Endometriosis is a condition where tissue that usually lines the womb grows outside of it, becoming trapped in the pelvic area and abdomen. It is sometimes even present in other areas of the body.

Endometriosis causes include problems with menstrual period flow, genetic factors, immune system weaknesses, hormones or surgery. The process sees misplaced endometrial tissue following the menstrual cycle under the influence of hormonal changes. This tissue grows, thickens and break downs, becoming trapped over time, as it has nowhere to exit. This causes irritation, scar formation or adhesions (binding of organs by abnormal tissue) with the surrounding tissues.

What are its symptoms?

Endometriosis symptoms include:

  • Chronic pelvic pain
  • Severe period pain
  • Pain during or after sexual activity
  • Fatigue
  • Painful bowel movements during periods
  • Lower back pain

There is a link between endometriosis and infertility, with between 30 to 50 percent of women with endometriosis experiencing infertility problems.

There are four main stages or types of endometriosis, namely:

  1. Subtle: Subtle types look like a small sac or cyst, ranging from 1 to 3mm in size. They are not serious, but can look like ovarian cancer.
  2. Typical: These appear as black spots over a white fibrous area and vary in size from 1 to 2cm in diameter. They are found around your pelvis and/or your diaphragm.
  3. Cystic Ovarian: This stage involves cysts bigger than 4 to 5cm, growing as large as 15cm, and covering the ovary. They may form adhesions with the wall of your pelvis or other organs in the pelvis.
  4. Deep: Solid tumours of up to 5 or 6cm in diameter. They are mostly found in the space between the back wall of your uterus and the rectum.

How is it diagnosed?

An endometriosis diagnosis can be challenging as symptoms often overlap with those of other conditions, such as irritable bowel syndrome (IBS) and pelvic inflammatory disease (PID). Often women do not even realise that the pain they are experiencing is caused by endometriosis. There is also no single test for endometriosis, and it can take up to a few years to be diagnosed.

A doctor or gynaecologist will usually rely on a physical examination, scans (ultrasound and a magnetic resonance imaging, or MRI scan) and other tests. The most accurate diagnostic tool is a laparoscopy. During this procedure, a thin tube containing a camera is inserted into the abdomen (usually through the belly button) allowing the doctor to inspect the organs in the pelvis and take a tissue sample for analysis.

What are your treatment options?

There is no cure, but endometriosis treatment can improve pain and fertility. Treatment options primarily include surgery and medication. Women with endometriosis will be treated primarily with surgery but drugs can also be used, particularly in those about to undergo in vitro fertilisation (IVF).

Conservative surgery includes the removal of the growths without damaging your reproductive organs. An alternative is radical surgery — that is, a hysterectomy, which involves the removal of the uterus and cervix.

Medication options include hormone therapy, pain medication and hormonal contraceptives.

A healthy diet and elimination of foods that aggravate your symptoms can help to reduce your oestrogen levels, normalise your hormone levels and stabilise your emotions.

Can it be prevented?

There is no way to prevent endometriosis but you can reduce your chances of developing it by lowering the levels of oestrogen in your body. Long-term use of birth-control hormones, early diagnosis and complete removal through surgery can prevent it from worsening.

For more info
The Endometriosis Society of South Africa

The accuracy of this information was checked and approved by physician Dr Thomas Blake in January 2015