Endometriosis Q&A with Miss Sujata Gupta, Consultant Gynaecologist at The Wilmslow Hospital

Endometriosis affects an estimated 176 million women worldwide – that’s one in 10 women on average.

Endometriosis is a common condition that can have a significant impact on the quality of life for women who are diagnosed, in particular due to the often-painful symptoms of the condition and the fact that it is the biggest cause of infertility in women. It can also have an impact on sexual relationships, energy levels and emotional wellbeing.

Knowing the symptoms of endometriosis can help you access diagnosis and treatment earlier. Whilst there’s no cure for endometriosis, an early diagnosis means that doctors can slow down its progress, help manage symptoms and limit any long-term impacts.

To learn more about endometriosis, including the signs and symptoms you should look out for, we asked Miss Sujata Gupta, Consultant Gynaecologist at The Wilmslow Hospital, part of HCA Healthcare UK, to answer some commonly asked questions, including what causes this condition and how it is diagnosed?

The lining of the uterus is called the endometrium because it is lined with endometrial tissue. Each time you have a menstrual cycle your body grows a new endometrium to prepare your uterus for a fertilised egg. During your menstrual cycle this lining will thicken, break down and bleed, leaving your body and making way for your next cycle and a new lining.
Endometriosis occurs when endometrial-like tissue grows outside of the uterus where it’s not supposed to, most commonly involving the ovaries, fallopian tubes and the tissue lining the pelvis.

With endometriosis, the endometrial-like tissue responds to the sex hormones which are released during each menstrual cycle as it would in the uterus by swelling, breaking down and bleeding, but in this case the blood is unable to leave in the usual way and becomes trapped.

Because of this the surrounding tissue in the pelvis becomes inflamed and causes pain, which can sometimes be severe, and often leads to scarring and potential fertility problems.

Often there is no sign that anything is wrong and the endometriosis is only discovered by chance. However, for many it can be very uncomfortable and distressing. The symptoms will also depend on where in the body the endometrial tissue is found, which varies from person to person.

The most common symptoms include:

• Painful, heavy or irregular periods: Period pain is a common symptom associated with your menstrual cycle - usually described as tummy cramps – and the pain can also spread to your lower back and even your thighs. This pain is usually treatable at home with over-the-counter painkillers or other remedies such as using a heat pad or a hot water bottle on your tummy, taking a warm bath or massaging your tummy in circular motions, which can all help relieve or ease the pain. However, some women experience more intense and painful periods that can be caused by an underlying medical condition, including endometriosis, where period pain can be severe. They may also notice a change to their periods, they may be heavier or become irregular in frequency.
• Pelvic pain: The pain of endometriosis can be severe and the ongoing inflammation can cause pain that lasts throughout your menstrual cycle.
• Fatigue and malaise: Many women with endometriosis will feel weak, tired and generally unwell.
• Painful sex: Especially deep pain, which can continue even after intercourse has stopped.
• Difficulty getting pregnant: The bleeding in the pelvis from endometriosis can lead to the tubes and ovaries getting inflamed and stuck together which can then affect fertility.
• Pain on opening the bowels or passing urine: This can be a sign of a more severe form of endometriosis that affects the bowel and the bladder.

Each person’s experience with endometriosis is different, you may have some of these symptoms, all of these symptoms or none of them. It’s also worth noting that having severe pain is not necessarily a sign of more severe endometriosis; some women might have mild endometriosis with severe pain, whereas others could have advanced endometriosis and experience little or no pain.

The symptoms of endometriosis are not always easy to recognise because they can be similar to other conditions. If you have any of the symptoms above, or any other new or worrying symptoms which are not normal for you, make sure you visit a GP as soon as possible.

It may not be anything serious, but the sooner endometriosis is detected, the easier it can be to treat.

Once you have seen your GP, if they believe that you require further investigation they will refer you to a consultant gynaecologist or endometriosis specialist.
Your consultant or specialist will usually begin by asking about your symptoms and medical history. They will then perform a careful physical examination of your tummy and vagina. If from this discussion and examination they are unable to determine if you have endometriosis or not, they will refer you for some more tests.

In this case, an ultrasound scan is usually recommended as the first investigation, followed by a pelvic MRI if needed. In many cases a laparoscopy will also be required to make a definitive diagnosis of endometriosis. This is a common procedure where a camera will be inserted into the pelvis to help your consultant see any signs of endometriosis. 

Treatment for endometriosis requires a very personalised approach as every person is different and the condition can present in multiple ways.

There is currently no cure for endometriosis, but there are many ways that symptoms can be treated and managed, including painkillers, hormone medicines or contraceptives. In some cases, surgery will be recommended to remove the endometrial tissue. There are also some people may not require any treatment at all. 

It is true that endometriosis can affect fertility in some women, with around 40% of infertile women being diagnosed with endometriosis. With the right treatment though, many women with endometriosis can get pregnant. How endometriosis affects a person’s fertility depends on their age, severity of the condition and whether or not endometriosis has affected ovaries or the fallopian tubes.

If you have been diagnosed with endometriosis it’s important that you get advice from a team who specialise in this complex condition, to ensure you receive the right care for you. 

Miss Sujata Gupta, Consultant Gynaecologist at The Wilmslow Hospital is a sub-specialist expert in endometriosis and will be able to provide you with a personalised treatment and care plan based on your individual diagnosis and personal needs.