What is Endometriosis?

Endometriosis is a condition when endometrial tissues (inner lining of the womb) are
found outside the womb. These endometrial tissues can be located in the pelvis,
ovaries, fallopian tube, bladder, bowel, vagina and other areas of the body. It is a
common disease that affects 1 in 10 women during their reproductive years. 

Cause of endometriosis
The exact cause of endometriosis is unknown, but it is likely to have a genetic
component activated by hormonal factors and the immune system. The disease is
rare in African-Caribbean but more common in Asian women which suggest a
genetic involvement.

Symptoms of endometriosis 
During the menstrual cycle, the inner lining of the womb thickens to receive a
fertilised egg. If the egg is not fertilised, pregnancy does not happen and the inner
lining of the womb breaks down as a period (menstrual blood). The endometrial-like
tissue located outside the womb also responds to the hormonal changes during the
menstrual cycle and thickens. The blood from the thickened tissue, however, cannot
leave the body as a period because it is trapped outside the womb.
Endometriosis may not cause any symptoms in some women while other women
can be severely affected. The symptoms will be related to the area in the body the
endometriosis is located. They are usually associated with pain due to
the inflammation and scarring caused by the process. The most common symptoms

  • Painful or heavy periods
  • Pain in the lower back and pelvis (usually associated with menstrual
  • cycles)
  • Pain during sexual intercourse
  • Bleeding between periods
  • Fertility problems (damage ovaries or fallopian tubes)

Diagnosis of endometriosis

Endometriosis can be difficult to diagnosis. This is because the symptoms vary from
women to women and they can be similar to other common conditions such as pelvic

inflammatory disease. In addition, a definitive diagnosis can only be given by
laparoscopy which is an invasive procedure with a small risk of major complications.
During laparoscopy, a thin camera is inserted into the tummy to allow the direct
visualisation of the uterus, fallopian tubes, ovaries, and other pelvic organs.

A pelvic ultrasound scan may be used to check the womb, fallopian tubes, the
ovaries and to detect cysts associated with endometriosis. A normal scan, however,
does not exclude the diagnosis, especially when the endometriosis is located
superficially in the pelvis.

Delays of 4 to 10 years can occur between first reporting symptoms and confirming
the diagnosis.

Treatment of endometriosis 
At the moment, there is no cure for endometriosis. The treatments available aim to
relief the symptoms, increase the chances of becoming pregnant and improve the
quality of life for women living with the condition. The options include:

  • Pain control – pain can be controlled with anti-inflammatory medications

like ibuprofen. They work more effectively if taken the day before the expected
period giving sometime to decrease the inflammation caused by the
endometriosis. In more severe situations, stronger pain killers can be given
and a referral to a specialist pain team can be done if pain is not well

  • Hormonal treatment – hormone may be given to reduce or stop ovulation.

This will decrease oestrogen production and shrink the endometriosis. The
choice of hormonal treatment depends on whether the patient wishes to
become pregnant or not, as some of them are contraceptive while other are
not contraceptive. There are four types of hormonal treatments which include:
the contraceptive pill, progestogens, antiprogestogens and Gonadotrophin
Releasing Hormone.

  • Surgical treatment – surgery can remove areas of endometriosis to

improve pain and fertility. The procedure is usually done during the
laparoscopy diagnosis. In severe cases, however, the surgeons will discuss
the laparoscopy findings with patient before offering a surgical treatment.
Although surgery improves pain and fertility of women, the endometriosis can
sometimes reoccur.                                                                 


Endometriosis is a common condition that affects women during their reproductive
years. The treatment should be personalised accordingly with the severity of the
symptoms and the importance of future fertility. Endometriosis is a complex and
variable disease that still challenges modern science. The growing recognition that
and early diagnosis can slow down the disease and limit long term consequences offers current support to women. Hopefully, more specific treatment will be developed in the future.

N.B. The article contains views based on latest guidance. It should not be used as
individual advice which should be obtained from your doctor.