Endometriosis is the presence of cells that normally line the uterus (womb) in abnormal positions in the pelvis and abdomen. Two percent (2%) of all women are affected at some time.
The term endometriosis is derived from three Greek words: “Endon” which means within, “Metra” which means uterus, and “Itis” which is a suffix used for any form of infection or inflammation.
The uterus is lined with endometrial cells that during the second half of a woman’s monthly cycle may accept a fertilised egg and allow it to grow into a baby. If no pregnancy occurs, these cells degenerate, break away from the inside of the uterus, and are carried out of the body in a woman’s period. From the top of the uterus, a Fallopian tube leads out to each of the two ovaries. In a small number of women, the endometrial cells go into and through these tubes to settle in abnormal positions around the ovary, on the outside of the uterus, or in the pelvic cavity, where they can start growing and spread further. These cells still respond to the woman’s hormonal cycle every month, and will bleed with every period, releasing blood in places where it can cause symptoms. The abnormally positioned endometrial cells can also irritate the bladder, settle on the outside of the intestine, or they may block the Fallopian tubes to cause infertility.
The symptoms depend on the site of the endometrial deposits, but pelvic pain, often worse at the time of a period, is usual. They may also cause uterus and bowel cramps, diarrhoea and frequent passage of urine due to bladder irritation.
The condition can be diagnosed through pelvic examination by a Gynaecologist. If it fails, an ultrasound of the uterus may help. And even if it does not work then usually a Laparoscopy is recommended.
Various medications (eg. hormones, danazol) taken as tablets, implants or nasal sprays for many months, settle mild to moderate cases. Removal of endometrial deposits is normally possible by laparoscopy (passing a number of small tubes into the abdomen), but open operation may be necessary to remove large amounts of abnormal tissue. As a last resort, a hysterectomy may be performed.
Most patients are cured with medication and/or surgery, but some will be left permanently infertile. Artificial means of fertilisation can help these women conceive, as their ovaries still function normally.