March 1st marks the start of Endometriosis Awareness Month, shining a light on a condition that, according to the Endometriosis Association of Ireland, is estimated to affect approximately 10% (190 million) of all girls, women, and individuals assigned female at birth worldwide.
Cork-based GP, Dr. Doireann O’Leary, MB BCh BAO MICGP, has offered valuable insights into the most frequently asked questions regarding this condition, including what endometriosis is, its symptoms, and the testing and diagnosis process. Graduating with an honours degree in Medicine from University College Cork in 2011, Dr. Doireann is a passionate advocate and educator of women’s health. She serves as a LARC (long-acting reversible contraception) provider and registered cervical smear taker, alongside her role as a lecturer at the University College Cork School of Medicine.
What is endometriosis?
The inner lining of the womb is called the endometrium. The endometrium is sensitive to hormonal changes during the menstrual cycle. In response to hormonal changes, the endometrium sheds every month; this is our period.
In endometriosis, cells that are similar to the inner lining of our womb grow outside of womb. Endometrium-like cells can be found on the ovaries for example, which can result in cysts forming on the ovaries. They are often very dark in colour due to monthly bleeding and are sometimes referred to as “chocolate cysts”.
Parts of the body with endometrium like cells in the “wrong” place respond in the same way to our monthly hormonal changes, the cells break down/shed in the same way as in the womb. This causes cause inflammation and pain.
The exact cause for this happening isn’t well understood. More research is desperately needed on the disease.
Endometriosis occurs most commonly in the pelvis but can occur almost anywhere in the body.
What are the symptoms of endometriosis?
Symptoms of endometriosis vary in from person to person. Some women with endometriosis have no symptoms and only discover it when trying to get pregnant, as endometriosis can often result in poorer fertility.
For women who are symptomatic, most report lower abdominal or pelvic pain. Pain can be severe. Some women will have irregular and unpredictable periods.
Periods can be quite painful too; some women will get pain before their period. Pain during intercourse (dyspareunia) may also occur. Symptoms involving the bowel (gut) or bladder may also be bothersome; this means pain when passing urine or having a bowel motion.
Is there a test to check if I have endometriosis?
There are some tests. The first thing to do is sit with your doctor and discuss the timing, severity, and duration of your symptoms. Your doctor will explore more likely causes and rule those out by doing an abdominal examination, and maybe an internal examination. Blood tests, a urine test, an STI screen and an ultrasound of the abdomen and pelvis may also be done; these tests don’t diagnose endometriosis, they rule out other causes of abdominal pain.
If all of the above tests are negative, your GP may seem it appropriate to refer you to a gynaecologist. Sometimes a “working diagnosis” of endometriosis can be made before tests are done, if the symptoms are very suggestive of endometriosis. Depending on the assessment of the GP or gynaecologists an ultrasound scan or MRI of pelvis may be done; the gynaecologist may need to do an operation to look in to the pelvis. Sometimes endometriosis can be seen by the naked eye during surgery, and oftentimes it can be treated there and then if it’s seen.
How is endometriosis treated?
Endometriosis can be treated in different ways, including medicines and or surgery. The right treatment for you will depend on your symptoms and treatment preferences.
How does it impact the menopause?
Symptoms of endometriosis settle after menopause. It’s important to remember, though, that some women with endometriosis may undergo hysterectomy. Most women who’ve had a hysterectomy take Oestrogen only HRT during peri and post menopause. However, women with endometriosis who’ve undergone hysterectomy are advised to take Oestrogen and Progesterone HRT, in order to protect the endometrial-like cells outside of the uterus from potential growth or activation, which could lead to continued symptoms or complications.
Dr. Doireann previously hosted Dr. Hugh O’Connor, Consultant Obstetrician and Gynaecologist at The Coombe Hospital in Dublin and the leading expert on endometriosis in Ireland, on her eponymous podcast. Together, they explored symptoms, diagnosis, treatment, and management strategies for endometriosis, while also discussing its implications on fertility, quality of life, and pregnancy. Tune in to their insightful conversation by listening here: http://tinyurl.com/DrDoireannPodcast
