The inside lining of the womb (uterus) is called the endometrium. It is this layer that thickens during your monthly menstrual cycle. If pregnancy occurs the baby will implant on this thickened lining of the womb. If pregnancy does not occur this lining is shed which produces a monthly bleed (period).

Endometriosis is where this inside lining of the womb (endometrium) grows in other areas outside the womb. Commonly this is in the pelvis through the wall of the womb (adenomyosis), on the ovaries, fallopian tubes, or the ligaments that support the womb. Rarely endometriosis grows in other organs such as the bowel, lungs or kidneys. The hormones that cause the inside lining of the womb to shed to produce a period acts on this tissue which also sheds. This can cause a lot of pain, especially during periods, also pain while having sex (dyspareunia) and infertility (difficulty getting pregnant).

Endometriosis can run in families; if your mother or sister has it, you are 7 times more likely to get it. The cause of endometriosis is largely unknown but it is thought to have some connection with periods that not just flow down the vagina and out, but that also go back up into the womb and through the tubes to spread to other organs (retrograde menstruation).

Although endometriosis does cause pain and infertility, it is not linked with cancer and can be treated successfully.

Treatment of endometriosis depends on whether you are trying to get pregnant.

If your period pains are severe, you can be given medication to take during your period to reduce the pain and amount of bleeding.

If you are not trying to get pregnant the combined oral contraceptive pill is also used to reduce period pains. This works in the same way as it does as a contraceptive by preventing the ovary from producing an egg ( ovulation), this in turn doesn’t stimulate the inside lining of the womb to thicken nor the other tissue outside the womb (endometriosis). The pain is therefore reduced. The ‘pill’ can be taken non stop for 2 or 3 packets which gives less periods and therefore less pain. Other stronger medication can be given in the form of an injection (gonadotrophin releasing hormone (gnrh) analogue,) once per month for 6 months. The injection (gnrh analogue) effectively puts your body into the menopause and again like the ‘pill’ prevents this tissue being stimulated. Women taking this injection do get symptoms of the menopause; such as hot flushes and night sweats. A form of hormone replacement therapy (HRT) can be given in tablet form daily to overcome these symptoms. This treatment option works well for many women.

If the endometriosis is severe or you are trying to get pregnant, surgical treatment may be required. This is because endometriosis can cause scar tissue to form and organs, including the fallopian tubes, can stick together causing further pain and infertility. If endometriosis is on the ligaments supporting the womb (uterus), these ligaments can become rigid, the womb doesn’t move as much, causing pain deep inside during intercourse (deep dyspareunia). This may need surgical intervention. Surgery is usually by ‘keyhole’ method.

If you have further difficulty getting pregnant, you may require Invitro Fertilisation (IVF), this is where the egg is fertilized outside the womb and then the baby (embryo) is placed inside the womb to develop (‘test tube baby’)

If you have any further questions regarding your condition or if you feel worried at all, do not hesitate to email Marble Arch Private Health for more information.

www.endometriosis.ie

www.endometriosis-uk.org

www.womens-health-concern.org-Factsheet-induced-menopause-in-women-with-endometriosis