The exact cause of endometriosis is still unknown. One theory is that during menstruation, fragments of the endometrium pass backwards through the fallopian tubes and into the pelvis where it attaches and grows.
About one in ten of those assigned female at birth have endometriosis. Endometriosis does seem to run in families, so you will be more likely to have it if your mother or sister has had it.
What are the symptoms?
Many women have endometriosis with no symptoms or problems but this is not always the case.
Symptoms of endometriosis include:
- period pain
- pain with sex
- pelvic pain at other times of the menstrual cycle
- back pain during period time
- pain when passing a bowel motion or passing urine during period time
- fatigue or low energy
- difficulty becoming pregnant
All of these symptoms have other possible causes, and sometimes more than one cause can be present. Adenomyosis, when endometrial tissue grows in the muscle of the uterus, is another reason for severe pain with periods. Sometimes period pain can occur without a visible cause (‘primary dysmennorrhoea’).
Other conditions that have overlapping symptoms include irritable bowel syndrome, chronic fatigue syndrome and tension of the pelvic floor muscles. These conditions are also more common in women with endometriosis.
How is endometriosis diagnosed?
A discussion about your symptoms and a physical examination should provide your doctor with enough information to determine if you might have endometriosis.
If your doctor thinks you may have endometriosis they will most likely recommend you have an ultrasound, which may be performed using a small ultrasound probe in the vagina. Ultrasound can usually diagnose moderate or severe cases of endometriosis by identifying endometriosis cysts on the ovaries (known as endometriomas). Experienced ultrasound scanners may also be able to see lumps (nodules) of endometriosis in the pelvis, including on the bowel, and sometimes scar tissue related to endometriosis. However, mild endometriosis is usually not able to be seen on ultrasound.
A conclusive diagnosis can only be made if you have a laparoscopy (keyhole surgery). Small incisions are made on your abdomen and a small telescope is used to examine the pelvic organs, including the uterus, fallopian tubes and ovaries. If endometriosis is seen or suspected, the abnormal tissue is removed and sent for examination under the microscope to confirm whether endometrial tissue is present. Depending on the location of the endometriosis lesions, they may be excised or ablated. Based on the severity of your symptoms, your doctor will plan the best treatment for you.
There are currently no non-invasive tests for endometriosis available.
Endometriosis and fertility
There are many reasons why a couple may be infertile. Endometriosis is sometimes found in women who are having trouble getting pregnant. In a minority of these women, scar tissue caused by the endometriosis will have caused a blockage of the fallopian tubes. The tubes may also become swollen and full of fluid (known as, ‘hydrosalpinx’).
However, in most women it is not clear why the endometriosis affects their fertility. Theories include that the endometriosis:
- results in eggs that are less likely to fertilise
- produces natural toxins to sperm
- reduces the frequency of sexual intercourse if sex pain is a symptom of the endometriosis
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