Endometriosis awareness month – you are not alone.

March is endometriosis awareness month and a condition that doesn’t get enough airtime for the effects that is has on the quality of life for many women.

Endometriosis is a progressive condition affecting 1 in 10 women of reproductive age with an estimated 176 million women affected worldwide. There is a strong family association with developing endometriosis, where women who have a family member with the condition being 7-10 times more likely to develop endometriosis. 

What is it?

Endometriosis is a chronic condition where cells similar to those that line the uterus are found in other parts of the body, most commonly on or around reproductive organs in the pelvis such as on the outside of the uterus and fallopian tubes, ovaries as well as other areas such as the bladder and in the small or large bowel.

Some causes of endometriosis include:

• Having a family history
• Metaplasia
  

Some other factors that further contribute to endometriosis are:

• Having first pregnancy at later age
• Heavy bleeding or periods lasting longer than 5 days
• First period before 11 years
• Having less than 27 days between menstrual cycles
• Changes in immune cells
• Low body weight
• Alcohol use
  

Factors lowering the risk of developing endometriosis:

• The number of children – chances of developing endometriosis reduces with each pregnancy
• Younger age of first pregnancy
• Breastfeeding
• Regular exercise
  

What are the symptoms?

The symptoms of endometriosis overlap with a number of other health problems, so mis-diagnosis and delayed diagnosis are common. Common symptoms include: 

• Pain before and during a period
• Pain during sex
• Abdominal, back and pelvic pain
• Pain going to the toilet, urinating and opening bowels
• Pain during ovulation (this can also happen for women who do not have endometriosis)
• Heavy bleeding or periods lasting longer than 5 day
• Irregular bleeding or irregular menstrual cycles
• Bleeding before a period is due
• Bleeding from the bladder or bowel
• Blood clots
• Change in bowel habits
• Need for more frequent urination
• Increased abdominal bloating during the period
• Feeling lethargic particularly during menstruation
• Mood changes, anxiety or depression due to pain
• Pelvic floor muscle spasms or tightening due to fear of pain

Symptom severity does not always indicate the extent of damage that endometriosis is causing to the body. 

How is endometriosis diagnosed?

Endometriosis may be detected by a specialised scan, a doctor may feel affected tissue in the pelvis or see an endometriosis cyst on the ovaries or other organs or a growth of endometriosis tissue may be seen growing through the vagina.

The only way to know for sure however is to have a diagnosis made through a laparoscopy where a biopsy is taken of tissue. This procedure is performed under general anaesthetic where an assessment is made of the organs of the pelvis and abdomen. Tissue can be magnified and identified if it is affected by endometriosis. If this is the case, endometriosis can be removed and often providing symptom relief for most patients.

It is also important to note that there are different types of endometriosis; this is determined by the parts of the body affected by endometriosis.

Treatment?

There is unfortunately no known cure for endometriosis however, there are some management therapies to treat the condition and endometriosis does go away after menopause in cases where hormone replacement therapy (HRT) is not used.

Treatment includes:

• Surgically removing affected tissue
• Hormone therapy using; oral contraceptive pills, progesterone, gonadotrophin-releasing hormone (GnRH) agonist
• Pain management with medications such as anti-inflammatory agents
• The low FODMAP diet as an adjunct therapy **
• Healthy lifestyle through stress relief, physical activity and adequate sleep

**The low FODMAP diet is being investigated as a possible dietary therapy that can be used for endometriosis patients due IBS-like symptoms associated with the condition and aiming at reducing those symptoms. The low FODMAP diet however is not recommended as a long term diet and therefore working with a dietitian in this area is essential.