Endometriosis

Endometriosis is defined as the presence of endometrial-like tissue outside the uterus. Endometriosis triggers a chronic inflammatory reaction resulting in pain and adhesions. Adhesions develop when scar tissue attaches separate structures or organs together. The activity and the complaints due to endometriosis may vary during the woman’s menstrual cycle as hormone levels fluctuate. Consequently, symptoms may be worse at certain times in the cycle, particularly just prior to and during the woman’s menstrual period. 

While some women with endometriosis experience severe pelvic pain, others have no symptoms at all or regard their symptoms as simply being ‘ordinary menstrual pain’. In rare instances, cyclical pain can also involve the upper part of the abdomen e.g., under the ribs or the chest.

It is estimated that between 2 and 10% of the women within the general population have endometriosis and that 30% – 50% of the infertile women have endometriosis.

Women with endometriosis often experience severe symptoms and significantly reduced quality of life, including restraint of normal activities, pain/discomfort, and anxiety/ depression.

Because the symptoms of endometriosis are not very specific, the diagnosis of endometriosis cannot be made by the symptoms alone. However, symptoms can give a doctor a first hint towards the diagnosis of endometriosis.

The symptoms of endometriosis are:

  • Painful menstrual periods (dysmenorrhea)
  • Non-menstrual pelvic pain or pain occurring when a woman is not menstruating.
  • Pain during or after sexual intercourse (dyspareunia)
  • Pain emptying bladder/painful urination (dysuria)
  • Pain emptying bowel (dyschezia)
  • Painful rectal bleeding or the presence of blood in the urine (haematuria)
  • Shoulder tip pain
  • Cyclical lung problems (pneumothorax)
  • Cyclical cough, chest pain, or coughing of blood (haemoptysis)
  • Cyclical scar swelling and pain
  • Fatigue
  • Infertility
  • Any other cyclical symptom

Cyclical symptoms are symptoms that develop a few days before a woman’s menstruation and disappear a few days after her menstruation has stopped, or symptoms that occur only during the menstruation. The symptoms reappear the next month, following the woman’s menstrual cycle. Severe pain can be measured by not doing your normal daily activities (without taking pain medication).

In 2022, ESHRE European Society of Human Reproduction and Embryology, elaborated on recent data for non-medical management strategies for relieving endometriosis associated pain, and improving quality of life by including more recent studies on acupuncture, physical therapies, psychological interventions, electrotherapy and traditional Chinese medicine and nutrition.