Publication date Sep 14, 2007
Endometriosis happens when small pieces of the lining of your womb spread and grow outside your womb. It can be painful, and you may have difficulty getting pregnant. But there are good treatments that can help.
The lining of your womb is called the endometrium. Each month, the lining grows thicker as part of your monthly cycle, when your body makes more of the hormone oestrogen. You get endometriosis when pieces of endometrium start growing on other parts of your body. No one knows for certain why some women get endometriosis.
Usually endometriosis grows around your ovaries, fallopian tubes, the outside of your womb or the lining of your pelvis. Endometriosis can grow on your rectum and your bladder.
Like your endometrium, the patches of endometriosis react to the different hormones your body makes during your monthly cycle. So they grow thicker each month, when your body releases oestrogen. Then the patches break away from the part of your body they were growing on. They also start to bleed (like the lining of your womb does when you have your period).
This extra blood can't drain away quickly. Your body slowly gets rid of the blood, but it can damage the surrounding area. You may get scars or small bags of fluid called cysts.
The endometriosis can damage your fallopian tubes or your ovaries. If this happens, your fallopian tubes or your ovaries may stick together and stop working properly. That can mean you may have problems getting pregnant.
The chances of getting endometriosis rise from puberty onwards and peak at about 40. After the age of 40, the risk goes down.
The two main symptoms of endometriosis are pain and difficulty getting pregnant. But some women don't have any symptoms at all.
Pain is the most common symptom. Most women with endometriosis get pain in the area between their hips (the pelvis). The pain can be severe or it may be a dull ache. Some women get the pain all the time. Others get pain only at certain times: for example, during sex, when emptying their bowels or during their period. Having severe pain can be distressing. Some women may worry that it means they have cancer. But endometriosis isn't cancer.
Pain during your periods is very common. The pain starts a few days before your period and gets worse when the bleeding starts. It eases off towards the end of your period.
Some women with endometriosis find they feel exhausted and generally unwell or have trouble sleeping.
Many women with endometriosis can get pregnant naturally. But about one-third of women who have been diagnosed with endometriosis need medical help to get pregnant. For some women, when they are having difficulty getting pregnant may be the first time they realise that they have endometriosis.
There's no simple test for endometriosis. You need to have a type of surgery to show for certain whether you have endometriosis. It's called a laparoscopy. In a laparoscopy, a surgeon looks inside your body using a small camera. You might have an ultrasound scan first to check for other possible causes of pain.
If you have painful periods but no other symptoms, your doctor may recommend you try painkillers or the contraceptive pill, before thinking about having a laparoscopy. If this works, you may not need a laparoscopy.
You’ll need different treatments, depending on whether or not you want to get pregnant. If you don’t want to get pregnant, hormonal treatments like the contraceptive pill may work for you. Hormone treatments help the patches of endometriosis to shrink, bleed less and hurt less.
If you do want to get pregnant, surgery to remove some of your endometriosis may be the best option. It can relieve pain and may help you to get pregnant. There are also fertility treatments for women with endometriosis. For more information, see our information on fertility treatments.
If your main symptom is painful periods, you could try painkillers first.
There’s good research to show that painkillers called nonsteroidal anti-inflammatory drugs (NSAIDs) work well to relieve period pain. Some NSAIDs (and their brand names) are ibuprofen (Nurofen) and diclofenac (Voltarol). You can buy ibuprofen from a pharmacist.
Other painkillers, such as aspirin or paracetamol, are also likely to help. Using heat may help as much as taking NSAIDs. You can try a hot water bottle or a warm bath.
If you don't want to get pregnant, your doctor may suggest you try contraceptive pills first. They work for all kinds of endometriosis pain, including painful periods, continuous pain and pain during sex. In one study, more than half the women taking contraceptive pills got rid of their pain completely.
The pills used for endometriosis contain oestrogen and progestogen. Doctors call them combined contraceptive pills. You take one pill each day for three weeks, then have a week off (or take dummy pills). You can take contraceptive pills for as long as you want.
There are many different types. Examples are Femodene, Marvelon and Ovranette. Your doctor will help you find a pill that suits you.
Contraceptive pills have side effects, but they are usually mild. Some people get headaches, put on weight, feel bloated, have mood changes and get tender breasts.
You may be slightly more likely to get a blood clot in the veins in your legs. For a very small number of women this can be dangerous because the blood clot may travel to the lungs. If a blood clot travels to your lungs, it can be life-threatening.
If you still get pain despite taking contraceptive pills, your doctor may suggest you try a hormone treatment called medroxyprogesterone. It’s similar to the female hormone progesterone.
You can take medroxyprogesterone as a pill (called Provera) or as an injection (called Depo-Provera). It’s normally prescribed for about three months. It works as well as contraceptive pills for continuous pain or for pain during sex. And it seems to work better for period pain.
Medroxyprogesterone can have the same mild side effects as the birth control pill. You may also get breakthrough bleeding when it’s not your period or get no bleeding at all.
If you take medroxyprogesterone as an injection, your periods may not return to normal for a while after you stop the treatment. And you may not be able to get pregnant right away. There's also a risk of thinning bones (osteoporosis).
Other hormone treatments are sometimes used for endometriosis. But there is less evidence that they work, and they can cause unpleasant side effects.
Surgery to remove endometrosis is likely to help with the pain. One study found that surgery to remove endometriosis helped reduce pain for about three-quarters of women. But the pain may come back. You can also have this kind of operation to help you get pregnant.
The surgeon normally does the operation using keyhole surgery. This is quicker and less painful than open surgery. The surgeon may use laser treatment or heat treatment to get rid of patches of endometriosis. The surgeon also cleans up any scars and separates organs that are stuck together.
Between 7 in 10 and 8 in 10 women have less pain after surgery to remove endometriosis. About 9 in 10 out of those women who felt better had less pain for a year. And more than half of the women had less pain for up to five years. Surgery to remove endometriosis seems to help all kinds of pain, including period pain or pain when you have sex.
Any operation has risks. With surgery to remove endometriosis, it is common to have soreness around the small cuts in your abdomen and to feel sick after the operation. Some other side effects are more serious, but much less common. You might get damage to your bowel or your bladder, bleeding inside your body, infections or adhesions (tissue that sticks to organs and stops them working properly). Adhesions can make it harder to get pregnant.
Some women have hormone treatments after surgery to remove endometriosis. This may make the benefits of the operation last longer. Other women have hormone treatments before surgery to remove endometriosis, to make the operation easier for the surgeon to carry out. But there’s not much research to show if this helps.
If you have endometriosis on your ovaries, it may form small bags called cysts. If you have surgery on your ovaries to take out the cysts, you're less likely to have pain. This kind of surgery may also help if you have trouble getting pregnant.
If you don't get treatment, your endometriosis could get gradually worse, then get better when you go through the menopause. This happens to about half the women who get endometriosis. Or endometriosis might disappear on its own over a year or so after you realise you have it. This happens to about a third of women who have mild endometriosis.
Getting treatment should help, whatever kind of pain you have. Most women who have treatments get good relief from pain. Unfortunately, the pain often comes back sooner or later. But if your pain comes back, you can have more treatment.
It's less clear how well treatment works for women who have problems getting pregnant. But one study showed that nearly 1 in 3 women with endometriosis were able to get pregnant after having surgery.
Endometriosis UK is a charity offering support to women with endometriosis. You can call their helpline on 0808 808 2227 or see the website http://www.endo.org.uk/index.html.
This information does not replace medical advice. If you are concerned you might have a medical problem please ask your Boots pharmacy team in your local Boots store, or see your doctor.
© BMJ Publishing Group Limited ("BMJ Group") 2007. All rights reserved
This information does not replace medical advice.
If you are concerned you might have a medical problem please ask your Boots pharmacy team in your local Boots store, or see your doctor.