to remove the endometriosis.

Hysterectomy (removal of the uterus) and possible removal of your ovaries is considered a last resort.

Endometriosis U.K. Help. NHS Information

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