Endometriosis explainer: A debilitating condition often dismissed

A condition as common as diabetes, endometriosis affects 1 in 10 women. In Ireland, it takes on average nine years to diagnose. What is endometriosis, and what are some of the symptoms of this debilitating condition?

March marks endometriosis awareness month, a chronic condition named after the endometrium.

With endometriosis, the tissue that normally lines the inside of the uterus or the womb. It is caused when tissue similar to the lining of the uterus grows outside of it during menstruation – where it does not belong, such as on the ovaries and fallopian tubes.

During menstruation, these cells react the same way as those lining the uterus. However, they have no way to escape, and become more or less 'trapped'.

What are the symptoms?

Symptoms can vary, but most of them are characterised by intense pain. Intense pain during menstruation, intense pain during sex, intense pelvic cramping, pain during urination, bowel pain, constant fatigue, migraines, nausea, and irregular periods. The pain can also occur outside the menstrual cycle.

In some cases, endometriosis can also cause infertility.

How can the pain be managed?

To this day, there is still no cure for endometriosis. However, there are lines of treatment for pain management. 

Firstly, anti-inflammatories drugs help treat menstrual cycle pain. Secondly, a hormonal treatment, like a contraceptive pill, can be used to control the cycle and therefore control endometriosis. 

Hormone treatments lower the levels of oestrogen in the body, which prevents the lining of the womb or any other endometriosis tissue to grow quickly.

Surgery is advised by some medical professionals to alleviate the pain and remove the endometriosis adhesions or cysts. It is important to note that even though the surgery provides relief, symptoms can recur in time.

A laparoscopy is often necessary to see the endometriosis lesions. It's an inspection of the pelvic and abdominal cavity. 

With a laparoscopy, the surgeon either cut the lesions, which is referred to as excision surgery, or they can destroy the endometriosis by using heat or a laser - this is known as ‘ablation’.

Depending on how advanced the endometriosis is and on how a patient responds to drug treatments or the surgeries mentioned above, some more radical options are sometimes explored.

However, these are not to be taken lightly and have to be thoroughly discussed with a gynaecologist.

A hysterectomy, which is irreversible, is performed under general anaesthetic. A hysterectomy removes the womb, with or without removing the ovaries.

Another option, which also has to be thoroughly discussed, is a procedure called an oophorectomy, which is the removal of the ovaries. Once both ovaries are removed, women go through menopause - which is irreversible.

To this day, the cause of endometriosis remains unknown. 

What are the four stages of endometriosis?

There are four stages to endometriosis.

Stage one sees the condition manifest in small lesions on and around the pelvic.

Stage two endometriosis is more widespread. At this stage, scarring can occur and is often found on the ovaries and uterosacral ligaments.

Stage three endometriosis affects the pelvic organs, and cysts can develop on one or both of the ovaries. 

Stage four endometriosis affects the majority of the pelvic organs, which causes deformation and adhesions. In some extreme cases, endometriosis can evolve and spread to organs outside the pelvic region - such as the bowels, heart and lungs. At this stage, the chance of infertility is higher.