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Endometriosis

Endometriosis is a chronic disease that affects about 10% of women. Dr.Dropin wants to increase knowledge among women and healthcare professionals so that more people can get help with the symptoms as early as possible.

What is endometriosis?

In patients with endometriosis, tissue similar to the lining of the uterus (endometrium) grows outside the uterine cavity. It can grow in one or more other places in the body and the most common places to find the tissue are in the fallopian tubes, ovaries, peritoneum, intestines, bladder and vagina. Adenomyosis is another condition in which endometrium grows into the uterus's muscle wall. This article focuses on endometriosis.

Symptoms

The symptoms of endometriosis can vary from person to person, and some people can have endometriosis without any symptoms. Endometriosis can cause a variety of symptoms, including:

  • pain in the abdomen and lower back, especially during menstruation
  • menstrual cramps that are worse than normal
  • pain during intercourse
  • infertility or difficulty conceiving
  • irregular bleeding
  • constipation, diarrhoea and bloating
  • bloody urine during menstruation
  • pain during urination during menstruation
  • fatigue and anaemia are also common complaints.

It is important to point out that these symptoms can also be signs of another disease and it is important to rule out other conditions as part of the investigation.

Diagnosis

If you're experiencing symptoms of endometriosis that are significantly impacting your daily life, it's advisable to schedule an appointment with your general practitioner (GP). Prior to your visit, consider documenting your symptoms for a more comprehensive discussion with your doctor.

Given the varied nature of endometriosis symptoms and the potential overlap with other conditions, diagnosis can be challenging. During your GP consultation, expect questions about your symptoms, and your doctor may conduct an examination of your abdomen and vagina.

If your GP suspects endometriosis, they may recommend initial treatments. In cases where these treatments prove ineffective, a referral to a gynaecologist, a specialist in women's health, may be suggested. The gynaecologist may conduct additional tests, such as an ultrasound scan, MRI, or laparoscopy.

A laparoscopy involves a surgeon inserting a thin tube through a small incision in your abdomen to visually inspect for any patches of endometriosis tissue. This procedure is the definitive method to confirm the presence of endometriosis.

Treatment

While there is currently no cure for endometriosis, various treatments are available to alleviate its symptoms. Your doctor will explore these options with you, taking into account your specific circumstances and preferences.

Treatment modalities include:

1. Painkillers: Over-the-counter pain relievers like ibuprofen and paracetamol can be effective in managing pain associated with endometriosis.

2. Hormone Medications and Contraceptives: Your doctor may recommend hormone medicines or contraceptives, such as the combined pill, contraceptive patch, intrauterine system (IUS), contraceptive implant, or gonadotrophin-releasing hormone (GnRH) analogues, to regulate hormonal fluctuations and alleviate symptoms.

3. Surgery to Remove Endometriosis Tissue: Surgical interventions may involve cutting away patches of endometriosis tissue to provide relief.

4. Organ Removal Surgery: In some cases, surgery may be considered to remove part or all of the affected organs, such as the colon, appendix, or womb (hysterectomy). This option is typically reserved for more severe cases and will be thoroughly discussed with you by your healthcare provider.

Your doctor will engage in a detailed discussion with you, weighing the benefits and potential risks of each treatment option. In certain situations, they may suggest a cautious approach, delaying the initiation of treatment to observe whether your symptoms improve naturally over time. It's essential to communicate openly with your healthcare team to make informed decisions about your treatment plan.

FAQs about endometriosis

What causes endometriosis?

It is not known what causes endometriosis, but it may be genetic and may be related to hormones. There are treatments for endometriosis, but there is no cure for the condition.

Why does endometriosis cause pain?

When you have your period and the endometrium bleeds in the uterus, it will also bleed in the other locations where the abnormal tissue grows. It leads to inflammation, blood accumulation, scar tissue and pain.

The mucosa-like tissue that makes up endometriosis is affected by hormones in the same way as the normal tissue in the uterine cavity. When you are affected by hormones in your cycle, your endometriosis will also be affected. In the uterus, the blood will be pushed out when bleeding from the vagina, but in the case of endometriosis, which is located elsewhere where the blood does not have the opportunity to find a way out, small blood cysts will form.

How and how much pain is common?

Women with endometriosis often experience severe pain during menstruation. Some also experience pain during ovulation and in the days before menstruation. The pain outside the uterus is localized where the endometriosis grows – be it in the bowel during defecation, shock pain during intercourse or urination. If the endometriosis has been allowed to develop over many years, the pain can become constant. This also applies if the endometriosis presses on nerves and painful areas. Walking with pain over time can lead to reduced sleep quality, altered appetite and fatigue.

Why can it be difficult to make the diagnosis?

The symptoms of endometriosis can easily be confused with conditions from the organs that are affected. For example, endometriosis in the bladder can be confused with a urinary tract infection. In the gut, it can be interpreted as part of irritable bowel syndrome. Often the symptoms can worsen over time when you have had many periods that have affected the tissue time and time again. This will make the diagnosis clearer as the years go by and it is easier to link it to e.g. cyclical pain.

Oestrogen is a prerequisite for the development of endometriosis. The symptoms appear in childbearing age and will for most people decrease with menopause. Contraceptive pills can be used as part of the investigation, if the pain subsides when using the pills, it could provide a good clue.

What is the difference between endometriosis and adenomyosis?

Endometriosis is a condition where tissue similar to the lining of the womb (the endometrium) grows outside the womb. This tissue can be found on the ovaries, fallopian tubes, peritoneum or other organs near the uterus.

Adenomyosis, on the other hand, is a condition where the endometrium grows inside the muscle tissue of the uterus (the myometrium). This leads to thickening of the uterus and can cause increased bleeding during the menstrual cycle. Adenomyosis can also lead to painful periods, chronic pelvic pain and in some cases infertility. The exact cause of adenomyosis is unknown, but hormonal and genetic factors may play a role.

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