The condition affects people who have menstrual periods and is more common in those aged between 30 and 40. Evidence suggests people are more susceptible if they:
- Have never had children
- Have periods that last 7 days or more
- Have short menstrual cycles of 27 days or less
- Have a family history of endometriosis
- Have a health problem that affects the normal flow of menstrual blood
The pain from endometriosis can be moderate to severe, this normally depends on the volume of endometrial tissue found outside of the womb, but sometimes those with very few endometrial deposits are heavily affected by pain and vice versa. We talk more about the stages and severity of endometriosis below, but here we will explain why endometriosis is painful.
Endometrial tissue is made up of glandular cells usually only found in the lining of the uterus. Their purpose is to provide a place for a fertilised embryo to attach to at the beginning of a pregnancy. Endometrial cells grow in size and number during the menstrual cycle in response to the hormones produced by the ovaries. Normally, these cells die and shed when a person does not fall pregnant, and they leave the body through the vagina during a menstrual period.
Endometrial tissue that grows outside of the womb also responds to the hormones produced by the ovaries. In response to the hormones, the legions thicken and swell and then shed off and bleed during a menstrual period. This causes pain through irritating organs that the endometrial tissue adherent too. It also causes pain through the collection of blood in the abdomen and pelvis which irritates the lining, which is rich with nerve fibres. Finally, endometriosis can lead to scarring and the development of adhesions between pelvis and abdominal organs, leading to pain during routine bodily functions and therefore resulting in pain outside of menstrual periods.
What Causes Endometriosis?
Endometriosis is extremely common and is estimated to affect 1 in 10 women of reproductive age.
Whilst the exact cause of endometriosis is unknown, the most common explanation given for the condition is ‘retrograde menstruation’ whereby endometrial tissue migrates out of the womb through propulsion of tissue out of the fallopian tubes during a menstrual period. Risk factors that are associated with the development of endometriosis include:
- Genetics – having a close relative who has the condition increases the likelihood of also having endometriosis
- Menstrual and reproductive history – early age of first period (less than 12 years), short menstrual cycles (less than 26 days), not having children
- Weight – Leaner individuals have been shown to be more likely to have endometriosis
- Ethnicity – caucasian individuals are more likely to have endometriosis compared to those of other ethnicities.
The symptoms of endometriosis include:
- Pain in the lower area of the stomach and/or the back
- Chronic period pain that impacts the ability to complete normal day-to-day tasks
- Pain during or after sex
- Pain during bladder or bowel movements
- Diarrhoea or constipation
- Bloody in the urine or poo during a period
- Difficulty conceiving a baby
Additional to these signs of endometriosis, one may experience heavier than normal periods. People with endometriosis may use a lot of sanitary pads or tampons and may even bleed through clothing.
The symptoms can be debilitating and seriously impact an individual’s life, potentially affecting their mental health and wellbeing.
It is important to see a GP if any mentioned symptoms are present, especially if they are significantly impacting daily life.
Diagnosis can take time as symptoms may vary considerably between patients and can be very similar to those of other conditions. On average, it takes people with endometriosis 7.5 years to receive a diagnosis.
Initially, a GP will ask about the symptoms – it is recommended to keep a diary of pain and symptoms, particularly if these are related to the menstrual cycle.
The GP may also complete an examination of the tummy and vagina.
A GP may consider a short trial of painkillers to try and help with pain, as well as offering hormonal treatment, such as the combined oral contraceptive pill or a progestogen-only contraceptive.
If these are not effective, or severe, persistent, or recurrent symptoms of endometriosis a GP may refer to a gynaecologist to make a formal diagnosis. This can only definitively be made by keyhole (laparoscopic) surgery, however, they may also consider an MRI or ultrasound on a case-by-case basis.
Endometriosis is graded in stages according to the location and number of endometrial deposits seen during keyhole (laparoscopic) surgery. These stages refer to stages of endometriosis with respect to the severity of visible disease during this investigation. It does not represent the severity of symptoms someone may be affected by, which may be discordant with these findings for many individuals. The stages are categorised as follows:
Stage 1 endometriosis (minimal)
Stage 2 endometriosis (mild)
Stage 3 endometriosis (moderate)
Stage 4 endometriosis (severe)
Treatments for Endometriosis
There is no cure for endometriosis but symptoms can be managed by trialling different endometriosis treatments.
The treatment will depend on the severity of the symptoms and include:
- Painkillers such as ibuprofen and paracetamol
- Hormone medicines and contraceptives
- Surgery can be considered to remove endometrial tissue that has grown outside of the womb
In severe cases, surgery may be considered to remove part or all of the organ affected by the condition.