This may affect up to a third of women of childbearing age and can cause intensely painful periods
(see dysmenorrhoea above), pain during intercourse and sometimes infertility.
Some women however have no symptoms.

Tissue from the womb lining (endometrium) travels to other places, including the ligaments that support the
womb, ovaries, bladder and bowel, even the navel or lungs. Mild cases may involve a few isolated patches,
severe disease may be widespread.

The growth and spread of the tissue is dependent on oestrogen and progesterone so endometriosis will stop at
menopause. Meanwhile, wherever the endometrial tissue ends up, it goes through a monthly cycle and bleeds just
like the womb lining. Because the blood can’t escape, it gathers and irritates the surrounding tissues.
That can stimulate the formation of web-like scar tissue, known as adhesions, which can ‘glue’ any of the
pelvic organs together and, in severe cases, wrap itself right round them.

The cause is unknown but endometriosis is more likely to happen, and to be severe, if a close family relative has it.
So current research is looking into a genetic basis.

Diagnosis can’t be made from symptoms alone, since some women with endometriosis have no symptoms and not
all pain is due to endometriosis. A doctor may suspect the disease if a women is having difficulty getting pregnant,
or has painful periods, pelvic pain, pain during intercourse or a close relative with the condition. Tests may include
a vaginal examination or laparoscopy. Ultrasound scanning or occasionally MRI scanning may be used to
assess the spread.

Management

Treatment depends on your symptoms. A healthy lifestyle is vital. Scientific research into alternative treatments
to help symptoms includes positive findings from:

• Ayurvedic medicine
• Biofeedback
• Dietary changes and nutritional supplements
• Herbal therapies from different cultures
• Relaxation, using TENS machines
• Cognitive Behavioural Therapy
• Physical therapy

If you want a baby, pregnancy may help the condition too so doctors may advise trying sooner rather than later
to see if it’s possible. Often, having a baby is unrealistic so do discuss different options with your doctor.
Help is available but an integrated approach involving conventional and complementary professionals is most
effective and you should ask for this. For instance, research shows that reflexology can be as effective as painkillers.

If the condition is mild, laparoscopic surgery may help the condition and improve fertility but surgery can cause
more scar tissue (adhesions) and thus often problems. Traditional surgery may be necessary if the condition is
widespread but does carry risks of damage to nearby organs.

Patches of wandering tissue may also be destroyed by diathermy (heat cauterisation), vaporised by laser, or
cut out with specially designed laparoscopic scissors.

Hormone drug treatment, which includes the contraceptive pill, is based on mimicking the changes to oestrogen
and progesterone at pregnancy or menopause, which both lead to changes in the womb lining. However, periods
usually stop (that’s why it’s not recommended if you want to get pregnant). Cysts on the ovary often persist and
need surgery; also hormone treatment may have little effect on adhesions.

As a last resort, for women who have finished having children, women may choose to have their womb and ovaries
removed (hysterectomy and oophorectomy). This is surgical menopause and you must talk to your doctor about
the risk of osteoporosis.

Sadly a hysterectomy and removal of your ovaries is not a guarantee of cure.

But be aware that this surgery may not treat all your symptoms so discuss this fully with your doctor and
liaise with the National Endometriosis Society.