Dr Tariq Jagnarine
Family Medicine, Endocrinology & Diabetes

Endometriosis is a common health problem in women. It gets its name from the word endometrium, the tissue that normally lines the uterus or womb. Endometriosis happens when tissue similar to the lining of the uterus grows outside of the uterus and on other areas in the body where it does not belong.
It may affect more than 11% women between 15 and 44. It is especially common among women in their 30s and 40s and may make it harder to get pregnant; it can begin as early as 8 years old. It chiefly affects adults from pre-menarche (before starting menstrual cycle) to post menopause, regardless of race or ethnicity or whether or not they have had children. It is primarily a disease of the reproductive years. The rate of recurrence of endometriosis is estimated to be 40-50% for adults over a 5-year period
Most often, endometriosis is found on the:
• Ovaries
• Fallopian tubes
• Tissues that hold the uterus in place
• Outer surface of the uterus
Other sites for growths can include the vagina, cervix, vulva, bowel, bladder, or rectum. Rarely, endometriosis appears in other parts of the body, such as the lungs, brain, and skin.

• Never having children
• Menstrual periods that last more than seven days
• Short menstrual cycles (27 days or fewer)
• A family member (mother, aunt, sister) with endometriosis
• A health problem that blocks the normal flow of menstrual blood from the body during periods

The cause of endometriosis is unknown; however, Researchers are studying possible causes such as:
• Problems with menstrual period flow. Retrograde menstrual flow is the most likely cause of endometriosis. Some of the tissue shed during the period flows through the fallopian tube into other areas of the body, such as the pelvis.
• Genetic factors. Because endometriosis runs in families, it may be inherited in the genes.
• Immune system problems. A faulty immune system may fail to find and destroy endometrial tissue growing outside of the uterus. Immune system disorders and certain cancers are more common in women with endometriosis.
• Hormones. The hormone oestrogen appears to promote endometriosis. Research is looking at whether endometriosis is a problem with the body’s hormone system.
• Surgery. During a surgery to the abdominal area, such as a Caesarean (C-section) or hysterectomy, endometrial tissue could be picked up and moved by mistake.

Symptoms of endometriosis can include:
• Pain. This is the most common symptom. Women with endometriosis may have many different kinds of pain including:
o Very painful menstrual cramps that may get worse over time.
o Chronic (long-term) pain in the lower back and pelvis
o Pain during or after sex. This is usually described as a “deep” pain and is different from pain felt at the entrance to the vagina when penetration begins.
o Intestinal pain.
o Painful bowel movements or pain when urinating during menstrual periods. In rare cases, they may also find blood in the stool or urine.
• Bleeding or spotting between menstrual periods. This can be caused by something other than endometriosis. If it happens often, you should see your doctor.
• Infertility.
• Stomach (digestive) problems: including diarrhoea, constipation, bloating, or nausea, especially during menstrual periods.
Endometriosis growths are benign (not cancerous). Nevertheless, they can still cause problems. Endometriosis growths may swell and bleed in the same way the lining inside of the uterus does every month — during a menstrual period. This can cause swelling and pain because the tissue grows and bleeds in an area where it cannot easily get out of the body.
The growths may also continue to expand and cause problems, such as:
• Blocking the fallopian tubes with growths cover or grow into the ovaries. Trapped blood in the ovaries can form cysts.
• Inflammation (swelling)
• Forming scar tissue and adhesions (type of tissue that can bind organs together). This scar tissue may cause pelvic pain and make it hard for women to get pregnant.
• Problems in intestines and bladder

This illness is diagnosed through a thorough clinical review, physical examination and laboratory investigations including:
• Pelvic exam. During a pelvic exam, doctors will feel for large cysts or scars behind the uterus. Smaller areas of endometriosis are harder to feel.
• Imaging test. An ultrasound to check for ovarian cysts from endometriosis can be ordered.
• Magnetic resonance imaging (MRI) is another common imaging test that can be use especially when the cause is suspected to be not related to the reproductive organs.

There is no cure for endometriosis, but treatments are available for the symptoms and problems it causes.
• Medicine
Hormonal birth control is generally the first step in treatment. This may include:
• Extended-cycle (having only a few periods a year) or continuous cycle -have no periods birth control. These types of hormonal birth control are available in the pill or the shot and help stop bleeding and reduce or eliminate pain.
• Intrauterine device (IUD) to help reduce pain and bleeding. The hormonal IUD protects against pregnancy for up to 10-12 years. However, the hormonal IUD may not help the pain and bleeding due to endometriosis for that long.
Hormonal treatment works only as long as it is taken and is best for women who do not have severe pain or symptoms.
• In the case of infertility, doctor may prescribe a gonadotropin-releasing hormone (GnRH) agonist. This medicine stops the body from making the hormones responsible for ovulation, the menstrual cycle, and the growth of endometriosis. This treatment causes a temporary menopause, but it also helps control the growth of endometriosis. Once the medicine is stopped, the menstrual cycle returns resulting in a better chance of getting pregnant.
• Surgery: Surgery is usually chosen for severe symptoms, when hormones are not providing relief or if there is a fertility problem. During the operation, the surgeon can locate any areas of endometriosis and may remove the endometriosis patches. After surgery, hormone treatment is often restarted unless someone is trying to get pregnant.
Other treatments includes:
• Pain medicine. For mild symptoms, g over-the-counter medicines for pain can be used. These include ibuprofen (Advil and Motrin) or naproxen (Aleve).
• Complementary and alternative medicine (CAM) therapies. Some women report relief from pain with therapies such as acupuncture, chiropractic care, herbs like cinnamon twig or licorice root, or supplements, such as thiamine (vitamin B1), magnesium, or omega-3 fatty acids.

Endometriosis cannot be prevented; however, the chances of developing it can be reduce by lowering the levels of the hormone oestrogen in the body. Oestrogen helps to thicken the lining of the uterus during a menstrual cycle.
Oestrogen levels can be lowered by:
• Hormonal birth control, such as pills, patches or rings with lower doses of oestrogen.
• Exercise regularly (more than 4 hours a week). This will also help to keep a low percentage of body fat. Regular exercise and a lower amount of body fat help decrease the amount of oestrogen circulating through the body.
• Avoid large amounts of alcohol. Alcohol raises oestrogen levels. No more than one drink per day is recommended for women who choose to drink alcohol.
• Avoid large amount of drinks with caffeine. Studies show that drinking more than one caffeinated drink a day, especially sodas and green tea, can raise oestrogen levels.
For some women, the painful symptoms of endometriosis improve after menopause. As the body stops making the hormone oestrogen, the growths shrink slowly. However, some women who take menopausal hormone therapy may still have symptoms of endometriosis.