Endometriosis

The colonisation of the uterine mucous membrane (endometrium) outside the uterus is known as endometriosis. Uterine mucous membrane "islands" form and can be found all over the abdomen, such as on the ovaries, the peritoneum, the bladder or between the vagina and the bowel.

Causes of endometriosis

It is not completely clear why endometriosis occurs. It is suspected that some of the menstrual period blood flows into the abdomen via a fallopian tube during the period. This blood contains viable uterine mucous membrane cells, which can colonise the abdomen.

The endometriosis nodes respond to the female cycle in the same way as the uterine mucous membrane. This also results in a cycle-dependent build-up and reduction in the mucous membrane outside the uterus, and accordingly to bleeding during the menstrual period.

What are the symptoms?

The symptoms of endometriosis typically occur around the time of the menstrual period and are therefore often misinterpreted. 

Typical symptoms of endometriosis are:

  • Severe pain in the lower abdomen which starts several days before menstruation
  • Chronic lower abdominal pain
  • Back pain
  • Pain during sexual intercourse
  • A lack of energy and lethargy
  • Difficulty in passing water (bladder) or with defaecation (bowel)

The symptoms of endometriosis are often not recognised immediately because they are interpreted by affected women as normal pain associated with menstruation. It is assumed that around one in ten women suffers from endometriosis. This means that endometriosis is one of the most common diseases among women. In some cases, endometriosis nodes do not cause any symptoms at all and go unrecognised throughout a woman's life. 

Fertility issues caused by endometriosis

It is especially important to recognise the disease as it is more often than not a cause of Infertility, particularly when endometriosis nodes occur in the ovaries or fallopian tubes. Almost half of all women who are unable to fall pregnant are affected by this disease. Medical diagnosis can then bring clarity in such cases. 

Diagnosis of endometriosis

Various examinations are used to diagnose it. Sometimes endometriosis nodes can be felt between the bowel and the vagina during a gynaecological examination. They may be discovered outside the uterus with an ultrasound. Sometimes other examinations such as an MRI or even a laparoscopy, cystoscopy are needed.

Treatment

Treatment depends on the location and the severity of the disease. As endometriosis nodes are hormone-related, they can be treated with hormones. If surgery is required to remove them, this is usually possible with a minimally invasive procedure. The type of treatment – medication or surgery – depends on whether the patient wishes to have children.

Illustration of a uterus with endometriosis nodes