Examining Endometriosis

A 2019 study found that one in nine Australian women are diagnosed with endometriosis by the time they reach 44 years of age.

Endometriosis in Australia

An Australian study conducted this year found that:

• 1 in 9 people who identified as women born between 1973 and 1978 were diagnosed with endometriosis (by the time they reached age 44);
• From 2016-17 there were around 34,200 endometriosis-related hospitalisations;
• More than 730,000 (over 10%) of Australians experience endometriosis at one stage of their life, often beginning in adolescence; and
• The economic burden of endometriosis on Australia is estimated at 7.4 billion. This is mostly as a consequence of reduced quality of life and loss of productivity. There is a strong possibility this number could be higher, due to the difficulties of diagnosing the condition and the known underdiagnosis in Australian society.

(AIHW 2019; Endometriosis Australia 2019a)

What is Endometriosis?

Endometriosis Australia (2019a) provides the following definition: 'Endometriosis is present when the tissue that is similar to the lining of the uterus (womb) occurs outside this layer and causes pain and/or infertility.'

The cause of endometriosis is not entirely clear.

The dominant theory is that during menstruation, menstrual tissue (comparable to lining in the womb) passes back through the fallopian tubes and into the pelvis, where it attaches and grows (The Royal Women’s Hospital 2014; Endometriosis Australia 2019a).

People who have endometriosis often report experiencing crippling pain. It has the potential to impact a person’s relationships; their capacity to work and study; physical health; and mental wellbeing (Queensland Health 2019).

Endometriosis has the ability to affect the:

• Ovaries;
• Fallopian tubes;
• Bowel;
• Lining of the pelvis;
• Cervix;
• Vagina;
• Vulva;
• Ureters; and
• Bladder.

(Queensland Health 2019)

Endometriosis appears to run in families. If a person’s mother has endometriosis, it is more likely they will develop it too (The Royal Women’s Hospital 2014).

Endometriosis is sometimes found in people who are not able to fall pregnant. In a small sample of these people, scar tissue caused by endometriosis is blocking the fallopian tubes (The Royal Women’s Hospital 2014).

Causes of Endometriosis

It is believed that stray endometrial tissue (known as endometrial implants or lesions) continues to behave as it would inside the uterus. It thickens, breaks down and bleeds with each menstrual cycle. Because the stray tissue can’t leave the body as normal menstrual blood would, it remains inside the pelvis and causes inflammation (Queensland Health 2019).

Risk Factors

While the reasons why certain people experience endometriosis is unclear, there appear to be factors that increase the likelihood of developing it.

• Beginning to menstruate at an age earlier than 11;
• Experiencing menopause at an older age;
• Experiencing more frequent periods of cycles less than 27 days;
• Extended, heavy menstrual periods;
• Not giving birth;
• Being a lower body weight;
• Having higher oestrogen levels; and
• Any abnormalities to the reproductive tract.

(Queensland Health 2019)

Symptoms of Endometriosis

A primary symptom of endometriosis is having period pain so severe it stops a person from going about their day-to-day life around or during their period (Endometriosis Australia 2019a).

Other symptoms include:

• Pain during sex;
• Pelvic pain outside of the menstrual cycle;
• Back pain;
• Bleeding between periods;
• Lethargy; and
• Pain while passing a bowel motion.

(The Royal Women’s Hospital 2014; Healthdirect 2019)

People who have endometriosis often report the difficulty of getting their pain under control even after medical intervention, including surgery (Sinclair et al. 2019).

Self-Management Techniques

To highlight how severe the pain of endometriosis is, a recent study revealed that among participants aged 18 to 45, the percentage of people who reported using self-management techniques for endometriosis in the past six months was 76% (Sinclair et al. 2019).

These self-management techniques included:

• Heat packs (70%);
• Altering diet (44%);
• Exercise (42%);
• Yoga or pilates (35%); and
• Cannabis (13%).

(Sinclair et al. 2019)

In North America, [opioids] (oxycodone and codeine) are often prescribed for endometriosis pain management. Rates of opioid prescription are lower in Australia but are still prominent enough to cause concern. This puts people who experience endometriosis at a high risk of opioid dependence, addiction or overdose (Sinclair et al. 2019).

Diagnosis

If someone is experiencing pain with their period, between their periods, during intercourse, or when they open their bowels or use their bladder, it is advised that they see their general practitioner (GP) (Endometriosis Australia 2019b.

If a GP suspects that a patient has endometriosis, they will likely recommend an ultrasound. An ultrasound will often be able to determine whether the patient has lumps (nodules) of endometrium growing around or in the bowel and bladder (The Royal Women’s Hospital 2014).

A laparoscopy (keyhole surgery) is required to make a definitive diagnosis. In laparoscopy, a very small insertion is made in the abdomen and a small sample of tissue is taken. Tests will then confirm the diagnosis. A treatment plan will then be suggested based on the severity of symptoms (The Royal Women’s Hospital n.d.).

Underdiagnosis of endometriosis in society might be due to the following:

• Pain associated caused by the condition is dismissed as ‘normal’ pain relating to a period;
• People experience symptoms irregularly and therefore do not feel confident to seek help; and
• Being seen as having a high pain threshold is a virtue in our society.

(Endometriosis Australia 2019b)

Treatment

Endometriosis-related pain and infertility is usually treated and managed with medicines or surgery. There is currently no cure for endometriosis (NICHD 2020).

Medicines may include hormone-based treatments such as oral contraceptives, an implant or IUD, and pain relief medicines. As hormones cause endometriosis patches to have a similar cycle to a woman’s menstrual cycle, hormone therapies can be effective when treating endometriosis symptoms. However, not all treatments work for all women and symptoms may return once hormonal treatment is stopped (NICHD 2020).

Surgical treatment aims to remove the presence of endometriosis as much as possible. There are multiple options available. These include:

• Laparoscopic surgery (as mentioned above) to facilitate examination and removal of tissue.
• Laparotomy, a major surgery, in which an abdominal cut is used to cut out or burn tissue or cysts.
• Bowel surgery, necessary if the endometriosis has expanded to the bowel wall.
• Hysterectomy, performed only in severe cases, it is the removal of the uterus.

(Healthdirect 2019; Better Health Channel 2018)

Conclusion

Endometriosis is a painful and unfortunately common condition. It has previously been linked with infertility and can cause a reduction in quality of life.

People who are experiencing symptoms of endometriosis should talk to their GP regardless of whether symptoms are consistent month by month. There are treatments available for people who live with endometriosis.

Additional Resources

• Endometriosis Australia
• Endometriosis and Pelvic Pain Course

References

• Australian Institute of Health and Welfare (AIHW) 2019, ‘Endometriosis in Australia: Prevalence and Hospitalisations’, AIHW, viewed 20 November 2019, https://www.aihw.gov.au/reports/chronic-disease/endometriosis-prevalence-and-hospitalisations/contents/table-of-contents
• Better Health Channel 2018, Endometriosis, Better Health Channel, viewed 20 November 2019, https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/endometriosis
• Endometriosis Australia 2019a, What is Endometriosis?, Endometriosis Australia, viewed 22 January 2021, https://www.endometriosisaustralia.org/about-endo
• Endometriosis Australia 2019b, Webinars: Diagnosis, Endometriosis Australia, viewed 20 November 2019, https://www.endometriosisaustralia.org/webinars
• Eunice Kennedy Shriver National Institute of Child Health and Human Development 2020, What are the Treatments for Endometriosis?, National Institutes of Health, viewed 22 January 2021, https://www.nichd.nih.gov/health/topics/endometri/conditioninfo/treatment
• Healthdirect 2019, Endometriosis, Healthdirect, viewed 20 November 2019, https://www.healthdirect.gov.au/endometriosis
• Health Queensland 2019, Know the Signs and Symptoms of Endometriosis, Health Queensland, viewed 20 November 2019, https://www.health.qld.gov.au/news-events/news/signs-symptoms-endometriosis
• The Royal Women’s Hospital 2014, About Endometriosis, The Royal Women’s Hospital, viewed 22 November 2019, https://www.thewomens.org.au/health-information/periods/endometriosis/about-endometriosis/
• Sinclair, J and Armour, M 2019, ‘1 in 10 Women with Endometriosis Report Using Cannabis to Ease Their Pain’, The Conversation, viewed 20 November 2019, https://theconversation.com/1-in-10-women-with-endometriosis-report-using-cannabis-to-ease-their-pain-126516