How is endometriosis diagnosed?

Endometriosis is a condition in which tissue similar to the lining of the womb (the endometrium) grows outside the womb. It most often affects the ovaries, the fallopian tubes and the tissue lining the pelvis. In some cases, endometriosis can grow in other parts of the body too. In this post I explain how endometriosis affects the body, the symptoms to look out for, and how it is diagnosed and treated.

How does endometriosis cause pain?

Each month, the lining of the womb thickens, breaks down and leaves the body as a period. When you have endometriosis, the tissue outside the womb goes through the same monthly cycle. However, unlike a period, it has no way to leave the body. Instead, it becomes trapped, causing inflammation, scarring and adhesions, bands of tissue that can stick organs together. This is why endometriosis can be so painful.

Symptoms of endometriosis

You might have endometriosis if you have any of the following:

• painful periods
• pain during or after sex
• pain when passing urine or opening your bowels
• heavy periods
• difficulty getting pregnant
• ongoing pelvic pain

Endometriosis is often not subtle, yet many women live with heavy bleeding and pelvic pain for years, believing it is simply part of life. It is not something you have to put up with. If your periods stop you from working, studying or doing the things you enjoy, please speak to a doctor. Effective treatment is available, and we understand how hard endometriosis can be, especially when you are trying to conceive.

How is endometriosis diagnosed?

Diagnosis usually begins with a conversation about your symptoms and a pelvic examination to check for anything unusual. Imaging can then give more information about what is causing your symptoms:

• Ultrasound: a transvaginal scan can show endometriosis cysts on the ovaries and some deeper disease (see gynaecological ultrasounds).
• MRI: magnetic resonance imaging can help map deeper endometriosis before surgery.
• Laparoscopy: a laparoscope is a very thin instrument with a light and a camera. It is passed through small cuts in the tummy, so Mr Jafaru Abu can see your pelvic organs directly. A tissue sample can be taken during the same procedure to confirm the diagnosis.

A normal scan does not rule out endometriosis, so laparoscopy remains an important way to confirm it. NICE sets out how endometriosis should be diagnosed and managed.

How is endometriosis treated?

Treatment is tailored to your symptoms, your priorities and whether you would like to have children. It may include a combination of:

• pain relief
• hormone treatment, to calm the monthly cycle
• conservative surgery that removes endometriosis while preserving your reproductive organs, usually by keyhole surgery
• a hysterectomy to remove the womb, and possibly the ovaries, for women who have completed their family

Mr Abu will explain the benefits and risks of each option, so you can choose the approach that suits you best. You can read more on our endometriosis page, and the Royal College of Obstetricians and Gynaecologists has patient information on endometriosis and its treatment.

Living with endometriosis

Endometriosis is a long-term condition, but the right support makes a real difference. Keeping a pain and period diary helps you and your doctor see what is working. Regular exercise, heat pads and good sleep can ease symptoms for some women. If you are trying for a baby, tell your doctor early, because treatment can be planned around your fertility. Above all, you should feel listened to: endometriosis pain is real, and it deserves proper care.

If you think you may have endometriosis, you can book an appointment with Mr Jafaru Abu at The Park Hospital, Nottingham.