Continuing our hugely popular column Medical Matters, Dr Ciaran Roarty of Scally/McDaid Medical Practice addresses the issue of Endometriosis.
Endometriosis is a condition where endometrial tissue (the tissue that normally lines the inside of the womb or uterus) is found outside the uterus, usually within the pelvic and lower tummy area. Whenever something in the body is not where it should be then this can cause problems.
In endometriosis women experience painful periods from a few days beforehand until the period finishes. The pain is usually more severe and longer lasting than normal period pain. Sometimes the pain is constant but may be worse on the days leading up to and during a woman’s period. In some women it may cause pain deep inside during intercourse.
Other menstrual problems may occur such as bleeding in between periods or difficulty becoming pregnant. Some women with endometriosis experience pain when opening their bowels or lower abdominal pain when passing urine.
Is it common?
As many women have only mild or very little symptoms it often goes undiagnosed and so we don’t know exactly how many women it affects. It is estimated to affect anywhere from 1 in 10 women to 1 in 2 women. Symptoms usually start in a woman’s late twenties or early thirties. Sometimes it seems to run in families.
How is it diagnosed?
Your doctor may suspect Endometriosis, especially if your symptoms follow the same cyclical pattern as your periods. To confirm the diagnosis a procedure called a laparoscopy is performed. A tiny camera is inserted into your abdomen under anaesthetic and the gynaecologist can visualise the endometrial tissue where it is not supposed to be.
Will it get worse?
If left untreated about 4 in every 10 cases will become worse, 3 will get better without treatment and 3 will stay the same. Complications such as adhesions ( where internal organs can get stuck together) or obstructions of the bowel or ureter can occur. Treatments aim to improve pain and heavy periods as well as improve fertility if this is affected.
Types of treatment.
Which treatment is chosen will be determined by patient preference and the severity of the symptoms. Options include:
- No treatment. This may be an option if symptoms are very mild and fertility is not an issue. In just under a third of cases, it may settle by itself.
- Pain relief. Paracetamol, ibuprofen and diclofenac have been used as well as combinations of paracetamol and codeine. They should be taken at the correct dose throughout your period.
- Hormone treatments. Your doctor may prescribe hormonal medicines to reduce the amount of oestrogen that is made in your body or block its action and this will help reduce symptoms. If your doctor has a high degree of suspicion for endometriosis he/she may opt to go ahead and treat, while waiting for laparoscopy to confirm the diagnosis. It can take some time for hormonal treatments to “kick in”.
- Surgery. This may be advised if there are large patches of endometrial tissue located outside the womb and is often done by keyhole methods. This results in a much smaller scar and a quicker return to day to day activity than full open surgery. If your surgeon suspects endometriosis but has not confirmed it yet, they may seek your permission to perform a laparoscopy to confirm the diagnosis but also to treat it “while they are there” saving you having two surgeries.
Symptoms may improve during pregnancy but the longer you have endometriosis the more likely it is to interfere with fertility. If your endometriosis settles with treatment, unfortunately, it can recur in the future and may require repeat treatment.
The above information is intended as advice only and should you have any concerns contact your own Doctor.
Dr Ciarán Roarty MB, BCh BAO MICGP DRCOG Grad. Cert. Obst. Ultrasound is a full-time GP at Scally McDaid Medical Practice , Scally Place, Letterkenny, Tel 0749164111