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Te kōpū whakatupu pūtautau Endometriosis

Endometriosis is a condition where tissue similar to the lining inside your womb (uterus) starts to grow in other parts of your body, such as your ovaries, bowel or bladder, and the lining inside your tummy (abdomen). The lining tissue is called endometrium.

Symptoms of endometriosis

About a third of women with endometriosis have no symptoms. If you do have symptoms, they usually happen around the time you get your period. The most common symptom of endometriosis is pelvic pain. Other symptoms include:

  • pain during or after sex
  • pain when you poo or wee
  • bloating
  • constipation
  • pain when you exercise
  • having low energy (lethargy).

Endometriosis can cause problems with getting pregnant, but this does not happen to everyone. It is important to remember that if you have endometriosis and do not want to get pregnant, you still need to use contraception.

Contraception

Symptoms of endometriosis can have a big impact on your life, and can even lead to feelings of depression. See your healthcare provider if you have any concerns about your mood.

Causes of endometriosis

Endometriosis is very common and can happen at any age. It affects at least 1 in 10 women (usually in their reproductive years).

Endometriosis is not an infection, and is not cancer.

We do not know the exact cause of endometriosis, but it is believed that it may be due to a combination of factors. Theories about what causes endometriosis include:

  • Genetics — a family history of endometriosis can make you more prone to getting endometriosis yourself.
  • Retrograde menstruation — this is when during your periods, some blood flows back into your body.
  • Immune system problems — we do not know if these cause endometriosis or are caused by it.
  • Blood vessel or lymphatic system spread — we think endometriosis tissue can be transported around the body.

Diagnosing endometriosis

It can often be difficult to diagnose endometriosis. Other conditions such as irritable bowel syndrome, adenomyosis and diverticulitis can cause similar symptoms.

Your healthcare provider will ask you about:

  • your pelvic pain including the type, frequency, and how severe your pain is
  • your periods
  • if you have been trying, or wish to become pregnant.

It can be helpful to complete a menstrual diary, which is a record of your periods. The diary can help them understand when you have period pain. You can also download a period tracker app, called Clue, for iPhones and Android phones, or Period Tracker for Android phones.

Your healthcare provider will examine your tummy, and may do an internal (vaginal) examination. They may do blood tests and swabs to check for infections, such as sexually transmitted infections. Endometriosis tissue does not usually show on an ultrasound but you may have one to check for other problems such as a cyst on your ovary.

The only way to definitely diagnose endometriosis is to have a laparoscopy (keyhole surgery), which allows your doctor to see inside your pelvis and examine the uterus, ovaries and tubes.

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  • You can help improve your symptoms by:

    • staying a healthy weight
    • eating well
    • being active
    • reducing stress
    • stopping smoking (if you smoke).

    You could also try cutting down on caffeine and alcohol.

    Using heat, such as from a hot water bottle, may help reduce discomfort.

  • Pain medications can help reduce inflammation and pain, especially anti-inflammatories such as: 

    Taking them regularly, with or without paracetamol, may be particularly useful.

  • Hormone treatment acts on the lining of your womb to reduce the growth of endometriosis. It can take a few months before hormone treatment works as well as it can. It comes in several forms.

    Combined oral contraceptive pill (the pill)

    The pill contains a mixture of estrogen and progesterone. It stabilises your hormone levels and stops your ovaries from releasing eggs (ovulating). This makes the uterus lining thinner and makes periods lighter and shorter.

    Progestogens

    Progesterones help by suppressing the growth of endometriosis tissue. Commonly used progesterones include:

    • tablets such as Cerazette, Provera, norethisterone
    • intrauterine device (IUD) — this is a small plastic T-shaped device that is placed inside your womb (uterus). It slowly releases progesterone over a period of 5 years. This helps thin the lining and partially suppresses the ovaries from releasing eggs. This can make your periods lighter and less painful.

    If these treatments do not help with your symptoms, your healthcare provider may refer you to a specialist doctor (gynaecologist). Specialist treatments may include medicines such as Zoladex or leuprorelin. 
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  • Laparoscopy, or keyhole surgery, is when a surgeon inserts a small tube, with a camera and instruments attached, into your tummy (abdomen), through your belly button. The aim is to destroy the endometriosis using heat or laser or remove it by cutting (called excising). They will also remove or destroy any ovarian cysts and divide any adhesions. Adhesions are scar-like tissues inside your body. They grow between surfaces such as organs and the abdominal wall, and make them stick together. Sometimes the surgeon fits a Mirena at the same time as doing a laparoscopy.

  • If your endometriosis involves your bowel or bladder, or you have a lot of scarring and adhesions to remove, you need more complex surgery. A laparotomy is open surgery, through a large cut in your tummy (abdomen).

  • If your symptoms badly affect your life and nothing else has worked, doctors may suggest a hysterectomy (removal of your uterus). This would mean you can no longer have children. This can be done with or without removing your ovaries. If your ovaries aren’t removed you may need an operation called an oophorectomy later to remove them. After an oophorectomy, you will go into instant menopause.

    You may still have some painful symptoms of endometriosis even after having a hysterectomy.

Clinical review

This content was written by HealthInfo clinical advisers. It has been adapted for Health Information and Services.

Clinical advisers — HealthInfo (external link)

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