10857 Endometriosis

Overview

Endometriosis is a condition where tissue similar to the lining of the womb grows outside the womb, such as on the ovaries, fallopian tubes, or elsewhere in the pelvis. This tissue responds to hormones during your monthly cycle, causing inflammation, pain, and sometimes scar tissue.

Yes. Endometriosis affects around 1 in 10 women and people assigned female at birth of reproductive age, though the true number may be even higher.

It can affect anyone who menstruates, including teenagers and adults. It most often starts in the years after your first period and can continue until menopause. Some people have a family history of endometriosis.

Symptoms

Common symptoms

• Painful periods that stop you doing normal activities
• Pain in your lower tummy, pelvis, or lower back at any time of the month
• Pain during or after sex
• Heavy or irregular periods
• Feeling very tired or lacking energy
• Difficulty getting pregnant
• Painful poos or peeing, especially during your period

Symptoms in children

• Endometriosis can start in teenagers. Symptoms are the same as in adults, such as severe period pain that makes you miss school or activities.
• A teenager may not realise their pain is not normal because they think painful periods are normal.

Symptoms in older adults

• Endometriosis usually affects people during their reproductive years. After menopause, symptoms often improve, but some people continue to have pain.
• Older adults with endometriosis may also have pain from scar tissue or previous surgery.

Causes

Main causes

• The exact cause is not fully understood, but there are several theories.
• One theory is that menstrual blood flows backwards into the pelvis, carrying womb-lining cells that attach and grow.
• The immune system may not clear these misplaced cells properly.
• Genetics may play a role – endometriosis can run in families.
• Hormones can influence the growth and inflammation of endometriosis tissue.

Risk factors

• Having a close family member with endometriosis
• Starting your period early (before age 11)
• Having short or heavy menstrual cycles
• Never having been pregnant
• Having a low body weight or being underweight
• Having a blocked fallopian tube or other womb shape differences

When to see a doctor

See a doctor urgently if:

• Severe pelvic pain that is getting worse or not relieved by simple pain relief
• Pain with fever, vomiting, or feeling very unwell
• Heavy bleeding that soaks through a pad or tampon every hour

Book a routine appointment if:

• Period pain that is interfering with your daily life or making you miss school or work
• Pain during or after sex
• Heavy, irregular, or long periods
• Difficulty getting pregnant
• Ongoing pelvic pain not related to your period

Diagnosis

Doctors diagnose endometriosis by listening to your symptoms, doing a pelvic exam, and using imaging tests like an ultrasound. The only way to be certain is with a keyhole surgery called laparoscopy, but this is not always needed for everyone.

Tests that may be done

• Pelvic examination – the doctor feels inside to check for pain, lumps, or tenderness
• Ultrasound scan – uses sound waves to look at your womb, ovaries, and pelvis
• MRI scan – uses magnets to create detailed pictures inside your body
• Laparoscopy – a small camera is inserted through a tiny cut in your belly to look for endometriosis tissue and sometimes take a small sample

What to expect at your appointment

Your doctor will start by asking about your symptoms and your periods. They may do a pelvic exam. You might be offered an ultrasound. If the diagnosis is still unclear, or if you want to discuss fertility, you may be referred to a specialist. A laparoscopy is usually done under general anaesthetic, and you can often go home the same day.

Treatment

There is no cure for endometriosis, but treatment can help manage symptoms, slow the growth of tissue, and improve quality of life. Your treatment plan will depend on your symptoms, whether you want to get pregnant, and how endometriosis is affecting your life.

Self-care at home

• Put a hot water bottle or heat pack on your lower tummy to ease pain
• Take warm baths to relax muscles
• Try gentle exercise like walking or stretching
• Rest when you need to, and plan around your symptoms
• Use relaxation techniques like deep breathing or meditation
• Wear loose clothing during painful flare-ups

Medical treatments

There are several prescription medicines that can help with endometriosis. These include hormonal treatments such as the combined oral contraceptive pill, progestogen-only methods, and other hormone-based options. These work by changing your hormone levels to reduce the growth of endometriosis tissue. Simple pain relievers can also help, but always ask your doctor or pharmacist which option is safe for you. Never take more than the recommended dose.

When is surgery considered?

If other treatments are not helping, or if you have fertility problems, surgery to remove endometriosis tissue may be recommended. The most common surgery is keyhole laparoscopy. In very severe cases, a hysterectomy (removal of the womb) or removal of the ovaries may be considered, but this is a major decision – especially if you might want to have children. Always discuss the benefits and risks with your doctor.

Living with this condition

Living with endometriosis can feel unpredictable. Some days are good, others are hard. Try to keep a symptom diary so you can spot patterns and plan your activities. Work with your doctor to find a treatment plan that fits your life. It is okay to ask for help with household tasks or work when you need it.

Lifestyle tips

• Get enough sleep and rest, especially before and during your period
• Manage stress with mindfulness, gentle yoga, or talking to a friend
• Stay active – but listen to your body and rest when you need to
• Track your symptoms to learn what your triggers are
• Keep a routine to help you feel in control

Diet and exercise

There is no one diet for endometriosis, but a balanced diet with plenty of fruit, vegetables, whole grains, and healthy fats can support your body. Some people find cutting down on caffeine and alcohol helps. Gentle exercise like swimming, walking, or yoga can reduce pain and improve your mood. Try to move a little every day, but don't push through severe pain.

Mental health and emotional wellbeing

Living with a chronic condition can be exhausting and frustrating. It is normal to feel anxious, low, or stressed. If you are feeling this way, talk to your doctor. Counselling, cognitive behavioural therapy (CBT), or joining a support group can also help.

Prevention

There is no known way to prevent endometriosis. However, getting a diagnosis early and starting treatment can help reduce symptoms and prevent some complications, such as severe pain or fertility problems.

Complications

If left untreated

• Severe chronic pelvic pain
• Internal scar tissue (adhesions) that can distort the organs in your pelvis
• Ovarian cysts filled with old blood, called endometriomas
• Difficulties getting pregnant (fertility problems)
• Heavy periods that can lead to tiredness and low iron levels

Long-term outlook

Although endometriosis is a long-term condition, most people find ways to manage their symptoms with treatment and support. Many people have successful pregnancies and live full, active lives. Symptoms often improve after menopause. A good relationship with your doctor and a strong support network can make a real difference.

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