March is Endometriosis Awareness Month and Dr Gareth Nye, a lecturer at Chester Medical School who specialises in female health, explains more about the medical science behind this condition and why we need to know more.
The facts:
- One in 10 women, from puberty to menopause, suffer from endometriosis;
- Current estimates say 176 million women worldwide have the condition;
- Infertility is present in 30 to 50% of patients;
- 54% of the general population do not know what it is – and that's not just men.
What is endometriosis and why should we care?
Dr Nye explains: “It has been estimated that one in every 10 women between 15 and 49 suffer from endometriosis, affecting approximately 176 million women in the world, or nearly three times the population of the UK.
“It develops when the cells/tissue that resemble the part of the womb which sheds during menstruation are found in locations outside of the womb. This can occur in a number of places, but in 60 per cent it’s found in the ovaries, leading to the fertility issues.
“This tissue is found by the immune system, which thinks it is harmful to the body and acts to remove it, leading to inflammation and pain. To make matters worse, the tissue is still acting like the endometrial lining and so, as the monthly hormonal cycles occur, you can see the growth of the tissues and even bleeding.
“It’s because of this that endometriosis is such a long-term disease, with a significant impact on a patient’s life and wellbeing. It’s been reported that the associated healthcare costs and time of work costs the UK economy £8.2 billion a year.”
Dr Nye says this condition is poorly understood by the general public and even some clinicians, as highlighted by recent research from Endometriosis UK which states that 54 per cent of people don’t even know what this condition is – and that includes women and men.
What’s normal and what goes wrong?
Within the female reproductive system the ovaries produce eggs which are normally released monthly and travel down the fallopian tubes to implant into the endometrium of the womb.
The accepted theory as to why endometriosis occurs is related to the monthly shedding of the endometrium during menstruation. Backflow of this womb lining causes travel to the uterine tubes.
This occurs in 90 per cent of women. The idea is that material can leave the uterine tubes via the small gap between ovary and tubes and move around the body, settling down in different regions. This explains why the ovary is the most likely place for endometriosis to occur. Endometriosis is also rarely seen in the bowel, kidneys and lungs leading to irregular symptoms and a difficult diagnosis.
Dr Nye says: “Most patients report some pain but symptoms can range widely from patient to patient and also vary depending on the time of the month as the hormonal changes occur during the normal cycles.
“Other symptoms include chronic pelvic pain, painful periods, painful sex, bowel and bladder problems and tiredness. What is more significant to women suffering with this condition however, is that in a third of cases infertility is reported.
“Infertility in anyone obviously has huge physical and emotional effects. The fact that girls as young as 15 can develop endometriosis has further implications when considering infertility.
“In all cases, it is a chronic, debilitating disease which is extremely painful, leads to lack of energy and depressive feelings and has an impact on both work and social activities.”
What’s needs to happen?
Dr Nye says: “It currently takes on average seven and half years from first symptoms to formal diagnosis. This is due to the symptoms replicating many other diseases and women considering symptoms as heavy menstrual flow and pain as not serious.
“In addition, there is a wide felt taboo around discussing women's reproductive conditions and some women may feel unable to seek help. This is made worse as over half of non-gynaecologists reportedly are not familiar with the correct guidelines.
“Many centres globally are looking at new ways to diagnose endometriosis rapidly and effectively although this is currently some way off but will undoubtedly improve the current time to diagnosis.”
There is currently no cure for endometriosis even when diagnosed. Most treatment options involve basic pain relief, although changing the body’s hormones through medication or surgery to remove the affected part are also options.
Dr Nye adds: “With other conditions, such as menopause, having widespread coverage now, we may begin to see knowledge and understanding improving in the general population.
“Endometriosis Awareness Month is a major spearhead to raise much-needed awareness and there are many events seen all around the world in support of this campaign. Ultimately though, society and people in power must understand what a life-changing disorder endometriosis really is before we see tangible change.”
He added: “At Chester Medical School, we put the study of reproduction, pregnancy and maternal health throughout our core modules at every level of study on every course. We realise that some of the biggest diseases and problems the world currently faces start before we are even born during the critical nine months of pregnancy.”
To find out more about the courses at Chester Medical School, visit https://www1.chester.ac.uk/chester-medical-school
