Endometriosis Awareness Month: Gynaecologist answers all questions about the disease that affects one in ten women

Heavy monthly bleeding, excruciating cramps, abdominal pain even when you’re not menstruating – the symptoms can vary in intensity and frequency, but the cause stays the same. It is endometriosis, a condition that affects one in ten women.

Endometriosis can bring a lot of pain and even more questions, yet there are so few answers. This Endometriosis Awareness Month, Dr Shree Datta, gynaecologist for INTIMINA, a brand dedicated to women’s intimate well-being and breaking taboos, sheds light on the disease.

What is Endometriosis?

Endometriosis is a state in which the endometrial tissue (tissue that normally lines the uterus) can be found outside the uterus (in the abdomen, ovaries, etc.). There are several theories about why this happens, but none can explain why the cells plant themselves outside the uterus. The most accepted explanation is Sampson’s theory, or the retrograde menstruation theory, which suggests that some of the cells go the opposite way during menstruation – they don’t go out through your vagina, but instead go towards your abdomen where they plant themselves. What is known is that endometriosis occurs most frequently in the pelvic organs and peritoneum, and some studies suggest that 1 in 10 women suffer from it.*

How to recognise the symptoms?

Living with endometriosis can be very difficult. You could be one of the lucky ones that have asymptomatic endometriosis, so you wander around the world, not even knowing what’s going on inside you because there are no symptoms. But you could also experience painful menstruations, bloating, pain during sex (dyspareunia), pelvic pain, etc. You may be thinking that these symptoms are pretty typical and that every woman feels at least one of them at some point in life. That is what makes the diagnosis tricky. Endometriosis symptoms are everything but specific, so there are many undiagnosed cases, and many women are suffering in silence. Some women experience mild symptoms, but in severe endometriosis, women may also experience pain in between periods and in a minority, it can affect fertility. Bear in mind that the severity of your pain may not reflect the severity of your endometriosis.

What causes endometriosis?

The cause of endometriosis is still not known, and diagnosing it can be challenging because it shares symptoms with many other conditions. Sometimes doctors don’t even think about endometriosis as a possible explanation of symptoms like abdominal pain and cramps.

What is the diagnosis process?

As you can imagine, endometriosis symptoms can have a huge impact on your life so it’s not unusual to feel down. You will be referred to a Gynaecologist who will find out your medical background and examine you. You may be asked to keep a diary of your symptoms because it can be difficult to distinguish endometriosis from other medical conditions. We’ll also send you for an ultrasound. Once we have this information, we will consider whether medication will help or we may suggest a laparoscopy – which is key-hole surgery under an anaesthetic – to investigate things further or to treat the endometriosis. In women with severe endometriosis, we may recommend an MRI before considering surgery.

Is there any treatment?

Possible treatments include medications such as the contraceptive pills, Mirena coil and surgery. In part, it depends on the type and location of your endometriosis and how severe it is. For some women, simple painkillers such as Ibuprofen can be helpful.

The contraceptive pill or Mirena coil can also manage symptoms but for others, surgery is helpful. If we consider the combined contraceptive pill, we may suggest that you “tri-cycle” it (take three packs without a break), so that it’s 3 months before you have a period. This can help heal the endometriosis over time.

If we consider surgery, we will try to remove and treat all areas of endometriosis. This may be a day case procedure or in more complex cases, require a laparotomy – a cut in your bikini line and a short stay in hospital. We will discuss which option is better for you depending on your symptoms and ultrasound findings; in some cases, you may need a mixture of different treatments. Remember it also depends on other factors – for example, if you are trying to conceive, we would not prescribe the contraceptive pill or the Mirena coil.

As well as considering medical treatment, we will also take a look at your diet because endometriosis is stimulated by estrogen, so liver and digestive care through nutrition is important – for example, eating lots of green vegetables and anti-inflammatory foods. Reducing the amount of caffeine and alcohol in your diet as well as exercising regularly may also be helpful.

Dr Shree Datta comments: “We don’t know the exact cause of endometriosis but it can be incredibly difficult to live with – both physically and emotionally. It’s a long term condition but fortunately, there are treatments for it – so make sure you speak to your Gynaecologist early. Many women are able to manage their symptoms and lead a normal life once they have received the treatment needed, so don’t be embarrassed to seek advice and get help. There are also lots of support groups, charities and online forums who are there to help – endometriosis is common so don’t feel like you have to suffer alone”.

Marcella Zanchi, spokesperson for INTIMINA UK adds: “Many women live with pain, not knowing the cause and keeping it a secret, thus making conditions like endometriosis a taboo. Endometriosis should be talked about, so women could know there is a name for their disease and do something to make it easier. It is essential to develop a good relationship with your doctor to communicate your symptoms and feelings freely and clearly.”