Endometriosis - Signs, Symptoms, Picture and Treatment using Laproscopy of Endometriosis

Some women are unaware that they have endometriosis, while in others it causes pelvic or abdominal pain that can be severe. One woman in three with endometriosis has fertility problems caused by patches on her ovaries and/or fallopian tubes and up to one in three women with fertility problems also has endometriosis.

About three in five women with endometriosis develop patches on their ovaries that turn into cysts. These look like blood blisters because they fill with blood during each period, Often they break and release their contents into the pelvic cavity, causing pain and inflammation, These cysts can enlarge and, if a large cyst ruptures, it can cause pain so severe that the woman goes into shock and needs emergency surgery, If cysts go on growing, pain is more likely, blood accumulates and older blood darkens, making cysts look dark brown ('chocolate cysts'), Despite all this, the cysts usually subside without treatment.

The cause of endometriosis is an enigma, although there are many suggestions, which is why it's sometimes called 'the disease of theories':

. It can run in families

. It's more common if you have your first baby over 30

.One study found that women who'd ever taken the Pill had double the risk

. It could be due to autoimmune damage (damage by the body's own, normally protective, antibodies), Women with chronic fatigue syndrome, fibromyalgia, an underactive thyroid or allergies are more likely to have endometriosis.

. 'Retrograde menstruation', in which some of the menstrual flow (which contains womb-lining cells) enters the abdominal cavity via the fallopian tubes, could be a cause. However, this is common in all women and normally the stray cells disappear, so something would have to happen to allow the cells to 'take root' and cause endometriosis. (Also, the retrograde menstruation theory wouldn't account for endometriosis in the nose and lungs.)

Trouble is more likely for women who have an oestrogen-dominant hormone imbalance, especially one with a low progesterone level in the second half of their menstrual cycle, meaning oestrogen is 'unopposed'. Endometriosis is also more common in women who have used tampons for more than 14 years.

Medical treatment for Endometriosis

Mild pain may improve with non-steroidal anti-inflammatory painkillers, such as naproxen, that inhibit the production of inflammatory prostaglandins. Hormones help to control pain in up to four in five women by reducing or preventing bleeding; they do this by counteracting oestrogen or in other ways. However, they don't treat the cause, often have side effects and are not suitable if you're trying to get pregnant. Also, the pain returns in one in two women within five years of stopping. The options are equally effective, and the choice is usually based on side effects and costs. They include:

. The low-dose combined Pill- which has relatively rare and, nearly always, only minor side effects. 'Tricycling' is often recommended - taking the Pill continuously for nine weeks, then waiting a week - when you'll have a 'period.

. A progestogen-releasing intrauterine system; in one survey this greatly helped seven in 10 severely affected women.

. Progestogens - taken continuously and often prescribed initially for ninen months. This is more likely than the progestogen-releasing intrauterine system to trigger side effects.

GnRH (gonadotropin-releasing hormone, or gonadorelin) analogues, such as

buserelin and goserelin - continued use helps by lowering the oestrogen level but the side effects may be unacceptable.

. Danazol and gestrinone - continued use helps by lowering the oestrogen level but the side effects may be unacceptable (although this is less likely than with gonadorelin).

One unofficial survey of the members of an endometriosis self-help group found drugs relieved symptoms in only 10-15 per cent, though this figure may be skewed since many of the women in such a group would have joined because they hadn't found relief from other treatments.

Tests and investigations

The only way of confirming endometriosis is for a gynaecologist to do a laparoscopy and see the patches somewhere in the abdomen or pelvic cavity.

Need to see a doctor

Your doctor can help to ascertain whether you have endometriosis. If your doctor suspects endometriosis, and your symptoms are troublesome, it's wise to see a gynaecologist. Many women and their doctors don't recognize what's wrong for years, leading to unnecessary delay in getting specialist help.