Endometriosis: The Enigma

March is endometriosis awareness month.

Endometriosis is a complex gynaecological condition characterised by the abnormal growth of endometrial tissue outside the uterus.

The uterus opens into the abdomen through tiny tubes known as fallopian tubes. During menstruation, menstrual blood containing the endometrium layer may travel into the abdomen through the fallopian tubes.

How endometriosis develops continues to evade medical knowledge as only some women develop the disease. It is believed that once the endometrium is in the abdomen, it has the potential to grow outside the uterus. Once implanted, the endometrial tissue outside of the uterus responds to the woman’s hormones, causing menstruation pain every month.

Endometriosis causes internal organs such as the intestines and uterus to be attached to each other.

The uterus is a female reproductive organ with the main function of carrying a baby during pregnancy. The uterus is made up of two layers: the non-regenerating muscular layer and a regenerating inner layer, the endometrium, which is shed as menstruation
blood monthly in non-pregnant women.

According to World Health Organisation data, there are approximately 10% of reproductive-aged women (190 million) globally diagnosed with this condition. The peak age of patients is between 25 and 45.

Endometriosis has a variable range of manifestations – from accidentally found asymptomatic lesions to a severe condition, which does not depend on the size of the lesion. The main symptoms caused by endometriosis are chronic lower abdominal pain, severely painful menstrual periods, painful sexual intercourse, pain during urination and/or painful defecation, abdominal bloating and constipation.

The other manifestation of endometriosis is infertility without any other symptoms: 40-50% of infertile women are diagnosed with endometriosis. Endometriosis has a significant negative impact on quality of life and social well-being of patients – due to
pain and other symptoms, e.g., fatigue, severe bleeding or mood swings, women have to skip their studies or work and might tend to avoid sex. It may also increase the risk of mental health issues, such as anxiety and depression.

While there is no cure for endometriosis, the disease can be controlled using birth control, typically the pill, a patch or a vaginal ring, but sometimes a hormonal intrauterine device (IUD).

The only way to effectively diagnose endometriosis is through laparoscopy, a surgery that involves a small incision in the abdomen. During the procedure, doctors may also remove or cauterise endometrial implants.

Emerging research is investigating what causes endometriosis and why some people may be more susceptible than others.

One of the significant challenges faced by people with endometriosis is receiving a diagnosis. It is estimated that patients experience an average delay of five years from the onset of symptoms to diagnosis, therefore, women who suspect they may have endometriosis must seek an assessment by a gynaecologist.

Dr David N Emvula is a specialist obstetrician and gynaecologist at Ob-Gyn Practice.