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Endometriosis
Endometriosis occurs when tissue similar to the lining of the womb becomes established outside the uterus, most often on the ovaries, the peritoneum and around the bowel and bladder. The severity of symptoms is not always proportional to how extensive the disease is.
Symptoms
- Severe period pain that persists despite painkillers
- Pelvic pain continuing outside menstruation
- Pain during or after intercourse
- Bowel and bladder symptoms worsening with periods
- Marked fatigue
- Difficulty conceiving
What causes it?
The cause is not fully understood. The main explanations considered are retrograde flow of menstrual blood into the abdomen through the tubes, failure of the immune system to clear this tissue, and a genetic predisposition.
Diagnosis
Listening carefully to the symptoms is the most important step. Examination and ultrasound may show ovarian deposits (endometrioma), and MRI helps in deep disease. A definitive diagnosis is made from a sample taken at laparoscopy where this is judged necessary.
Treatment
Treatment is planned according to the severity of pain, the extent of disease and whether pregnancy is desired. Pain control and hormonal treatment can slow progression.
Surgery is considered where pain cannot be controlled medically, where large cysts are present, or where infertility is an issue; it is usually performed laparoscopically. Endometriosis can recur, so follow-up after treatment matters.