SEXUAL HEALTH CONCERN

Endometriosis

Also called: endometriosis, painful periods, heavy periods, period pain, irregular periods, spotting, bleeding between periods, period problems, flooding, clots

Endometriosis is a long-term condition where tissue similar to the lining of the womb grows elsewhere in the body, most commonly within the pelvis. It can cause severe period pain, chronic pelvic pain, pain during or after sex and, for some people, difficulties becoming pregnant.

TYPICALLY OCCURS

Hormonal, genetic, immune and inflammatory factors

TREATED BY

Laparoscopic surgery, hormonal treatment and pain management

ALSO LINKED TO

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Why it happens?

Endometriosis develops when tissue similar to the endometrium — the lining of the womb — grows outside the uterus. These endometriosis lesions are most commonly found around the ovaries, fallopian tubes and the lining of the pelvis, although they can occur elsewhere. The tissue responds to hormonal signals and can contribute to inflammation, irritation and pain. Over time, endometriosis may be associated with scar tissue and adhesions that cause pelvic organs or tissues to stick together. Endometriosis affecting an ovary can also form a cyst known as an endometrioma.

The exact cause of endometriosis is not fully understood, and it is unlikely to have a single explanation. Several mechanisms have been proposed, including menstrual tissue travelling backwards through the fallopian tubes into the pelvis, known as retrograde menstruation. However, retrograde menstruation is common and does not explain why only some people develop endometriosis. Genetics appear to influence susceptibility, with the condition occurring more frequently in some families. Differences in immune responses, inflammation, hormone activity and the way certain cells develop or move within the body may also contribute.

Importantly, the amount of endometriosis present does not always correspond with the severity of symptoms. Someone with relatively limited disease can experience significant pain, while another person with more extensive endometriosis may have few symptoms. Pain can arise from inflammation, adhesions, ovarian endometriomas and involvement of tissues or nerves within the pelvis. Endometriosis can also affect fertility in some people by altering pelvic anatomy, inflammation and ovarian or tubal function, although many people with endometriosis can become pregnant naturally.

How far along is it?

Early

Small or superficial areas of endometriosis are present, sometimes with limited scar tissue. Symptoms can still range from minimal to severe.

Moderate

More numerous or deeper areas of endometriosis may be present, potentially involving the ovaries and other pelvic structures. Adhesions or ovarian endometriomas may develop.

Advanced

Deeper or more widespread disease may affect several pelvic organs, with significant adhesions, endometriomas or involvement of structures such as the bowel or bladder.

What addresses it?

Treatments that address this

Endometriosis surgery→

Medical assessment is worthwhile when period pain is severe enough to interfere with work, education, sleep or normal activities, particularly if symptoms are becoming progressively worse. Persistent pelvic pain, pain during or after sex, pain when opening the bowels or urinating around the time of a period, or difficulty becoming pregnant can also warrant investigation.

Endometriosis symptoms can overlap with several other gynaecological and gastrointestinal conditions, so symptoms alone cannot confirm the diagnosis. Seek urgent medical attention for sudden severe pelvic or abdominal pain, fainting or collapse, particularly if pregnancy is possible, as these symptoms can have causes requiring immediate assessment.

Quick Questions:

What are the most common symptoms of endometriosis?

Common symptoms include severe period pain, chronic pelvic pain, pain during or after sex and pain when opening the bowels or urinating, particularly around menstruation. Some people also experience fatigue, heavy periods or fertility difficulties.

What causes endometriosis?

The exact cause remains uncertain. Genetics, hormones, immune-system responses, inflammation and movement or development of endometrial-like cells are all thought to contribute.

Can you have endometriosis without knowing it?

Yes. Symptoms vary considerably, and some people have little or no noticeable pain. Endometriosis may sometimes be discovered during investigations for another condition or for difficulty becoming pregnant.

Does endometriosis affect fertility?

It can. Endometriosis may affect the ovaries, fallopian tubes and pelvic environment in ways that make conception more difficult for some people. However, having endometriosis does not automatically mean someone is infertile, and many people with the condition conceive naturally.