A Guide To Endometriosis

The condition has made the headlines as of late thanks to actress Lena Dunham – who revealed in this month’s Vogue she recently underwent a total hysterectomy as a result of the condition – and statistics, which have shown the number of those with the condition in Britain is on a par with diabetes. We spoke to consultant gynaecologist Mr Narendra Pisal on behalf of betty.me to find out more.

What exactly is endometriosis?

Endometriosis is a condition where the lining of the uterus (also known as endometrium) is found outside the uterus. When you have your period, this tissue swells up and bleeds, but unlike the tissue in the womb, this blood has nowhere to escape. This internal bleeding leads to intense pain, inflammation and the build-up of scar tissue.

Who’s at risk?

An estimated two million women in the UK are affected by endometriosis, with the majority aged between 25 and 40. If your mother or sister has endometriosis there’s a higher chance you’re likely to suffer with the condition too.

What are the symptoms?

While pain – during periods and intercourse as well as pelvic pain that sometimes lasts throughout the monthly cycle – is one of the most common symptoms, endometriosis symptoms can vary between individuals. Bleeding or spotting between periods can also be a symptom, as well as painful bowel movements, fatigue, back pain, irregular periods and even depression.

Which symptoms strongly suggest you have the condition?

The most common signs of the condition are severe pain during periods and heavy bleeding. Most women with endometriosis experience the pain in the area between their hips and top of their legs, with some getting this pain constantly.

How do you get tested?

Go to your GP with a diary of your menstrual cycle, making a note of how heavy or painful your periods are and any other symptoms you experience. Also, record how much pain relief you have had to take, including any days off work. Presenting your symptoms systematically like this will help a diagnosis.

And why do so many people struggle to get tested?

Because endometriosis manifests itself in a variety of ways and shares symptoms with other conditions, diagnosis can be difficult and often delayed. The only definitive way to diagnose endometriosis is by a laparoscopy – an operation in which a camera is inserted into the pelvis via a small cut near the navel – which is an invasive procedure and often not recommended if the condition can be ‘tamed’ with treatments like going on the contraceptive pill.

Scans, blood tests and internal examinations are not a conclusive way to diagnose endometriosis and a normal scan, blood test and internal examination does not mean that you do not have endometriosis.

Many women are told to get on with it and simply put up with ‘that time of the month’. However, if you have to put your life on hold every month or if your sex life is affected by pain during sex, it’s time to take note and ask for some tests.

Can it affect fertility?

Endometriosis can make it more difficult for you to get pregnant if scar tissue forms. However, if you have endometriosis and are already pregnant it’s unlikely to cause complications. Happily, pregnancy can sometimes offer temporary relief from symptoms, although it won’t cure the condition.

What are the treatment options?

Endometriosis can be treated by hormones or surgery – taking three packs of the contraceptive pill together without a break, known as tri-cycling, is the easiest form of treatment. It works by giving your body an opportunity to heal due to the longer gap between periods. When it comes to surgery, keyhole surgery is often used to cure the condition and remove scar tissue.

Is there anything you can do to manage the condition?

According to nutritional therapist Laura Southern, nutrition can play a role in easing symptoms by supporting the immune system and inflammation. A good starting point for diet changes are as follows:

• Ensure your diet is high in brightly-coloured, fresh vegetables to support both immunity and detoxification. Choose from the green ‘brassica’ family, such as broccoli, Brussel sprouts and kale, and add lots of deep red and purple vegetables; beetroots, purple ‘heritage’ carrots, red onions, red cabbage. Make soups and stir fries to maximize vegetable intake.

• Include lots of foods rich in ‘essential fat’ for their anti-inflammatory benefits. Eat oily fish such as salmon, mackerel, trout, herring and sardines two to three times per week and have a handful of raw nuts and seeds daily; try almonds, pumpkin seeds, pine nuts, walnuts and chia seeds. Use a good quality olive oil or flax oil on salads.

• Be wary of too much caffeine, tobacco and alcohol, which all place strain on the liver.

What would your advice be to someone who thinks they may have endometriosis?

Arrange a consultation with your GP and ask to be referred to a specialist. You can also visit BSGE.org.uk to look at accredited specialist centres. Whilst taking the contraceptive pill back-to-back can be a good treatment for some, it should only be started after specialist advice.

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