Women's Health: A guide to endometriosis

Written by Dr Tamica Lawrence and reviewed by Dr Karolina Afors (Consultant Gynaecologist) and published on 26/04/23

Endometriosis is a chronic condition that can be associated with severe pain during periods, sexual intercourse and bowel movements. It can sometimes be associated with depression, anxiety and difficulties conceiving. Endometriosis affects around 1 in 10 women, and those assigned female at birth, of reproductive age¹ and as the symptoms can be variable it can often be difficult to diagnose. The exact cause of endometriosis is unknown and while it is a lifelong condition there are treatment options available.

What are some of the symptoms?

The symptoms of endometriosis differ greatly from person to person and can also vary in intensity. Endometriosis can cause pelvic pain and painful periods. This pain may also be felt in your back and in your legs². Periods can be very heavy and other symptoms can include pain with urination or passing a stool. Some people may experience significant fatigue². Sex can be painful, and sometimes people with endometriosis can have trouble getting pregnant^3&4. Others may have no symptoms at all and do not know that they have endometriosis.

What causes the symptoms of endometriosis?

During your menstrual cycle, hormones produced by your ovaries cause the lining of your womb to become thickened and then, if you don’t get pregnant, the lining sheds. With endometriosis, tissue like that of your womb lining is present outside of your womb. This occurs most commonly in your pelvis. As you go through your menstrual cycle, this excess tissue responds to your body’s hormones in the same way as the womb lining and sheds. This tissue growth and subsequent bleeding can cause inflammation, pain and sometimes scarring^.

If there is significant scarring from endometriosis (called adhesions) this can affect the organs inside your pelvis, such as the bladder or bowel by causing pain and discomfort.

Pain with endometriosis often disappears after the menopause, when the body stops producing oestrogen, however, in some cases symptoms may persist.

Where can endometriosis be found?

On the ovaries, forming cysts
On the lining of the pelvis and abdomen
Behind the womb
On the bladder, bowel and the space between the rectum and vagina
On the uterine tubes
In the wall of the womb
Rarely, on the lining of the lungs

How is endometriosis diagnosed?

Endometriosis can be difficult to diagnose as often the symptoms can overlap with other conditions, such as irritable bowel syndrome and pelvic inflammatory disease. If you think you have endometriosis and would like to discuss it further, you should contact your GP. Your GP will listen to your symptoms and take a detailed medical history, which may include personal questions. They may offer a pelvic examination, which is an internal assessment to look at your womb and ovaries.

To confirm a diagnosis of endometriosis you will likely need to have a keyhole procedure, called a laparoscopy, but there is a move towards less invasive diagnostic methods such as ultrasound scans.

How is endometriosis treated?

Endometriosis can be treated with medication, surgery, or a combination. It is also important to remember that, like with any chronic condition, endometriosis can affect your mental health and wellbeing, so self-care, a balanced diet and mindfulness are valuable tools in the management of endometriosis.

Once a formal diagnosis has been given you can explore the various treatment options with the professionals involved in your care. The pain caused by endometriosis is due to inflammation, so pain relief such as anti-inflammatories like ibuprofen, as well as paracetamol or codeine can be helpful and should always be advised by a GP. As with any medication, you should always follow the directions for use carefully.

Pain medication, while helpful, does not treat the underlying cause of the pain. This can be done with hormonal treatments, which aim to decrease the activity of the endometriosis. In some cases, surgery may be recommended to remove endometriosis tissue.

Despite advances in medicine, we still do not have a cure for endometriosis. Thankfully though, it can be managed with combinations of the different treatment options discussed above. If you have endometriosis, or think that you may have, you should discuss it with your GP in the first instance, to understand what the best options are for you.

Support from Simplyhealth

Through our health plans, we offer customers 24/7 access to speak to a GP via video, at a time - and from a place - that suits them. GPs are on hand to listen, offer a second opinion and discuss any medical concerns such as suspected endometriosis.

An advice and counselling helpline is also available to support customers with any emotional struggles they may be facing, such as coping with the symptoms of endometriosis and the impact they may be having on their day-to-day life.

Sources:

Endometriosis UK facts and figures: https://www.endometriosis-uk.org/endometriosis-facts-and-figures
NHS Inform - Endometriosis: https://www.nhsinform.scot/healthy-living/womens-health/girls-and-young-women-puberty-to-around-25/periods-and-menstrual-health/endometriosis
National Institute for Health and Care Excellence (NICE): Endometriosis: Diagnosis and Management
NHS Choices: www.nhs.uk/conditions/Endometriosis/Pages/Introduction.aspx

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