All content within this page has been reviewed by
Dr David Nunns, Consultant Gynaecologist
Endometriosis can often go undiagnosed in teenagers and women, even if they experience common symptoms such as severe menstrual cramps, abdominal pain in between periods or heavier periods.
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Endometriosis is a common condition that affects millions of women worldwide. It can start during adolescence and continues throughout the reproductive years. Besides causing physical symptoms, it can also have an impact on a person's mental well-being.
Endometriosis occurs when the endometrium (the mucous layer that covers the inside of the uterus) moves out of its original location in the uterus. The usual place for the endometrial tissue to settle is the pelvis.
The tissue settles in the form implants which are small. When they settle in the ovaries than form cysts also known as endometriotic cysts or endometriomas. These contain blood, giving them a dark reddish-brown colour. Their size may vary but are usually a few cm in size. When endometriosis infiltrates the uterine wall in the form of roots, it is called adenomyosis. This leads to an increase in the size of the uterus, which becomes redder, more flexible and more painful.
Moreover, this disease can have an inflammatory component that causes adhesions, i.e. tissue bridges or scar tisseue, which cause organs such as the uterus, ovaries, fallopian tubes and intestines to stick together.
The exact cause of endometriosis is still unknown despite extensive research. However, there are several theories about its origin, including the following:
Depending on the stage of the disease, there are four degrees of severity of endometriosis:
It is important to start treating the disease as early as possible to prevent its progression. Treatments for the minimal and mild stages give the best results.
One theory is that part of the menstrual fluid flows through the fallopian tubes and falls into the abdomen instead of being lost as a period. However, this phenomenon occurs in many women who will never develop endometriosis, so this explanation does not completely solve the problem.
Another theory suggests a possible immunity defect responsible for 'cleaning' microbes and abnormal cells in the abdomen. Defences would not be reduced, just of poorer quality. This would prevent endometrial cells (normally present only inside the uterus) from being recognised as foreign, leaving them free to implant themselves in internal organs. In addition, research shows that first-degree relatives of women with endometriosis are more likely to develop it, so hereditary factors are probably involved in its genesis.
As for its evolution, endometriosis is an unpredictable process. For example, some women have small implants that do not change over the years, while in others, they can grow widely in the pelvis.
The symptoms of endometriosis are also highly variable. In some cases, there may be no symptoms at all (endometriosis is diagnosed by accident during abdominal surgery for other reasons). However, in other cases, internal inflammation of the abdomen and adhesions may be the cause of:
The intensity and frequency of these symptoms vary from case to case. A woman may suffer from a single symptom or several symptoms at once. In more rare cases, endometriosis can even affect the bladder - causing difficulty in urination and small amounts of blood loss - and the intestine - where it can cause spasmodic abdominal pain and diarrhoea.
The chronic pain of pelvic endometriosis and its other effects on the body lead to a feeling of chronic fatigue. There is also a general weakening of the body. All these sensations intensify during menstruation.
The symptoms of endometriosis can affect menstruation. Bleeding from the endometrium causes a number of symptoms. In the cases of most patients, menstrual bleeding is very painful and heavy, sometimes accompanied by blood clots. Periods may last longer than usual. The period is often preceded by premenstrual spotting or bleeding. Moreover, patients with uterine endometriosis may experience irregular menstrual bleeding.
Women with endometriosis who use tampons can often experience additional discomfort and pain. The reasons for endometriosis and tampon-related pain can be varied. Firstly, endometriosis itself can lead to increased sensitivity and pain in the pelvic area, which can be intensified when inserting or removing tampons. Secondly, tampons can cause tension in the pelvic muscles which also contributes to discomfort and pain.
In addition, endometriosis and pain caused by tampons may be due to anatomical changes caused by the disease such as adhesions or scars.
As a result, women with endometriosis may prefer other methods of menstrual protection that may be less painful and more comfortable for them. It is important to consult your doctor to determine the best method, taking into account your individual needs and your pain experience.
Endometriosis can impact on fertility by causing scar tissue on the pelvis around the fallopian tubes. Ovarian endometriosis may cause cysts and adhesions. Furthermore, deep endometriosis is caused by scarring of tissues, for example in the ovaries, which leads to ovulation problems and reduces the chances of getting pregnant.
Symptoms of endometriosis also include a feeling of bloating, heaviness and swelling in the lower abdomen. These sensations cause pain which generally occurs during menstruation, but over time can become constant and uncomfortable, even in between periods. One of the symptoms of endometriosis can be a intermittent bloating of the belly. This is a condition in which the abdomen becomes enlarged and tense, often as a result of the presence of extensive endometrial lesions in the pelvic region and the inflammatory response caused by these lesions.
Patients often experience uncomfortable bloating during their periods. Due to the disease, bloating in this area may stop you from wearing clothes in your size during menstruation.
Chronic endometriosis can manifest itself as intestinal discomfort. Problems passing stools are particularly intense during menstruation. In addition, stool frequency is altered: diarrhoea or constipation are frequent.
Weight gain is not a direct symptom of endometriosis, although certain aspects of endometriosis and its treatment can lead to overweight.
Fibroids are the most common benign tumours of the uterus when it comes to women of childbearing age. The symptoms of these two conditions can be similar, with painful, heavy periods and pain in the lower pelvis.
Endometriosis and polycystic ovary syndrome are often the cause of infertility. Both diseases can be treated with pharmacological means which improve the chances of getting pregnant.
Tampons have no impact on endometriosis. Many facts remain to be discovered about this disease, but one of its causes is linked to the fact that the menstrual fluid flows backwards outside the fallopian tubes. Some people think that a tampon could block the cervix and cause the menstrual fluid to flow backwards into the uterus and out of the fallopian tubes, which is simply not possible. Tampons cannot block the cervix and once they are full, menstrual blood that can no longer be absorbed is evacuated through the vagina. It does not pass into the uterus. Consequently, tampons, and more specifically the use of tampons during menstruation, cannot be considered a cause of the development of endometriosis.
The diagnosis of endometriosis cannot be made only on the basis of the symptoms presented by the patient. In many cases, in order to arrive at a correct diagnosis, the gynaecological examination should be supplemented by other tests to confirm the endometriosis and determine its degree of severity. These examinations may include gynaecological ultrasound and blood tests and, in some case a laparoscopy (an daycase operation that allows the inside of the abdominal cavity to be seen through small incisions of just a few millimetres, through which the working instruments are inserted) or other special diagnostic techniques such as an magnetic resonance imagin scan (MRI).
The treatment of endometriosis requires a holistic view of a woman. Age, symptoms and desire for pregnancy must be taken into account before deciding on treatment. In adolescence, the priority is generally to relieve the pain. Medical treatments with medicines, mainly pain killers and hormonal contraceptives, may be sufficient. However, other patients will require combined medical and surgical treatment. Day case surgery is sometimes indicated to make a diagnosis and treat any areas of disease. The purpose is therefore to eliminate the disease as far as possible while preserving as much healthy tissue as possible.
Although some women with endometriosis may experience reduced fertility rates and, treatment may improve the chances of getting pregnant in future.
Endometriosis is a benign (non-cancerous) condition!
Most symptoms of endometriosis resolve with the menopause, but this is not always the case. In the absence of hormonal secretion, the disease remains dormant. However, it should be noted that it can reappear if hormone replacement therapy is administered when menstruation stops.
Endometriosis remains a complex condition, but there is hope on the horizon. Ongoing research into diagnosis and treatment is advancing rapidly, and medical professionals are continuously learning more about how to effectively manage this condition. With time, these efforts will pave the way for better outcomes and improved quality of life for those affected.
If you are experiencing symptoms that may indicate endometriosis, such as persistent pelvic pain, painful periods, or fertility challenges, it’s important to seek medical advice. Don’t hesitate to consult a healthcare provider who can guide you through appropriate tests and treatment options. Early diagnosis can make a significant difference, so trust your instincts and reach out to a professional if you have concerns.