Understanding Endometriosis

What is Endometriosis

Endometriosis is a chronic condition in which tissue similar to the lining of the womb (endometrium) grows outside the uterus. These deposits most commonly affect the ovaries, fallopian tubes, pelvic lining, bowel, and bladder.

Each month, this tissue responds to hormonal changes, which can lead to inflammation, scarring, and adhesions. Over time, this may cause persistent pelvic pain and affect fertility.

Endometriosis affects approximately 1 in 10 women of reproductive age, although the severity of symptoms varies significantly between individuals.

Types of Endometriosis

Peritoneal endometriosis is the most common form of endometriosis.

It occurs on the pelvic peritoneum, which is a thin membrane lining the inside of the pelvis and covering the pelvic organs.

In this type:

• Lesions are usually small and shallow

• They sit on the surface of pelvic structures

• Despite being superficial, they can still cause significant pain and inflammation

Peritoneal (Superficial) Endometriosis

Ovarian Endometriosis (Endometrioma)

Ovarian endometriosis, also known as an endometrioma, occurs when cysts form within the ovaries.

These cysts are sometimes referred to as:

• “Chocolate cysts”, because they contain old, dark blood

In this type:

• Cysts develop inside one or both ovaries

• They may affect ovarian function

• They can be associated with pelvic pain and subfertility

Deep endometriosis occurs when lesions grow deeper beneath the surface, often affecting surrounding organs.

Common sites include:

• The bowel

• The bladder

• The recto-vaginal septum (the tissue between the vagina and rectum)

In this type:

• Lesions penetrate more than 5 mm beneath the surface

• It is often associated with more severe symptoms

• It may cause pain during bowel movements, urination, or intercourse

Deep Infiltrating Endometriosis (Deep Endometriosis)

Extra-pelvic endometriosis occurs when endometriosis develops outside the pelvis.

Although less common, it can affect areas such as:

• The thorax (chest)

• Caesarean section scars

• Other distant parts of the body

Symptoms depend on the location of the disease and may sometimes occur in a cyclical pattern related to the menstrual cycle.

Extra-Pelvic Endometriosis

Adenomyosis

A closely related condition is adenomyosis.

This occurs when cells similar to those lining the womb grow within the muscle wall of the womb.

Key points about adenomyosis:

• It responds to hormonal changes during the menstrual cycle

• It affects approximately 1 in 10 women

• It commonly causes:

  • Heavy menstrual bleeding

  • Painful periods

  • Pelvic discomfort

It is possible to have:

• Endometriosis alone

• Adenomyosis alone

• Both conditions together, which is relatively common

Common Symptoms of Endometriosis

Symptoms can vary widely, and some women may have severe disease with minimal symptoms, while others experience significant pain.

Common symptoms include:

• Severe period pain (dysmenorrhoea)

• Chronic pelvic pain

• Pain during sexual intercourse (dyspareunia)

• Pain when opening bowels, especially during periods

• Pain when passing urine

• Heavy periods

• Fatigue

• Infertility or difficulty conceiving

• Bloating, sometimes referred to as “endo belly”

Symptoms often worsen over time if untreated.

When Should You Seek Medical Advice?

You should consider seeing a specialist if:

• Period pain interferes with daily activities

• Pain is worsening over time

• Painkillers are no longer effective

• You have difficulty conceiving

• You experience bowel or bladder symptoms during periods

• Symptoms persist despite treatment

Early diagnosis may help reduce long-term complications.

Causes of Endometriosis

The exact cause of endometriosis remains unclear, but several theories exist.

Possible contributing factors include:

• Retrograde menstruation

• Genetic predisposition

• Immune system dysfunction

• Hormonal influences

• Surgical scar implantation (rare)

Women with a family history of endometriosis may have a higher risk.

How is Endometriosis Diagnosed?

Diagnosis begins with a detailed clinical history and physical examination.

Investigations may include:

Ultrasound Scan

A specialist pelvic ultrasound can detect:

• Endometriomas (ovarian cysts caused by endometriosis)

• Deep infiltrating endometriosis

• Adhesions

MRI Scan

MRI may be recommended for:

• Deep endometriosis

• Bowel or bladder involvement

• Surgical planning

Laparoscopy

Laparoscopy is considered the gold standard for diagnosing endometriosis. This is a minimally invasive surgical procedure performed under general anaesthetic, allowing direct visualisation and treatment of disease.

Treatment Options for Endometriosis

Treatment depends on:

• Symptom severity

• Age

• Fertility plans

• Disease extent

• Previous treatments

Management usually involves medical therapy, surgery, or a combination of both.

Medical Treatment

Medical treatment aims to control symptoms and suppress disease progression.

Options may include:

• Hormonal contraception (combined pill or progesterone-only methods)

• Hormonal intrauterine system (coil)

• GnRH analogues

• Pain management medications

These treatments may reduce symptoms but do not remove disease tissue.

Surgical Treatment

Surgery is recommended in selected cases, particularly where symptoms are severe or fertility is affected.

Procedures may include:

• Laparoscopic excision of endometriosis

• Removal of ovarian endometriomas

• Treatment of adhesions

• Treatment of bowel or bladder involvement (in advanced disease)

Excision surgery performed by an experienced specialist is associated with improved symptom relief.

Endometriosis and Fertility

Endometriosis may affect fertility through:

• Adhesions affecting fallopian tubes

• Ovarian cysts

• Inflammation within the pelvis

However, many women with endometriosis conceive naturally.

Fertility options may include:

• Ovulation monitoring

• Surgical treatment

• Assisted reproductive techniques

Management should be individualised.

Living with Endometriosis

Long-term management may include:

• Pain management strategies

• Hormonal suppression

• Lifestyle support

• Multidisciplinary care when required

Regular follow-up helps monitor symptoms and treatment effectiveness.

When to Seek Urgent Medical Advice

Seek urgent medical attention if you experience:

• Severe sudden pelvic pain

• Fever with pelvic pain

• Persistent vomiting

• Symptoms of bowel obstruction

• Severe bleedingx

FAQs

Can endometriosis be cured?

There is currently no permanent cure, but treatments can effectively control symptoms and improve quality of life.

Can endometriosis return after surgery?

Why Choose Specialist Care?

Can endometriosis cause cancer?

Does pregnancy cure endometriosis?

Endometriosis is a complex condition that often requires expert assessment and individualised treatment planning.

Specialist care ensures:

• Accurate diagnosis

• Individualised treatment

• Advanced surgical options when required

• Fertility-focused management

• Multidisciplinary support when needed

Pregnancy may temporarily improve symptoms, but it does not cure the condition.

Recurrence is possible, particularly without hormonal suppression following surgery.

Endometriosis is a benign condition. The risk of cancer is very low.

More resources

Provide a general summary of the services you provide, highlighting key features and benefits for potential clients.

This patient guide helped me understand my symptoms and feel less alone in my endometriosis journey.

Anna K

★★★★★