You’ve likely heard of endometriosis, and you might have a vague idea of what it is, but far fewer of us understand the ins and outs of the condition. Affecting roughly 190 million women and girls worldwide with impacts not only on their day-to-day lives but also their chances of conceiving, endometriosis isn’t something to be overlooked.

Endometriosis - what is it? 

So what exactly is endometriosis? Well, it’s a condition where the tissue that lines the womb starts to grow elsewhere, such as in the ovaries or fallopian tubes. Just like the lining of the womb, endometrial tissue located outside of the uterus responds to hormonal changes during the menstrual cycle and breaks down, causing a bleed. This abdominal bleeding then leads to inflammation, scarring and the swelling of regular tissue around the affected area. 

Anyone with a womb can get endometriosis at any time in their life - even teenagers. Currently, there is no cure for endometriosis, but there are a range of treatments that can make the long-term condition easier to deal with. 

What are the 4 stages of endometriosis? 

Endometriosis affects different people to different extents, which can make it difficult to tell what is needed to help them. Therefore, four stages of severity can be used to try and clarify how medically significant a person’s endometriosis is, based on the degree of misplaced tissue. These four stages are:

1. Minimal
2. Mild
3. Moderate
4. Severe

These stages don’t necessarily reflect the impact endometriosis has on your life. Instead, they look at the spread of endometrial tissue, whether other pelvic structures are affected and whether there are blockages in the fallopian tubes. This means that someone with stage one endometriosis could be in significantly more pain than someone with stage four endometriosis.

How to know if you have endometriosis

If you think you might be suffering from endometriosis, it is important to present a comprehensive list of your symptoms to your doctor. Keeping an up-to-date symptoms diary can be very helpful with this, as it makes it easier for you to keep track of which symptoms have happened when. This can also assist you and your doctor in spotting patterns or triggers. 

Symptoms you should be aware of include: 

• Pain in your abdomen or lower back (pelvic pain) that usually gets worse during your period - particularly if your period pain stops you from getting on with your everyday tasks
• Pain during or after sex - especially if it doesn’t stop when using lubricant
• Pain when using the toilet during your period
• Vomiting, diarrhoea or constipation during your period
• Blood in your urine or stools during your period
• Difficulty conceiving or female infertility
• Excessive, prolonged or heavy bleeding during your period

In addition to the symptoms listed above, endometriosis can also affect your mental health because of the impact it has on your lifestyle. This can lead to feelings of anxiety or depression. Some women, on the other hand, may be almost or entirely asymptomatic (meaning they don’t experience any symptoms of endometriosis) and not know about the problem until they try to conceive.

Unfortunately, many of the symptoms of endometriosis are also symptoms of various other health conditions, which can make diagnosis difficult. Usually, your doctor will physically examine your abdomen or vagina to try to rule out other causes of abdominal pain such as appendicitis or peritonitis. If they think it is endometriosis, they’ll recommend treatments. Often, a laparoscopy, ultrasound or MRI scan will only be suggested if these initial treatments are unsuccessful. 

What causes endometriosis? 

Currently, it isn’t known what causes endometriosis, which is part of the reason why there is no cure for the condition. It also makes it difficult to know how to prevent endometriosis developing in the first place. For this reason, treatments usually focus on limiting the symptoms, such as taking painkillers and using fertility treatments.

Some theories that have been suggested are: 

• Gene involvement, as patterns suggest you are more likely to have endometriosis if your mother, sister or daughter has it
• An impairment of the immune system, which defends your body against infection and illness
• Endometrial cells being spread through the body via the lymphatic system or the bloodstream

However, these theories have not been confirmed. As yet, it’s unclear what causes endometriosis, but some medical experts think it might be a number of factors, rather than one single cause. 

How common is endometriosis? 

Endometriosis is believed to affect as many as 10% of women and girls across the globe. However, that number is likely to be greater as many women lack access to healthcare facilities to get a diagnosis. Also, of those women who do have access to the appropriate healthcare services, the similarities of endometriosis symptoms to those of other diseases can hamper diagnosis.