Is it endometriosis or something else?

Endometriosis, which is a painful gynaecological condition, affects around 10% of women in the UK and worldwide, yet the average time it takes to diagnose is over seven years. The symptoms of endometriosis can often overlap with other common gynaecological symptoms, so it can be difficult to know whether it’s endometriosis or something else.

If you’d like to know more about the symptoms of endometriosis, you’re in the right place. We spoke to Miss Zoe Woodward, a consultant gynaecologist who specialises in minimal access surgery for gynaecological concerns including endometriosis. Here she talks us through the signs and symptoms of endometriosis.

What is endometriosis?

Endometriosis is a common gynaecological disorder that affects around 10% of women during their reproductive years. It is the second most common gynaecological disorder in the UK, after uterine fibroids.

The condition occurs when tissue, also referred to as endometrial tissue, similar to that which is normally found in the lining of your womb grows elsewhere in your body. Tissue in your womb builds up and breaks down each month and is released through your period. The tissue that lives outside of your womb behaves in the same way but can’t leave your body through the same route.

Some people may have mild symptoms or be asymptomatic, while others may experience significant pain and other complications.

Endometrial tissue can grow on various pelvic organs and tissues, such as your ovaries, fallopian tubes, bowel, and even your bladder. These growths can cause inflammation, pain, and sometimes fertility problems. Some key symptoms of endometriosis are pelvic pain, irregular or heavy bleeding, painful periods, pain during sex, tummy bloating, and even back pain.

What causes endometriosis?

The exact cause of endometriosis is not known, though it is generally associated with menstruation. Factors that might cause (or combine to cause) endometriosis include:

• Retrograde menstruation: normally, during menstruation, the lining of your uterus sheds and exits the body through your cervix and vagina as menstrual blood. But in some cases of retrograde menstruation, some of this menstrual fluid flows in the opposite direction, entering your pelvic cavity
• Genetics: it’s thought that endometriosis could be a genetic condition
• Lymphatic or circulatory spread: endometriosis particles might be carried around your body by your blood or lymphatic system
• Immune dysfunction: this is when your immune system can’t fight endometriosis
• Environmental causes: some studies have suggested our environments could affect our likelihood of developing endometriosis
• Metaplasia: some people believe that other cells can change into endometriosis cells, perhaps due to changes in your body

What are the symptoms of endometriosis?

It's important to note that the severity and type of symptoms can vary widely among people with endometriosis. Some people may have mild symptoms or be asymptomatic, while others may experience significant pain and other complications. The most common symptoms of endometriosis include:

• Pelvic pain: this is the main symptom of endometriosis. The pain can range from mild to severe and might occur before, during, or after your period. It can be described as a deep, aching pain or as sharp, stabbing pain. It is typically felt in your lower abdomen or pelvic region but can also radiate to your lower back
• Dysmenorrhea: painful and heavy periods (dysmenorrhea) are a common symptom of endometriosis. This pain is often more intense than usual menstrual cramps
• Painful sex (dyspareunia): endometriosis can cause pain or discomfort during sex
• Painful bowel and bladder symptoms: endometrial tissue that grows on or near your bowel or bladder can lead to pain during bowel movements and peeing, especially during menstruation

What else can endometriosis be mistaken for?

The symptoms of endometriosis are very similar to those of some other common conditions, which is why it can take a long time to be diagnosed. These other gynaecological conditions include uterine fibroids, which cause pelvic pain, and irritable bowel syndrome, which has symptoms such as stomach cramps and disrupted bowel movements.

There are others, too, such as ovarian cysts, interstitial cystitis, adenomyosis and more.

How is endometriosis diagnosed?

The only conclusive way to diagnose endometriosis is with a laparoscopy. Endometriosis is also treated through this type of surgery, which is a minimally invasive (keyhole) procedure.

During a laparoscopy, small incisions are made across your tummy so that your consultant can access your abdomen and pelvis without making large, open incisions. A laparoscope is a specialist instrument that has a small light and camera attached to the end of it. The camera is connected to the monitor so your consultant can see inside your stomach to perform the operation with precision without having to ‘open you up’. The benefits of keyhole surgery compared to open surgery include a faster recovery time, less pain and bleeding after your operation, and reduced scarring.

Laparoscopic surgery for endometriosis is usually performed under general anaesthetic, meaning you won’t be awake throughout the procedure.

Often, when endometriotic growths or nodules are removed through surgery, they’ll be sent to the laboratory to confirm your diagnosis under a microscope (if you haven’t already been diagnosed with endometriosis).

How is endometriosis treated before surgery?

There is no cure for endometriosis (it can even return after surgery), but there are many treatment options available that can reduce your symptoms and improve your quality of life significantly. The main non-surgical treatment options to reduce or manage your symptoms are:

• Hormonal treatment
• Pain relief
• Pelvic rehabilitation

These treatments can reduce symptoms and may slow the progression of the condition, but they can't remove it. Surgery is currently the only way to remove endometriosis adhesions or cysts, though even after surgery your endometriosis can still grow back. Many people who have surgery will continue to have hormonal treatment afterwards, which can slow the progression of the disease.

Your consultant gynaecologist will help you decide on the best treatment for you. This will depend on factors personal to you, including your age, your symptoms, and whether you are looking to become pregnant soon after surgery.

How can endometriosis affect your fertility?

Many women worry that endometriosis will stop them from getting pregnant. However, you should still be able to conceive naturally if you have the condition. You might find it harder to conceive, particularly if your endometriosis is severe, but there are treatments available that can help you.

If you are hoping to get pregnant soon after surgery, your gynaecologist will be able to offer personalised advice.

What is endo belly?

Endo belly refers to the painful and debilitating pelvic bloating that women with endometriosis can experience. As endometrial tissue grows outside of your uterus, it becomes trapped inside your body. This is because it cannot leave your body through your uterus (as a period). This trapped endometriosis tissue causes swelling, pain, and bloating. These symptoms lead to what is commonly referred to as endo belly.

In addition to bloating, other gastrointestinal (stomach and bowel) symptoms of endometriosis include diarrhoea, constipation, and, as mentioned above, painful bowel movements.

Why does endo belly happen?

As mentioned above, the cause of endo belly is trapped endometriosis tissue, which leads to debilitating bloating and pain in the pelvic area.

When does endo belly occur?

These gastrointestinal (stomach and bowel) endometriosis symptoms such as diarrhoea, constipation, and endo belly, can be cyclical. These symptoms typically appear a few days before your period starts and ease after menstruation has ended. These symptoms will reappear the following month before your menstruation begins. In some women these symptoms can occur throughout their cycle.

What are the best endo belly remedies?

While many women use traditional treatment options for endometriosis such as pain relief and pelvic rehabilitation, some remedies are available to help alleviate pain.

One potential remedy for endometriosis pain in general is CBD oil. There is evidence reported by Harvard Medical to show that cannabidiol, otherwise known as CBD oil, can help with chronic pain and inflammation.

While they are not remedies as such, heat therapy and massage therapy can be effective alternative therapies for endometriosis pain. Applying a warm compress such as heat pad or a hot water bottle wrapped in towelling to your lower back or pelvic area (the lower stomach) can reduce pain and swelling.

Some people find that certain foods can exacerbate their bloating and digestive discomfort. Consider trying an elimination diet to identify trigger foods and incorporate new, safe foods into your diet. Common trigger foods include dairy, gluten, caffeine, and processed foods. Adding more fibre-rich foods to your diet can help with digestion and regular bowel movements.

Staying well-hydrated can also help prevent constipation and ease digestive discomfort. Drinking herbal teas such as peppermint or ginger tea might provide relief.

Massage therapy is another option. Research shows that this form of therapy can reduce menstrual pain caused by endometriosis.

Getting help for endometriosis with Circle Health Group

We hope this expert information has helped you understand more about your symptoms and whether they might be endometriosis. Our experienced gynaecologists are available to help you reach a firm diagnosis.

At Circle Health Group we offer expert treatment for endometriosis including everything from hormonal medication to laparoscopic surgery, with a network of thousands of consultant gynaecologists. We also have bespoke aftercare programmes to help you recover from surgery as soon as possible, including pelvic rehabilitation.

If you want to know more about our treatment options, book your appointment online today or call a member of our team directly.