Endometriosis

ENDOMETRIOSIS IS A COMMON BUT OFTEN MISUNDERSTOOD CONDITION. UNDERSTANDING ITS CAUSES, SYMPTOMS, DIAGNOSIS AND TREATMENT IS VITAL FOR WOMEN’S HEALTH, AND HELPS TO IMPROVE PUBLIC AWARENESS – ESPECIALLY FOR SUPPORT IN THE WORKPLACE.

Endometriosis is a severe condition that affects up to 10% of reproductive-age women; around 190 million women worldwide and at least one in nine Australian girls, women and those assigned female at birth. Endometriosis occurs when tissue similar to the lining of the uterus, called the endometrium, grows outside of the uterus. This may lead to chronic, often extreme pain, discomfort and sometimes infertility. Management of the condition may include medical treatments, surgical treatments and complementary treatments.3 The Australian government has recently acknowledged the historical lack of awareness, education, diagnosis, research, and treatment into endometriosis, with the ‘National Action Plan for Endometriosis’ released in 2023. The plan highlights the need to develop a more robust response to the management and treatment of the condition, with an emphasis on improving the quality of life for those affected by endometriosis.3

Causes

The exact cause of endometriosis remains unclear, and it is likely that genetic, biological, and environmental factors may influence the development of the condition.4 Some factors may increase the risk of developing endometriosis, including:

• ‘Retrograde menstruation’: If menstrual blood flows back through the fallopian tubes and into the pelvis, this can lead to the growth of endometrial tissue in the wrong places.4

• Movement of endometrial stem cells: If these cells move through the bloodstream or lymphatic system to other parts of the body, these parts could begin to grow and form endometrial tissue.4

• Cellular metaplasia: This refers to the ability of cells to change from one form to another, e.g., cells outside the uterus of change into endometrial-like cells and begin to grow.4

Symptoms

The symptoms of endometriosis can vary widely; some people may experience no symptoms at all. Common symptoms include:5

• Pelvic pain: This is the most common symptom and may occur before, during and/or after menstruation. The pain may be mild or severe and may worsen over time. Pain can also be present in the lower back or legs.

• Painful and/or heavy periods: Many women will experience pain during their period, which may be so debilitating they cannot participate in day-to-day activities including education, work or sport. Heavy bleeding or clotting, irregular bleeding, or bleeding for longer than ‘normal’ may also signal endometriosis.

• Pain during intercourse: Experiencing pain during intercourse, especially during deep penetration, can be another common symptom of endometriosis.

• Painful bowel movements or urination: Endometrial tissue may grow on the bowel or bladder, causing pain or changes to urination or bowel movements.

• Infertility: Endometriosis can cause scarring and adhesions in the pelvic area, which can make it difficult to conceive.

• Fatigue: Many women with endometriosis experience extreme tiredness with low energy levels.

Diagnosis

On average, it takes over seven years to get a diagnosis.6 Before that, 58% of sufferers will visit their GP at least 10 times, and over a quarter will go to the emergency room with severe symptoms. Unfortunately, many of those affected by endometriosis will not receive adequate support from their GP or gynaecologist.7

The diagnosis of endometriosis typically involves a combination of a physical exam, imaging tests, and possibly laparoscopy (keyhole surgery in the abdomen). If you suspect endometriosis, you will need to visit a GP to receive a diagnosis.

During the physical exam, the doctor will ask about your symptoms and medical history and may feel for any lumps or abnormalities in your pelvic area. Imaging tests such as an ultrasound or MRI may be used to detect the presence of endometrial tissue outside of the uterus.8

If the diagnosis is still unclear, a laparoscopy may be performed in a hospital setting. Under general anaesthetic, a small camera will be inserted through a small incision in your abdomen to examine your pelvic organs. A biopsy may also be taken to confirm the presence of endometrial tissue beyond the uterus.

Treatments

Treatment for endometriosis depends on the severity of the symptoms and the desire for fertility. Mild cases may be managed with pain relievers and hormone therapy to suppress the menstrual cycle.8 More severe cases may require surgery to remove the endometrial tissue and any adhesions.

These surgical procedures can include laparoscopy, laparotomy (a larger incision), and/or hysterectomy (removal of the uterus).9 Unfortunately, even the removal of the uterus means the condition may still return, as endometrial tissue can continue to grow in other parts of the body.

Managing endometriosis

In addition to medical treatments, there are several steps that may manage symptoms and improve overall health and well-being. These include:4

• A healthy diet: Inflammation can exacerbate the symptoms of endometriosis. A diet that is rich in fruits, vegetables and whole grains can help to reduce inflammation in the body.

• Regular exercise: This can help to reduce stress, manage your symptoms, and improve your overall health.

• Stress management: Stress can exacerbate endometriosis symptoms, so practices such as meditation, mindfulness or yoga can be helpful.

• Pain management: Over-the-counter pain relief, such as ibuprofen or acetaminophen, can be helpful. In more severe cases, prescription pain medication may be necessary.

• Hormonal birth control: This can regulate your menstrual cycle and reduce the growth of endometrial tissue.

• Alternative therapies: Acupuncture, massage or herbal remedies can provide some relief for some, but you should always consult your healthcare provider before trying any alternative therapies.10

Living with endometriosis

Endometriosis can be a challenging condition to live with, but resources are available to help those affected manage their symptoms and improve their quality of life. The Endometriosis Association and the National Endometriosis Society offer information and support groups.

Additionally, many healthcare providers specialise in the treatment of endometriosis and can provide guidance and support in managing the condition. There are also several government programs designed to make life easier for those suffering with endometriosis through increasing awareness and developing potential treatments.2 These programs include over $87 million in funding, allocated as part of the ‘National Action Plan for Endometriosis’.

While endometriosis remains a severe condition, there are increasing resources dedicated to awareness and education. With advancements in research and technology, the aim is to develop better support and assistance and improve the quality of life for those affected by endometriosis.

1Endometriosis: https://www.who.int/news-room/fact-sheets/detail/endometriosis

2What we’re doing about endometriosis: https://www.health.gov.au/topics/chronicconditions/what-were-doing-about-chronic-conditions/what-were-doing-aboutendometriosis

3What is endometriosis: https://www.endometriosisaustralia.org/about-endo 4Montgomery et al, “The search for genes contributing to endometriosis risk,” Human Reproduction Update 14.5 (2008): 447-57.

5Endometriosis: https://www.healthdirect.gov.au/endometriosis

6Endometriosis: https://www.bbc.com/news/health-49897873

7Satisfaction with medical support in women with endometriosis: https://www.ncbi. nlm.nih.gov/pmc/articles/PMC6264517/

8Endometriosis: https://www.hopkinsmedicine.org/health/conditions-and-diseases/ endometriosis

9Treating endometriosis: https://www.thewomens.org.au/health-information/periods/ endometriosis/treating-endometriosis

10Endometriosis & natural therapies: https://www.jeanhailes.org.au/health-a-z/ natural-therapies-supplements/endometriosis-natural-therapies