Endometriosis affects 1 in 10 women in the UK, but many put up with its symptoms for years, not realising the damage they are doing to their health and fertility. Here, Mrs Caroline Overton, a Consultant Gynaecologist at Nuffield Health Bristol Hospital, gives you a need-to-know guide on the symptoms of endometriosis.

Endometriosis explained

Endometriosis is a condition where cells like those found inside the womb (uterus) grow outside the womb. Often, women won’t know they have it because the symptoms can start as a teenager, and they learn to accept them as normal. In most cases, endometriosis is treatable, but the longer it goes undiagnosed, the more damage it may be doing to your lifestyle, internal organs and future fertility. If you’re concerned about any of the following symptoms, speak to your GP.

Painful periods

Endometriosis often runs in families, so many women regard their painful periods as normal when they compare themselves with their mother or sisters.

During the menstrual cycle, the lining of the womb (endometrium) builds up and bleeds as a period. With endometriosis, the womb lining-like cells (endometrial cells) in the pelvis build up and bleed in the same way. This is why the pain starts in the days before the period, and why the period pain is more severe and lasts longer than normal period pain.

Normal healthy periods do not interfere with everyday life or work. You should be able to manage a normal period with a tampon or a pad. It might be normal to take painkillers to manage the pain, but you shouldn’t need to regularly take time off work or school.

Mrs Overton says: “If you are having to change the way you dress, miss work or social activities, have a ‘bed day’, stop exercising, and are planning your life around your periods, then your periods are not normal. These could be signs of endometriosis.”

Pain going to the toilet

Over time, the womb lining-like cells in the pelvis can create adhesions between the pelvic organs, causing them to stick to each other, sometimes contributing to pain during bowel movements and urinating. This can happen at any time, not just during the period.

Pain during sex

Unfortunately, women with endometriosis may have only known sex to be painful and so think this is normal. The monthly bleeding in the pelvis has no way to leave the body and so can build up and cause internal scarring and inflammation. These painful areas are agitated during sex, diminishing a woman’s ability to enjoy intercourse, and sometimes placing a strain on sexual relationships.

Difficulty getting pregnant

When endometriosis is left untreated, fibrosis (scarring) can occur and the adhesions between organs in the pelvis can damage the ovaries and tubes. Not only does this make getting pregnant more difficult, but can also render women infertile.

Treatment for endometriosis

The contraceptive pill or Mirena IUS are often effective treatments for endometriosis because they make the periods shorter and lighter. They are good treatments for women who don’t want to start a family, but are not suitable for women trying to get pregnant, as they are contraceptive. When and if women stop the pill When and if women stop the pill, the symptoms of endometriosis can re-appear.

When treatment hasn’t worked or when women want to start a family, there is the option of surgery. Laparoscopy is an operation carried out under general anaesthetic with a day’s stay in hospital. Laparoscopy can diagnose endometriosis and, if agreed beforehand, it is possible to treat by removing the endometriosis and releasing adhesions at the time of the operation. When endometriosis is severe, it can cause extensive inflammation, scarring and damage to the pelvic organs, including the bowels. Under these circumstances, removal of the endometriosis is more complex and may require further surgery at a later date.

If you are experiencing any of the issues described, don’t simply accept them as normal. Mrs Overton says: “Although there is no known cure for endometriosis, we offer evidence-based treatments to help you live a pain-free life. If surgery is the best option, then we offer abdominal and laparoscopic techniques to ensure that you are back on your feet as quickly as possible.”

Caroline Overton is a recognised national expert in endometriosis, with over 30 years’ experience of treating women with known or suspected endometriosis. She completed two years of research at Oxford University, studying Pain and Endometriosis, and in 2016, she received an award as one of the top 100 researchers in the UK. She founded the University Hospitals Bristol NHS Foundation Trust Endometriosis Centre, and chaired a national committee setting standards for the treatment of endometriosis in 2017. At Nuffield Health Bristol Hospital, Mrs Overton offers Endometriosis clinics for women with known or suspected endometriosis, providing expert advice as well as support from Physiotherapists and specialist nurses, who can offer personalised dietary and exercise advice.

If you would like to book an appointment with Mrs Overton, call the Bristol Women’s Clinic at Nuffield Health Bristol Hospital, The Chesterfield, on 0117 906 4887, or visit our website: www.nuffieldhealth.com/hospitals/bristol/womens-health

Featured image: Consultant gynaecologist, Mrs Caroline Overton