General information about Endometriosis 

Endometriosis is a condition where tissue similar to the lining of the womb (uterus) is found elsewhere in the body. It is most commonly found in the pelvis (in or on the ovaries, behind the uterus, in tissue that holds the uterus in place and on the bowel and the bladder) but it can be found in other locations such as the chest cavity, lungs, abdominal wall scars and the navel. Endometriotic tissue may be located on the surface of organs and over the lining of the abdominal cavity (peritoneum). It may infiltrate deeper into the structures or may form cysts within the ovaries. These cysts are known as ‘chocolate cysts’ or endometriomas, which may be identified by an ultrasound scan.

Every month, if a woman is not pregnant, the lining of the womb breaks down and is shed as a menstrual period. The endometriotic tissue (endometriosis) goes through a similar cycle and bleeds during menstruation. This may cause pain during periods, inflammation and scarring. The scarring can cause organs or structures to stick to each other and this may distort the normal anatomy. Anatomical distortion of the pelvic organs may cause difficulty in becoming pregnant. Deep endometriosis tissue and scarring can sometimes form small lumps and these are called ‘endometriotic nodules’. These nodules can be very tender and painful to touch. Scarring and nodules of endometriosis may cause some women to experience pain during sexual intercourse.

Who is affected by endometriosis?

Any woman in the reproductive period of her life can be affected from teenage years to the menopause. Endometriosis usually improves with the onset of menopause.

What are the signs of endometriosis?

Some women with endometriosis may have no significant symptoms. Common symptoms of endometriosis include:

  • Painful periods
  • Pelvic pain
  • Pain during sexual intercourse
  • Difficulty in becoming pregnant
  • Pain with bowel movements
  • Pain passing urine.

It is worth noting that endometriosis is not an infection, not contagious and not cancer. It is in fact the second most common gynaecological condition. It is estimated that two million women in the UK have endometriosis.

What causes endometriosis?

The exact cause is not known. It is possible that there are multiple contributing factors and that these factors may be inherited in some families.

The theories on how endometriosis develops include:

  • Retrograde menstrual flow: menstrual blood flows backwards down the fallopian tubes into the pelvis. Cells from the lining of the womb (endometrial cells) within this blood may implant onto the surface of structures in the pelvis and continue to grow there, giving rise to endometriosis. This theory best explains why endometriosis is commonly found in the pelvis.
  • Lymphatic or vascular spread: endometrial cells may be carried to different parts of the body via the lymphatic drainage or blood vessels. This is probably how distant site endometriosis develops.
  • Metaplasia: this is a term used to describe a process during which cells in the body may undergo change into endometrial cells. Examples include cells lining the inside of the abdomen and cells from the ovary.

How is endometriosis diagnosed?

  • History: a careful and thorough history may highlight symptoms which could be due to endometriosis.
  • Pelvic examination: a pelvic examination may identify ovarian cysts, endometriotic nodules or scarring on the ligaments supporting the uterus and between the bowel and vagina (rectovaginal endometriosis).
  • Ultrasound scan: an ultrasound scan can help in assessing the severity of endometriosis. If cysts are present on the ovaries these can be identified and in addition, ultrasound also allows us to make an assessment of how stuck the ovaries and womb are. Ultrasound can also aid in identifying other areas of endometriosis within the pelvis. This information is useful when planning treatment.
  • Laparoscopy: this is the most reliable way to diagnose endometriosis. It involves inserting a telescope through a small cut in the navel to look inside the abdomen and pelvis.