Endometriosis is a chronic, inflammatory gynaecological condition that causes significant pain and infertility. It is surprisingly common, affecting 1 in 10 women during their reproductive years, and approximately 176 million women worldwide.
Endometriosis occurs when tissue that normally lines the uterus (known as the endometrium), grows in and around other organs in the body. These ‘stray’ endometrial tissues are known as endometrial ‘implants’ or ‘lesions’. Organs affected by endometriosis include the ovaries, fallopian tubes, bowel, the lining of the pelvis, cervix, vagina, vulva, ureters and bladder.
As the stray endometrial tissue implants and grows, it continues to behave as it does inside the uterus - thickening, breaking down and bleeding with each menstrual cycle. But because the tissue can’t exit the body like normal menstrual blood does, it remains trapped in the pelvis where it causes irritation and inflammation in the surrounding pelvic organs. The presence of stray tissue also causes the formation of scarring and ‘sticky’ adhesions that bind pelvic organs together. As a result, normal bodily functions such as ovulating, having sex, and going to the toilet can become extremely painful, and fertility can be compromised.
While the precise cause of endometriosis is not known, there are a range of factors that put women at increased risk of developing this condition. Known as ‘risk factors’, these include:
There are a range of common symptoms associated with endometriosis. These include:
The type of endometriosis symptoms experienced varies depending on the location of the stray endometrial tissue. Symptom severity also varies from mild to severe, although symptom severity is not a good indicator of the extent of the condition, as women with mild symptoms can have severe disease and women with severe symptoms can have mild disease.
By now you might be wondering why a blog dedicated to the FODMAP diet for IBS might be discussing endometriosis. There are a few reasons for this:
The two conditions share common symptoms (e.g. visceral hypersensitivity, bloating, diarrhoea or constipation, pain on defaecation, nausea, and·reduced quality of life). This makes distinguishing between the two conditions difficult, raising the possibility of misdiagnosis and/or delayed diagnosis.
Also, because gastrointestinal symptoms are common in endometriosis, a low FODMAP diet is often used to manage these symptoms. While research is underway to determine the efficacy of a FODMAP diet in this population, we don’t yet know if it works.
Because of these overlapping symptoms, it is recommended that endometriosis is ruled out before a diagnosis of IBS is made in women in their reproductive years. Red flags that signal the possible presence of endometriosis include:
If you suspect you have endometriosis, it is important to seek help. See your GP and ask for a referral to a gynecologist. While many women wait 7-10 years before receiving a diagnosis, early diagnosis and treatment can reduce the severity of the condition. The only way to accurately diagnose endometriosis is with a laparoscopy. This ‘keyhole’ surgical procedure involves the insertion of a thin tube (telescope) with a light (laparoscope) into the abdomen via a small cut in the belly button. The gynaecologist can then see if there are any endometrial deposits inside the pelvis. If endometriosis is detected, it is removed during the procedure, often providing immediate symptom relief.
There are a range of treatments available to women with endometriosis, including:
Endometriosis is a surprisingly common condition, affecting one in 10 women. Although effective treatments are available, mis-diagnosis and delayed diagnosis are common. If you suspect you have endometriosis, seek help. We recommend you see your GP and get a referral to a gynecologist.