Endometriosis

Endometriosis is a condition in which tissue similar to the lining of the uterus grows outside the uterus, most often on the ovaries, fallopian tubes, or pelvic lining. This tissue responds to the menstrual cycle, causing inflammation, pain, and sometimes fertility problems.

• Pelvic pain, often worsening around or during menstrual periods
• Pain during or after sexual intercourse
• Heavy menstrual bleeding or bleeding between periods
• Pain with bowel movements or urination, particularly during periods
• Difficulty conceiving in some women
• Fatigue, particularly around the time of menstruation

• The exact cause is not fully understood; leading theories include retrograde menstrual flow (menstrual blood flowing backward into the pelvis), immune system factors, and possible genetic predisposition.
• Family history of endometriosis increases risk.
• It typically affects women during their reproductive years and is influenced by hormonal changes across the menstrual cycle.

• Often suspected based on a history of pelvic pain closely linked to the menstrual cycle, together with a pelvic examination.
• Pelvic ultrasound, where available, can sometimes identify endometriosis-related cysts, though it cannot always detect smaller areas of disease.
• Laparoscopy (a minimally invasive surgical procedure) remains the definitive way to confirm the diagnosis and assess the extent of disease, and is generally reserved for cases needing confirmation or surgical treatment.

Pain relief with an NSAID is used for symptom control, particularly around the time of menstruation.

Hormonal treatment — such as a combined oral contraceptive pill or another hormonal method — is commonly used to suppress the menstrual cycle and reduce the growth and activity of endometriosis tissue, easing pain over time.

For persistent symptoms not controlled with medicine, or when fertility is affected, surgical removal of endometriosis tissue may be considered by a specialist, sometimes performed at the same time as a diagnostic laparoscopy.

Management is individualised based on symptom severity, whether pregnancy is currently desired, and response to initial treatment, often requiring an ongoing, adaptable long-term plan.

• Seek assessment for pelvic pain that is severe, worsening, or significantly affects daily life or menstrual periods rather than assuming it is normal period pain.
• Keep a symptom diary noting pain patterns in relation to the menstrual cycle, which can help guide diagnosis and treatment.
• Discuss fertility plans with a health worker if trying to conceive, since endometriosis can affect fertility and management may need to be adjusted accordingly.
• Attend regular follow-up, as endometriosis is a chronic condition that may need long-term management adjustments.