Endometriosis Awareness – Why More Needs to Be Done

Environmental factors

Animal studies have shown that exposure to specific environmental toxins can lead to the development of endometriosis [5]. This is yet to be proven in humans.

Genetics

There is some evidence that suggests the condition can be passed down through families [6]. Some ethnic groups are more susceptible to endometriosis but the reasons for this are still unclear.

Immune dysfunction

There is a suggestion that the body’s immune system could be a cause of endometriosis. Some studies show that women who have the condition have a reduced defence against other conditions [7].

Metaplasia

Metaplasia is where one cell type can turn into a different type of cell. It usually happens in response to inflammation and allows cells to better adapt to their surrounding environment. It may help to explain why endometriosis cells appear in other parts of the body or why some men develop them when they take certain hormonal treatments [7].

Retrograde menstruation

When you have a period, the womb lining leaves the body via the vagina but some of the endometrium flows backwards, through the fallopian tubes. Although it has been suggested that everyone who has a period experiences some form of retrograde menstruation, most are able to clear the tissue. However, in some cases the endometrial cells deposit on the organs of the pelvis, leading to endometriosis [7].

Lymphatic or circulatory system

Another theory is that cells from the womb lining can travel around the body either in the blood or the lymphatic system [4].

Although all these proposed theories could offer some explanation about why or how endometriosis occurs, none of them present a full rationale. Instead, it is likely that the condition is caused by a mixture of these factors.

Endometriosis Symptoms

The symptoms of endometriosis can vary from woman to woman. Some experience just mild symptoms which do not interfere with their everyday lives, whereas others are more severely affected.

According to the NHS, the main symptoms of endometriosis include:

• severe period pain that stops you from carrying out normal activities
• lower stomach or back pain which is often worse during your period
• pain during or after sex
• nausea, constipation or diarrhoea
• blood in your urine during your period
• pain when going to the toilet during your period
• difficulty falling pregnant [4]

How is Endometriosis Diagnosed?

There is currently no endometriosis blood test available for diagnosing the condition, but they can be used to rule out other conditions. The only way endometriosis can be diagnosed is by a laparoscopy. A laparoscopy is performed by a gynaecologist and is where a camera called a laparoscope is inserted into a small cut in the abdomen to look for endometriosis tissue in the pelvis.

Getting a diagnosis for endometriosis can be difficult because many of the symptoms overlap with other conditions or they can differ between women.

Because of this, achieving a diagnosis can be a lengthy process. The average time it takes from first seeing a doctor about symptoms to getting a diagnosis is 7.5 years. This is far too long given the impact the condition has on women’s quality of life and further demonstrates the inequality in women’s health provision.

It is important to see a doctor if you think you are experiencing the symptoms of endometriosis. It’s helpful to keep a diary of your symptoms and learn as much as you can about the condition so you can guide the conversation with your GP and ask for the support you need.

There are many reasons why endometriosis can take time to be diagnosed. This can include the misconception that it is “normal” for women to have pain. Endometriosis is difficult to distinguish from other chronic pain conditions. There is not a reliable non-invasive biomarker. The key point is that endometriosis presents with cyclical pain. So having an open discussion with your GP is really important to explore this possible diagnosis.

Living With Endometriosis

There is currently no cure available for endometriosis but there are treatments available that can help women cope with the symptoms, such as:

• painkillers such as paracetamol and ibuprofen
• hormone medicines and contraceptives
• surgery