Endometriosis and Pelvic Pain

Endometriosis is an often painful disorder in which tissue that normally lines the inside of your uterus — the endometrium — grows outside your uterus (endometrial implant). Endometriosis most commonly involves your ovaries, bowel or the tissue lining your pelvis. Rarely, endometrial tissue may spread beyond your pelvic region.endo1-1

In endometriosis, displaced endometrial tissue continues to act as it normally would — it thickens, breaks down and bleeds with each menstrual cycle. Because this displaced tissue has no way to exit your body, it becomes trapped. When endometriosis involves the ovaries, cysts called endometriomas may form. Surrounding tissue can become irritated, eventually developing scar tissue and adhesions — abnormal tissue that binds organs together.

Endometriosis can cause pain — sometimes severe — especially during your period. Fertility problems also may develop. Fortunately, effective treatments are available.

Common signs and symptoms of endometriosis may include:

  • Painful periods (dysmenorrhea). Pelvic pain and cramping may begin before and extend several days into your period and may include lower back and abdominal pain.
  • Pain with intercourse. Pain during or after sex is common with endometriosis.
  • Pain with bowel movements or urination. You’re most likely to experience these symptoms during your period.
  • Excessive bleeding. You may experience occasional heavy periods (menorrhagia) or bleeding between periods (menometrorrhagia).
  • Infertility. Endometriosis is first diagnosed in some women who are seeking treatment for infertility.
  • Other symptoms. You may also experience fatigue, diarrhea, constipation, bloating or nausea, especially during menstrual periods.

The severity of your pain isn’t necessarily a reliable indicator of the extent of the condition. Some women with mild endometriosis have extensive pain, while others with advanced endometriosis may have little pain or even no pain at all.

Endometriosis is sometimes mistaken for other conditions that can cause pelvic pain, such as pelvic inflammatory disease (PID) or ovarian cysts. It may be confused with irritable bowel syndrome (IBS), a condition that causes bouts of diarrhea, constipation and abdominal cramping. IBS can accompany endometriosis, which can complicate the diagnosis.

What investigations might be required?

Endometriosis may be suspected after a consultation; an internal examination can sometimes often detect signs of suggestive of endometriosis.

An ultrasound scan may be required to look for ovarian cysts related to endometriosis. An ultrasound however will not detect the typical spots of endometriosis that usually cause the pain.

At present, the only way to have endometriosis diagnosed is by having a minor surgical procedure called a laparoscopy. This is performed under general anaesthetic, and involves a laparoscope (telescope type instrument) being passed into the pelvic cavity, via the umbilicus.Endo Pic

In this way, the pelvis ~ including the uterus, fallopian tubes and ovaries ~ can be visualised. Endometriosis can be seen as red, blue, black, yellow or white areas on the surface of these organs, or sometimes as scar tissue, or ovarian “chocolate” cysts.

What treatments are available?

Treatment options include a spectrum of things from simple reassurance to surgery.

Simple treatments include pain relief and coping strategies surrounding the pain. Some women find treatments such as aromatherapy and acupuncture helpful.

Medical treatments all aim to suppress the natural menstrual cycle stopping ovulation (the release of eggs). These treatments are therefore useful for symptoms of pain but cannot be used if infertility is the main problem. The common medical treatments include the combined oral contraceptive pill (COCP), progestogens or Gonadotrophin-releasing hormone antagonists. There is a relatively high recurrence rate of symptoms after treatment is stopped.

Surgery is usually performed laparoscopically. The aim of treatment is to remove all spots of endometriosis. Surgical treatment doubles a woman’s fertility and removes pain in 75 – 80% of cases, although the disease can recur in 20% of women 5 years after the operation. In severe cases, a woman may need a hysterectomy or possibly bowel surgery.

Patients with severe endometriosis may require fertility treatments such as IVF to become pregnant.

 

Further information

You may find further helpful information at the following websites:

The endometriosis association of Ireland.

http://www.endo.ie/index.php

http://www.endo.ie/modules.php?name=FAQ&myfaq=yes&id_cat=1&categories=

Royal College of Obstetricians and Gynaecologists (RCOG) Information

http://www.rcog.org.uk/womens-health/clinical-guidance/endometriosis-what-you-need-know

http://www.rcog.org.uk/womens-health/clinical-guidance/investigation-and-management-endometriosis-green-top-24

 

Chronic Pelvic Pain is a common problem affecting women of any age. The pain can occur on a regular cycle or may only occur at certain times i.e. before and after eating, while urinating, during the menstrual period. Chronic pelvic pain can often disrupt a woman’s work, movements, sexual relationships, sleep and family duties and lead to long-term problems in a woman’s menstrual and clinical health. If pelvic pain lasts for more than 6 months then it is advisable that you consult your doctor to identify an underlying cause.

The causes of pelvic pain are varied. Chronic pelvic pain may be caused by conditions such as endometriosis or fibroids. It may also be secondary to bowel, urinary or musculo-skeletal problems. Because there are varied causes of pelvic pain the process of identifying the underlying problem may be complex and time consuming. Preliminary tests required would include an ultrasound scan and if underlying gynaecological problems were suspected a laparoscopy in order to view the pelvic organs and determine whether there is a gynaecological cause for the problem.

 

What treatments are available?

Treatment options vary depending on the cause. Pain relief and pain management strategies are the cornerstone of management. Support regarding alternative treatments will also be offered.

If a specific cause for the pain is found more directed treatment will then be available.

 

Further information

You may find further helpful information at the following website:

Royal College of Obstetricians and Gynaecologists (RCOG) Information

http://northwalesgynaecology.com/resources/PILongTermPelvicPain2005.pdf