Condition: Endometriosis

Endometriosis is a relatively common condition that may be associated with pelvic pain and difficulty conceiving. The lining of the womb is called the endometrium and endometriosis is defined as the presence of tissue outside the womb which is very similar to endometrium. The causes of endometriosis are poorly understood but it appears that this abnormal distribution of endometrium-like tissue causes inflammation and scarring which may then lead to symptoms. The course of endometriosis is difficult to predict as it may spontaneously regress in up to a third although in 50% the disease is progressive – worsening with time.

The main symptoms of endometriosis are:

• Pelvic pain
• Painful periods
• Pain during intercourse
• Subfertility (difficulty or delay in conceiving)
• Bowel pain and rectal bleeding during menstruation
• Abnormal vaginal bleeding
• Heavy periods
• Pain or bleeding when passing urine

Any woman with symptoms suggestive of endometriosis will be asked a comprehensive series of questions by their consultant and an examination will also be performed. Usually a pelvic ultrasound would be organised to help identify other causes of pelvic pain and in particular to look for endometriosis in the ovaries where it can cause cysts called endometriomas. In some cases (particularly where severe disease is suspected) a more detailed MRI scan may be helpful.

Currently the only sure way to make a definite diagnosis is to perform a laparoscopy (which is a surgical procedure using a small telescope which is placed through the belly button). This approach not only allows accurate assessment of the pelvis but also treatment at the same time. There are however risks with any surgical intervention and it may not be appropriate in all patients.

As endometriosis is driven by the cyclical hormonal changes of the menstrual cycle all medical treatments involve hormonal manipulation to some degree.