What is Endometriosis?

Endometriosis occurs when tissue similar to the lining of the womb (the endometrium) grows outside the womb. This tissue can be found on various organs and structures within the pelvis, such as the ovaries, the bowel, and the bladder. In rare cases, it may also be found outside the pelvis, including inside the bowel, and on the lungs. These areas react in the same way as the endometrial tissue inside the womb — thickening, breaking down, and bleeding during each menstrual cycle. However, since this blood has nowhere to go, it can lead to inflammation, scarring, and significant pain.

Symptoms and Diagnosis

The symptoms of endometriosis can vary greatly, with some individuals experiencing only mild discomfort and others severe and debilitating pain. The symptoms typically follow a cyclical pattern and worsen around menstruation. Common symptoms include:

• Pelvic Pain: often worst during menstruation, can radiate to the back or legs
• Painful Periods
• Pain During or After Sex
• Painful Bowel Movements
• Painful Urination and sometimes blood in the urine
• Heavy Menstrual Bleeding
• Difficulties conceiving.

Other symptoms may include fatigue, anxiety, depression, and feelings of isolation, particularly when symptoms are not taken seriously by others. Unfortunately, all too often symptoms like painful periods are normalised, dismissed, and not recognised. Prior to receiving a diagnosis of endometriosis, due to their symptoms: 

• 58% of individuals visited the GP 10 times or more
• 21% of individuals visited doctors in hospital 10 times or more 

The Impact on Daily Life

Endometriosis can impact many areas of life beyond physical health. Studies show that 95% of people with endometriosis report that their condition negatively affects their overall well-being. The economic burden of endometriosis is substantial too:

• 42% of people say they miss school or work due to symptoms.
• 35% of people report a reduction in income because of endometriosis-related absence.

Diagnosis of Endometriosis

Diagnosing endometriosis can be a challenge because there can be many other reasons for the symptoms, blood tests are generally not helpful, and scans may appear normal. Laparoscopy (keyhole surgery) is the gold standard for diagnosing endometriosis. The cause of endometriosis is not known. There are lots of theories, and we know those with a first-degree relative with endometriosis have a 7-10 fold increased risk of developing the condition themselves.

Treatment Options

While there is no cure for endometriosis, there are various treatments available to help manage symptoms:

• Pain Management
• Lifestyle Adjustments: Nutrition, movement, stress management, and sleep support are always key foundations to look at. Physiotherapy and vulval care can also be supportive in managing symptoms.
• Psychological support can be invaluable
• Hormonal Treatments: hormonal contraception like pills, injections, implants, and coils can often effectively manage symptoms, and be prescribed by your GP surgery. Other injectable hormone treatments are available through gynaecology specialist teams.
• Fertility Treatment: For those wishing to conceive, early referral to fertility specialists is advised. 
• Surgical Treatment: In some cases, surgery is recommended. 

Resources and Support

If you are living with endometriosis, or suspect you may be, do seek help from specialists and support groups. Here are some useful resources:

• Endometriosis UK includes a symptom checker, factsheets, webinars, personal stories, and links to support groups
• Endometriosis Foundation
• Endometriosis information leaflet from the RCOG
• Endometriosis Experiences The Lowdown
• Endometriosis – YouTube including talks with Dr Sesay

Remember, if you’re struggling with endometriosis, you’re not alone. There are treatments available, and with the right care, it’s possible to manage the symptoms and improve your quality of life. Here at Rethink, I offer advice regarding lifestyle and hormonal treatments in supporting endometriosis.