Endometriosis is a painful, complex condition affecting about 1 in 10 women of reproductive age, but it is poorly understood. A new clinical review published in CMAJ (Canadian Medical Association Journal) https://www.cmaj.ca/lookup/doi/10.1503/cmaj.220637 provides an overview of the causes, diagnosis and management of endometriosis based on the latest evidence, to help clinicians and patients.
The review is timely, as March is Endometriosis Awareness Month.
Endometriosis, defined as the presence of endometrial-like tissue outside the uterus, is one of the most common gynecologic conditions. It is estimated to affect approximately 1 million women in Canada and an unknown number of gender-diverse people. It can cause chronic pelvic pain and organ damage, affect fertility and negatively impact quality of life.
“Endometriosis can involve multiple organ systems and its symptoms are often chronic, which can affect work productivity, social life, intimate relationships and mental health considerably, and lead to substantial societal costs,” writes Dr. Catherine Allaire, Department of Obstetrics and Gynaecology, University of British Columbia, and BC Women’s Centre for Pelvic Pain and Endometriosis, Vancouver, BC, with coauthors.
Although laparoscopy with histopathologic confirmation has been considered the gold standard for diagnosis, to address the unacceptably long interval between symptom onset and diagnosis, recent guidelines note that a diagnosis can be made based on symptoms, physical examination and imaging.
“Early recognition and diagnosis are key to providing timely treatment. Primary care providers can make a clinical diagnosis of endometriosis and start first-line medical management. Referral to a gynecologist for second-line hormonal therapy or surgery is important, when indicated,” the authors conclude.
“Reducing the delay to diagnosis and initiating treatment will help improve quality of life for the 1 million individuals affected by endometriosis in Canada,” say the authors.
Endometriosis is unseen and therefore often misdiagnosed disease that only affects women. The chronic condition can have an impact on both emotional wellbeing and physical health, yet so many still don’t fully understand what it is, its symptoms or the full extent of the condition.
Here, Dr Giuseppe Aragona, GP and Online
Doctor for PrescriptionDoctor.com a UK based online pharmacy and doctor service
providing customers with a safe, convenient and discreet way of accessing
treatments, provides answers to 7 key questions surrounding the condition. The
answers should provide some clarity, help aid awareness and highlight the
challenges those face whose lives have been affected by the condition.
What actually is Endometriosis?
“Endometriosis is a long-term condition,
which only affects women, whereby tissue (a bit like the lining of the womb)
begins to develop and grow in other places in the body such as the fallopian
tubes and the ovaries. We know that each month, as part of natural hormonal
changes, a woman’s tissue lining in her womb builds and then breaks down. When
no egg has been fertilised, the tissue lining exits the woman’s body as a
period, but for women living with endometriosis, its slightly different and not
quite as straightforward. When the tissue breaks down during the hormonal
change in a woman living with endometriosis, it is unable to exit the body so
the blood stores inside the body – making it very painful for some women.”
How does it develop?
“Firstly, you can’t catch it, and you can’t pass it on. Although there are several theories on
hormones, genetics and the way women menstruate; there is no known singular
cause. Whilst the condition does tend to run in families, its not been
exclusively proven and its likely that a combination of multiple elements cause
the condition.”
What
are the symptoms?
“As with any condition, there are some typical symptoms of endometriosis however it is really important to note that symptoms can vary from women to women. You may have a friend or family member who has been diagnosed with endometriosis, but their symptoms are completely different. Some women have no noticeable symptoms and the condition appears ‘hidden’ whilst other women may have severe symptoms both physically and mentally. For some women, unfortunately, endometriosis can be linked with a low mood and feelings of depression; this is because the condition can have a detrimental impact on day-to-day life.”
The main symptoms of endometriosis are:
Period
pain; women with endometriosis are more likely to have painful periods and this
can be anywhere from mild pain to excruciating pain meaning that they aren’t
able to do normal day to day activities;
Pelvic
pain; usually in the lower abdomen or the lower back.
Heavy
or irregular periods;
Nausea,
diarrhoea or constipation;
Pain
during sex;
Difficulty
when trying to get pregnant or infertility (not all women with endometriosis
will have fertility problems and not all women will need treatment to get
pregnant).
Who
does it affect?
“Endometriosis affects 1 in 10 women in the UK. Endometriosis is a
chronic and detrimental disease, impacting women (and girls) of childbearing
age, and it is estimated that around 1.5 million women in the UK are currently
living with the condition.”
How
can you manage it?
“Although
there is no cure for endometriosis, there are so many treatments for women and
these can help with the symptoms of the condition. Depending on the symptoms you have, your
circumstances and the severity of both the symptoms and the disease, will
affect what treatments are available for you.”
How
can you treat it?
“If your
symptoms are mild, there may be no need for treatment and you may find that
your symptoms get better on their own.
Some treatments
will focus on relieving the pain such as painkillers which may supress some of the
symptoms. Other women will be prescribed hormone medicines and different
contraceptive treatments to help manage the condition by trying to control the
level or stopping the production of oestrogen in their body.
A symptom and complication of endometriosis is the difficulty women
may be faced with when trying to get pregnant. There are treatments available
to help improve the chances of conceiving and slow the growth of the
endometriosis tissue such as surgery to remove the tissue during a laparoscopy.
The surgeon will be able to destroy parts of the affected tissue with a laser.
Whilst every
effort can be made to treat the condition, the outcome may be to have surgery
to remove all or part of the areas that are affected by the endometriosis
tissue. This can, in some cases, mean that surgery may be required to remove
the womb, also known as a hysterectomy. This is an option that your GP or gynaecologist
will discuss with you depending on your circumstances”
When
should you visit your GP?
“We’ve
mentioned that endometriosis can often be misdiagnosed especially because of
the difference in symptom levels and many other conditions may cause similar
symptoms. It is however really important to see a GP if you think you have
symptoms of endometriosis.
Some general
advice would be to write down your symptoms before your appointment, this is
because the GP may decide to examine the pelvic area and whilst symptoms can
get better by themselves, equally, left untreated, the condition may
worsen.
Your GP will
be able to advise you if they suspect there is a possibility that you do have
endometriosis and they may refer you to a gynaecologist to test for the
condition. The only way to be certain whether you do have endometriosis will be
from the test results, following either an internal or external ultrasound scan
and a laparoscopy. The gynaecologist will be able to discuss your options for
treatment depending on the results of your tests.”
This piece has been brought to you by
Prescription Doctor
Pain conditions that often occur together and either solely or predominantly affect women have been recently termed by the NIH as chronic overlapping pain conditions (COPCs). They include: vulvodynia, temporomandibular disorders, myalgic encephalomyelitis/chronic fatigue syndrome, irritable bowel syndrome, interstitial cystitis/painful bladder syndrome, fibromyalgia, endometriosis, chronic tension-type and migraine headache, and chronic low back pain. These patients often demonstrate common abnormalities in neural, immune, and endocrine function, which may explain the overlapping nature, as well as increased risk for developing new COPC. COPCs lead to physical and mental disability, poor sexual function, higher rates of drug addiction, and suicide. What symptoms should practitioners look out for?
This week is Endometriosis awareness week, it’s the unseen and therefore often misdiagnosed disease that only affects women. The chronic condition can have an impact on both emotional wellbeing and physical health, yet so many still don’t fully understand what it is, its symptoms or the full extent of the condition.
Here, Dr Giuseppe, GP and
Medical Advisor at Prescription Doctor, a UK based online pharmacy and
doctor service providing customers with a safe, convenient and discreet way of
accessing treatments, provides answers to 7 key questions surrounding the condition.
The answers should provide some clarity, help aid awareness and highlight the
challenges those face whose lives have been affected by the condition.
What actually is Endometriosis?
Endometriosis is a long-term condition, which only affects women, whereby tissue (a bit like the lining of the womb) begins to develop and grow in other places in the body such as the fallopian tubes and the ovaries. We know that each month, as part of natural hormonal changes, a woman’s tissue lining in her womb builds and then breaks down. When no egg has been fertilised, the tissue lining exits the woman’s body as a period, but for women living with endometriosis, its slightly different and not quite as straightforward. When the tissue breaks down during the hormonal change in a woman living with endometriosis, it is unable to exit the body so the blood stores inside the body – making it very painful for some women.
Howdoes it develop?
Firstly, you
can’t catch it, and you can’t pass it on. Although there are several theories on
hormones, genetics and the way women menstruate; there is no known singular
cause. Whilst the condition does tend to run in families, its not been
exclusively proven and its likely that a combination of multiple elements cause
the condition.
What
are the symptoms?
As with any condition, there are some typical symptoms of endometriosis however it is really important to note that symptoms can vary from women to women. You may have a friend or family member who has been diagnosed with endometriosis but their symptoms are completely different. Some women have no noticeable symptoms and the condition appears ‘hidden’ whilst other women may have severe symptoms both physically and mentally. For some women, unfortunately, endometriosis can be linked with a low mood and feelings of depression; this is because the condition can have a detrimental impact on day-to-day life.
The main symptoms of endometriosis are:
Period pain; women with
endometriosis are more likely to have painful periods and this can be anywhere
from mild pain to excruciating pain meaning that they aren’t able to do normal
day to day activities;
Pelvic pain; usually in the lower
abdomen or the lower back.
Heavy or irregular periods;
Nausea, diarrhoea or constipation;
Pain during sex;
Difficulty when trying to get pregnant or infertility (not all
women with endometriosis will have fertility problems and not all women will
need treatment to get pregnant).
Who
does it affect?
Endometriosis
affects 1 in 10 women in the UK. Endometriosis is a chronic and detrimental
disease, impacting women (and girls) of childbearing age, and it is estimated
that around 1.5 million women in the UK are currently living with the
condition.
How
can you manage it?
Although there is no cure for endometriosis, there are so many
treatments for women and these can help with the symptoms of the
condition. Depending on the symptoms you
have, your circumstances and the severity of both the symptoms and the disease,
will affect what treatments are available for you.
How
can you treat it?
If your symptoms are mild, there may be no need for treatment and
you may find that your symptoms get better on their own.
Some treatments will focus on relieving the pain such as
painkillers which may supress some of the symptoms. Other women will be prescribed
hormone medicines and different contraceptive treatments to help manage the
condition by trying to control the level or stopping the production of oestrogen
in their body.
A symptom and
complication of endometriosis is the difficulty women may be faced with when
trying to get pregnant. There are treatments available to help improve the
chances of conceiving and slow the growth of the endometriosis tissue such as
surgery to remove the tissue during a laparoscopy. The surgeon will be able to
destroy parts of the affected tissue with a laser.
Whilst every effort can be made to treat the condition, the
outcome may be to have surgery to remove all or part of the areas that are
affected by the endometriosis tissue. This can, in some cases, mean that
surgery may be required to remove the womb, also known as a hysterectomy. This
is an option that your GP or gynaecologist will discuss with you depending on your
circumstances.
When
should you visit your GP?
We’ve mentioned that endometriosis can often be misdiagnosed
especially because of the difference in symptom levels and many other
conditions may cause similar symptoms. It is however really important to see a
GP if you think you have symptoms of endometriosis.
Some general advice would be to write down your symptoms before your
appointment, this is because the GP may decide to examine the pelvic area and
whilst symptoms can get better by themselves, equally, left untreated, the
condition may worsen.
Your GP will be able to advise you if they suspect there is a
possibility that you do have endometriosis and they may refer you to a gynaecologist
to test for the condition. The only way to be certain whether you do have
endometriosis will be from the test results, following either an internal or
external ultrasound scan and a laparoscopy. The gynaecologist will be able to
discuss your options for treatment depending on the results of your tests.
This piece has been brought to you by
Prescription Doctor
The most common symptom of womb cancer is abnormal bleeding from the vagina, although most people with abnormal bleeding don’t have cancer.
Bleeding may start as light bleeding accompanied by a watery discharge, which may get heavier over time. Most women diagnosed with womb cancer have been through the menopause, so any vaginal bleeding will be unusual.
In women who haven’t been through the menopause, unusual vaginal bleeding may consist of:
Only 1 in 10 cases of unusual vaginal bleeding after the menopause are caused by womb cancer, so it’s unlikely your symptoms will be caused by this condition.
However, if you have unusual vaginal bleeding, it’s important to get the cause of your symptoms investigated. The bleeding may be the result of a number of other potentially serious health conditions, such as:
endometriosis – where tissue that behaves like the lining of the womb is found on the outside of the womb
fibroids – non-cancerous growths that can develop inside the uterus
polyps in the womb lining
Other types of gynaecological cancer can also cause unusual vaginal bleeding, particularly cervical cancer.
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