Living with Endometriosis – Causes, Challenges and Treatment Options

You've probably heard of it, but the sheer volume of information – or rather the lack of it – can be a real challenge. What happens inside a woman's body with endometriosis? Where does the condition come from and how can it be treated? These are just some of the questions we hope to answer in this article.

What is endometriosis?

Endometriosis mainly affects women aged between 25 and 35 and is the most common cause of chronic pelvic pain. Although it doesn't necessarily lead to infertility, endometriosis does affect fertility – that doesn't mean you can't get pregnant, but it will be harder. Recent research shows that around half of women struggling to conceive also have endometriosis. But what exactly is this condition?

Endometriosis is a chronic condition in which tissue similar to the lining of the womb (the endometrium), along with similar tissue components, is found outside the uterus. 

These patches of tissue are also known as 'endometriotic lesions' and vary in size; they are found within the abdominal cavity and can spread over the course of a menstrual cycle.

How endometriosis develops

Exactly how endometriosis develops is still not fully understood. There are several theories about how endometriotic lesions form, but the evidence base remains limited. The good news is that scientific research is progressing at pace.

What we know so far: 

• The lesions may be linked to menstrual blood flowing back through the fallopian tubes
• Endometriosis can also occur in women without a uterus, in adolescents and, in rare cases, in men
• There are several mechanisms behind the development of endometriotic lesions that have yet to be unravelled.

Types of endometriosis

Although there's no link between the intensity of the pain and the type of endometriosis, doctors distinguish four forms of the condition:

• Superficial (or peritoneal) endometriosis
• Ovarian endometriosis
• Deep infiltrating endometriosis
• Abdominal endometriosis

Symptoms of endometriosis

"Every month, 1.5 million British women are affected by endometriosis, yet sadly many of them simply put their symptoms down to painful periods." (Source)

The most common symptom of endometriosis is pelvic pain during menstruation. Many women experience period pain, but those with endometriosis describe the pain as far more severe than usual. The pain can also worsen over time and occur during sexual intercourse, making it painful. When we talk about more severe pain, we also mean being confined to bed and experiencing acute pain between periods. 

The symptoms therefore include:

• Dysmenorrhoea – that is, painful periods – where pain and cramps are accompanied by back and abdominal pain and can begin before the bleeding starts and continue after it ends.
• Pain during sexual intercourse
• Abdominal pain when passing urine and/or opening your bowels
• Heavy bleeding as well as bleeding between periods
• Infertility
• Fatigue, diarrhoea, nausea and other symptoms 

Important to know: the degree of pain tells you nothing about the type of endometriosis or how far the condition has spread – you could, for example, have superficial endometriosis with severe pain.

Causes of endometriosis

Unfortunately, the exact causes of endometriosis aren't known, but there are risk factors and several explanations that doctors can offer. 

First, retrograde menstruation. What does that mean? Retrograde menstruation occurs when menstrual blood flows back into the fallopian tubes instead of leaving the body – the cells then attach to the walls of the pelvic cavity and continue to grow there.

Then there's the 'induction theory', according to which hormones encourage peritoneal cells to transform into endometrial cells. Likewise, embryonic cells can turn into endometrial cells during puberty. 

Another cause would be surgical transplantation – after a procedure (hysterectomy or caesarean section), cells can attach to the scar.

Blood vessels can carry endometrial cells to other parts of the body. 

Immune system disorders can mean the body fails to recognise endometrial tissue growing outside the uterus.

How can endometriosis be prevented?

Precisely because the causes of endometriosis aren't fully known or understood, the options for prevention have been little researched. However, an annual check-up is advisable from the moment symptoms first appear. An early diagnosis can help you reduce pain, discomfort and the risk of infertility. 

Risk factors for endometriosis

As with many conditions, there are various risk factors that can influence whether the disease develops. If: 

• you have hormonal imbalances, particularly raised oestrogen levels
• you've never given birth
• there are cases of endometriosis in your family
• you have short menstrual cycles (fewer than 27 days)
• your periods are heavy and last longer than 7 days
• the menopause occurred at a later age
• you have a low body mass index (BMI)
• there are abnormalities of the reproductive system

These factors aren't direct causes of endometriosis, but they do increase the risk. Generally, the condition can develop a few years after your first period. Over time, symptoms may improve – particularly during pregnancy – and disappear altogether with the menopause. 

How endometriosis progresses 

It's important to know that endometriosis is progressive, has several stages, and that treatments to ease the symptoms can vary. In the first phase, small lesions form within the affected organs. The endometriotic lesions then multiply. The condition can progress to deep infiltrating lesions or ovarian cysts, and in the final stage there are numerous lesions, several large cysts and adhesions between the pelvic organs.

Complications of endometriosis

As the condition progresses, the risk of health complications rises, particularly difficulty conceiving, as well as involvement of other organs such as the bladder or bowel. 

The most significant complication, however, is 'impaired fertility' – that is, markedly reduced fertility. Recent studies show that more than a third of women with endometriosis are affected, and endometriosis remains one of the leading causes of infertility.

Endometrial cancer

As we mentioned at the start of this article, endometriosis occurs when the tissue lining the uterus – the endometrium – starts growing elsewhere. You might be wondering: is there a link between endometriosis and cancer of the womb lining?

Well, the two conditions do have some things in common (cell growth where it shouldn't be, pelvic pain), and there is indeed evidence that endometriosis may slightly increase cancer risk. But there are also significant differences.

Endometrial cancer develops when the cells of the womb lining take on an abnormal appearance, grow uncontrollably and form a tumour. These cells can then spread to other parts of the body and form tumours there.

But there's one thing you need to know: endometriosis is not cancer. 

Although endometrial cancer is more common after the menopause, it can also affect young women; over 95% of cases occur in women aged over 40. Cancer of the womb lining grows slowly and, if left undetected and untreated, can spread to other pelvic organs. The good news is that if it's caught at an early stage, it's completely curable.

Worldwide, endometrial cancer is the sixth most common cancer and the most common form of uterine cancer. Important to know: the first warning sign is usually unusual vaginal bleeding between periods or some years after the menopause. Speak to your gynaecologist if you notice this symptom!

Diagnosing endometriosis

Only a gynaecologist can reliably diagnose endometriosis. The condition can be diagnosed from puberty through to the menopause, and it's not unusual for it to be identified only 10 years after the first symptoms – many women have exactly this experience.

Diagnosis is usually easier in adolescents or young women, but the condition can also be discovered by chance, for instance during investigations or surgery carried out for other reasons. In recent years, an endometriosis test has also been developed: an innovative blood test that can detect up to 90% of endometriosis cases at the very first signs.

Treating endometriosis

As it's a chronic condition, endometriosis can't be cured outright, but the symptoms can be eased. The good news is that there are recommended treatment approaches – medical, surgical or complementary – all aimed at relieving endometriosis pain and improving quality of life.

Treatment depends on various factors, however, such as your specific symptoms, the severity of the condition and whether you want to become pregnant. All procedures and treatment recommendations may be aimed at relieving pain and/or achieving a pregnancy.

Hormonal therapy

Recommended medical approaches include hormone therapy: the aim of hormonal treatment is to lower oestrogen production by administering hormones over a limited period and under close medical supervision. Other medicines that can help relieve pain are anti-inflammatories – for which you don't need a prescription (such as ibuprofen).

Treatment with contraceptives has also been used for endometriosis for many years. How does it work? The pill eases endometriosis pain by suppressing menstruation and inhibiting the growth of endometriotic lesions.

Surgical treatment | Endometriosis surgery

Sometimes hormone therapies and anti-inflammatories don't work. In this case, a laparoscopy may be recommended – a minimally invasive surgical procedure in which endometriotic cysts are removed and infertility is treated. Even after this treatment, though, the condition can return.

Natural treatment

Unfortunately, there's no treatment for endometriosis that results in a 100% cure, and very few of those affected can say 'I'm cured of endometriosis'. But treatments are evolving, and the natural approach has its benefits too. If you follow a natural treatment plan, you'll focus on diet, herbal remedies, supplements and relaxation techniques.
 

Diet

• It's important that it includes foods that reduce inflammation in the body as much as possible, and excludes pro-inflammatory foods such as red meat or carbohydrates.

Medicinal plants

• Phytotherapy is an initial treatment approach for endometriosis, as certain plants have a positive effect on hormone balance and relieve pain. Recommended plants include raspberry leaf, yarrow, lady's mantle, ginger, fennel, chamomile or artichoke – you can take them as a tea; they're recommended for endometriosis

Supplements

• Or adding superfoods to your diet to help prevent oxidative stress and supply your body with antioxidants, vitamins and minerals such as B vitamins, vitamin C, magnesium or green tea. 

Relaxation

• You can turn to yoga, breathing techniques and meditation – all of which will help you manage the symptoms better. If you need to, you could also try reflexology or acupuncture.

 Living with endometriosis

It's no surprise that chronic pain affects everyday life. Living with endometriosis means living with obstacles, as the condition can leave you feeling low and angry and can disrupt your sleep. 

That's why relaxation techniques help not only with managing the pain, but also with feeling better mentally. Many patients are also recommended antidepressants, psychotherapy and meditation.

Recommended diet for endometriosis

When it comes to diet, the key is to eat as balanced and healthy a diet as possible and to exercise regularly. Certain foods are – as mentioned above – recommended, while others should be avoided. Although there aren't yet enough studies on this, you can learn from the experiences of others with the condition and find recommendations.

For example, it's recommended to avoid trans fats, red meat and gluten-containing products – if you find that a gluten-free diet eases your pain. What is recommended, on the other hand, is omega-3 fatty acids, plenty of vegetables, leafy greens, fruit, seeds, protein and plant-based fats.

To close our article: if your period feels more like a curse than a blessing, don't hesitate to book an appointment for a specialist assessment! Our advice: an annual check-up from the moment your first symptoms appear!