What is endometriosis, how is it diagnosed and where is the pain located?

Endometriosis impacts 1 in 10 people. Despite it being the second most common gynaecological condition in the UK, it still takes an average of 7.5 years to get diagnosed.

Endometriosis is a medical condition that primarily affects individuals with a uterus. It occurs when tissue similar to the tissue that lines the inside of the uterus, called the endometrium, grows outside of the uterus, typically in the pelvic area. This misplaced endometrial-like tissue can attach itself to various pelvic organs and structures, such as the ovaries, fallopian tubes, outer surface of the uterus, bowel, or bladder. 

Throughout a woman's menstrual cycle, the uterine tissue thickens, breaks down, and is released through menstrual bleeding in response to hormonal changes. In patients with endometriosis, the tissue outside the uterus also undergoes the same process as the endometrial tissue, leading to inflammation, chronic pain, the formation of scar tissue (adhesions), and endometrial lesions.

These adhesions can cause organs and tissues to stick together, resulting in a heavy period, severe pain, and potential complications, reducing a person's quality of life. In rare cases, these lesions may spread beyond the pelvic region.

In this article we will cover:

• What are the symptoms of endometriosis?
• What can you do to manage your endometriosis symptoms?
• What causes endometriosis?
• How is endometriosis diagnosed?
• Where is endometriosis pain located?

What are the symptoms of endometriosis?

Endometriosis is a chronic disease that can affect the daily lives of those struggling with it. There are a few different types of endometriosis: minimal or mild endometriosis, moderate, and severe endometriosis. 

There are also different types of endometriosis: superficial peritoneal, overian endometrioma, and deep endometriosis.

Symptoms can vary from person to person, with the most common symptom being severe pelvic pain. Other symptoms of endometriosis include painful periods, pain during sex, heavy bleeding, infertility, digestive issues, fatigue, pain with bowel movements or when going to the loo, and sometimes even emotional distress.

While the exact cause of endometriosis is not fully understood, several theories exist, including retrograde menstruation (when menstrual blood flows backward into the pelvic cavity), genetic predisposition, hormonal imbalances, immune system disorders, and environmental factors.

The diagnosis of endometriosis is typically made through a combination of medical history, physical examination, imaging tests, and sometimes through laparoscopic surgery (keyhole surgery).

Our doctors and nurses always say that if over-the-counter pain relief won't help alleviate your menstrual pains during your period, this could be a sign that something is wrong. We would recommend going to see your doctor or booking in a call with your Fertifa Patient Advisor to advise on next steps.

What can you do to manage your endometriosis symptoms?

As of now, there is no cure for endometriosis, however, there is treatment for endometriosis available. This includes over-the-counter or prescription pain medications, hormone treatment to suppress the menstrual cycle and reduce symptoms, and in severe cases, surgery for endometriosis is needed to remove or destroy the endometrial growths.

The type of endometriosis treatment a patient receives is determined by their symptoms, age, what stage of endometriosis they have, and their plans for pregnancy. In some instances, fertility treatments may be necessary for individuals who are experiencing difficulties getting pregnant.

What causes endometriosis?

The exact cause of endometriosis is not fully understood, but several theories exist. Here are some potential factors that may contribute to the development of endometriosis:

1. Retrograde menstruation: This theory suggests that during a womans menstrual flow, the blood flows backward through the fallopian tubes and into the pelvic and abdominal cavity. However, this blood contains endometrial cells, which can then implant and grow in the abdominal and pelvic organs, leading to endometriosis.
2. Genetic factors: A medical professional may look at your family history of endometriosis as it tends to run in families, suggesting a genetic predisposition. Certain genetic factors may make some individuals more susceptible to developing the condition.
3. Hormonal imbalances: Hormones, particularly estrogen, play a role in stimulating the growth and shedding of the endometrial tissue. It's believed that abnormal hormonal levels or imbalances may contribute to the development of endometriosis.
4. Immune system disorders: Issues with the immune system may prevent the body from recognizing and eliminating the misplaced endometrial tissue. This could allow the tissue to grow and cause inflammation and severe pain.
5. Embryonic cell transformation: Some researchers propose that cells outside the uterus may undergo a transformation into endometrial-like cells during fetal development. These cells can then develop into endometriosis later in life.
6. Environmental factors: Exposure to certain environmental toxins, such as dioxins, may increase the risk of developing endometriosis. However, more research is needed to establish a definitive link.

It's important to note that while these theories offer insights into the possible causes of endometriosis, they do not provide a complete understanding of the condition. Further research is necessary to fully comprehend the underlying mechanisms.

How is endometriosis diagnosed?

Endometriosis is diagnosed through a combination of medical history, physical examination, and often a surgical procedure called laparoscopy. Here's a brief overview of the diagnostic process:

1. Medical history: The doctor will discuss your symptoms, menstrual history, and any related factors that may suggest an increased risk of endometriosis. It's important to provide detailed information about your pain patterns, severity, and any other symptoms you may be experiencing.
2. Physical examination: The doctor will perform a pelvic exam to check for any abnormalities, tenderness, or masses in the pelvic region. However, it's important to note that physical examination alone cannot confirm the presence of endometriosis.
3. Imaging tests: Endometriosis can often be mistaken for pelvic inflammatory disease (PID), ovarian cysts, or Irritable bowel syndrome (IBS) as they all share similar symptoms. While it is tough to reach a definitive diagnosis for endometriosis, imaging tests such as ultrasound or magnetic resonance imaging (MRI) may be used to rule out other conditions and provide a better visualization of pelvic structures and reproductive organs.
4. Laparoscopic surgery: This procedure is the most reliable way to diagnose endometriosis. It is a type of keyhole surgery and is usually performed under general anesthesia. A thin, lighted instrument called a laparoscope is inserted through a small incision in the abdominal cavity to view the pelvic organs directly. If endometrial implants or adhesions are found, a tissue sample, or biopsy, may be taken for confirmation.

The procedure allows the doctor to assess the location, extent, and severity of endometriosis and may guide towards effective treatment decisions. It also provides an opportunity for simultaneous surgical treatment, which is the removal or ablating (destroying) the endometriosis tissue growths or adhesions.

Remember to consult with a healthcare professional or your Fertifa Patient Advisor if you suspect you may have endometriosis or are experiencing symptoms. They will evaluate your specific situation and recommend the most appropriate diagnostic approach to confirm or rule out endometriosis.

Where is endometriosis pain located?

Pain associated with endometriosis can occur in various locations within the body. The specific location of onset of symptoms and intensity of pain can vary among individuals. Here's a brief overview of the common areas where endometriosis pain may be experienced:

1. Pelvic pain: Pelvic pain is the most common and characteristic symptom of endometriosis. The pain may be deep and persistent, typically located in the lower abdomen or pelvic region. It may range from mild discomfort to severe and debilitating pain. 
2. Dysmenorrhea: Many individuals with endometriosis experience intense menstrual pain, known as dysmenorrhea. There is often severe abdominal pain described as cramping and can radiate to the lower back or thighs. It may start a few days before the onset of menstruation and continue throughout the menstrual period.
3. Pain during intercourse: Endometriosis can cause pain during sexual intercourse, known as dyspareunia. The pain may be localized or more widespread within the pelvic region and can occur during or after intercourse.
4. Painful bowel movements or urination: Endometriosis affecting the bowel or bladder can lead to pain during bowel movements or urination. This pain can be experienced as a result of the endometrial implants or adhesions interfering with normal organ function.
5. Chronic pelvic pain: Some individuals with endometriosis may experience more severe symptoms such as chronic pelvic pain that persists throughout the menstrual cycle and extends beyond menstruation. This pain can be present even when not actively menstruating.

It's important to note that the location and severity of pain can vary among individuals, and some women with endometriosis may not experience significant pain or may have pain in atypical locations.

If you suspect you may be experiencing symptoms of endometriosis or that you may have the disease, speak with your GP or Fertifa Patient Advisor for the correct diagnosis and to explore medical treatment options tailored to your specific situation. If you have any further questions feel free to reach out to our in-house clinical team, we are always here to help 💜