Endometriosis is a chronic and usually very painful disease. Affecting around 20% of women of menstruating age. Doctors don’t know why some women get this condition but there are several theories. This lack of knowledge means at present there is no medical cure for endometriosis. Yet, if we understand what is endometriosis, we can find ways to relieve the pain without drugs or surgery. 

Specialised cells form the lining of the uterus, the endometrium. During the menstrual cycle these endometrial cells respond to changes in reproductive hormones. Under the influence of oestrogen the endometrium thickens and prepares for implantation of an embryo. If the woman does not become pregnant, menstruation begins and the endometrium is shed. 

In someone with endometriosis, the endometrial cells also appear elsewhere in the body. It is possible they migrate from the uterus to other sites in the abdomen or pelvic area. Before sticking to, and growing on structures within the abdominal cavity. Typically, they adhere to the ovaries, uterus or their supporting ligaments. Or, sometimes to other organs, such as the intestines or bladder. Rarely they appear outside the abdominal cavity, for example, in the lungs, brain or skin.

Even though these cells are not in the uterus, they behave as if they are. Responding to the monthly changes in hormones that lead to menstruation. As a result, they can bleed within the abdominal cavity, leading to pain, inflammation and irritation. In addition, fibrous tissues called adhesions grow around, inside or outside other organs and tubes and stick them together. The adhesions can be a major cause of endometriosis pain.

Not only that but adhesions attached to organs or structures can greatly impact on the functions of the affected tissues. For example, endometrial tissue can block the passage of a fertilised egg along the fallopian tube. So, endometriosis can be a major cause of infertility.

Causes of endometriosis

Though the exact cause of endometriosis is not yet known. There are theories about how endometrial cells might migrate.

One popular theory involves the small pieces of uterine lining shed during menstruation. If, instead of flowing out through the vagina during menses, they move backwards. Could these cells move through the fallopian tubes and into the abdominal cavity? This theory could explain why many women have endometrial tissue on the surface of the ovaries and uterus as these sites are close the the ovarian end of the fallopian tubes.

Another theory suggests misplaced endometrial tissue occurs in the embryo. Supported by examination of foetuses at various stages of development. Researchers found the misplaced tissue may exist in some babies while they are still in the womb.

Other researchers suggest endometrial cells may migrate to other parts of the body via the blood or lymph.

There is also a question of whether endometriosis is an inherited condition. It is more common in women with a first degree relative with the condition – either a mother, sister, daughter.

Other possible causes include environmental factors such as toxins. We know that certain chemicals disrupt human hormonal balance. It is also possible that pelvic infections or uterine abnormalities are possible causes.

In addition, we know that previous abdominal surgery increases the risk of developing endometriosis.

A further theory arose when endometrial tissue was found in men. This theory suggests the possibility that other types of cells can transform into endometrial cells.

Symptoms of endometriosis

The main symptom is pelvic pain at the time of the period and often at ovulation. Since the pain can last for days some women can find their pain is present for almost the whole month. I have written about natural remedies for period pain before.

In endometriosis there is a wide variation in the amount of pain felt. The degree of pain is not always related to the volume of misplaced tissue. Some women have endometriosis without pain. Whilst others can have few signs of the disease but suffer excruciating pain. Many women have endometriosis for years before they experience pain during menstruation.

Typical signs and symptoms of endometriosis are:

• severe pelvic or abdominal pain, that worsens with each menstrual period
• period pain that radiates to the lower back, vagina, or upper thighs
• heavy and prolonged menstrual bleeds, with thick clotting
• pain during ovulation
• pain during or after sexual intercourse
• spotting or bleeding after sex
• infertility

The symptoms can also relate to the sites of endometrial tissue. For example, if the bowel is affected, it may cause pain and bleeding during bowel movements. Similarly, if the bladder is affected, there can be pain during urination.

Diagnosis of endometriosis

Generally a doctor diagnoses endometriosis during a laparoscopy. This is a surgical procedure in which a surgeon views the inside of the abdomen through a fibre-optic instrument.

Endometriosis is graded into stages. I describe the stages of endometriosis on my page Endometriosis stages explained.

Treatment of endometriosis

Conventional treatment is either drugs or surgery. Sometimes endometrial tissue can be removed during the diagnostic laparoscopy. However, in most women surgical removal of the tissue provides only temporary relief. Any remaining endometrial tissue continues to grow and symptoms usually recur.

Oral contraceptives can slow progression of the disease. Whilst women that are not planning to become pregnant have the option of removal of the ovaries. Both of these options can help to reduce the amount of oestrogen exposure and lead to some relief.