But in some women, the cells which make up the womb lining deposit themselves outside the womb. These deposits are called Endometriosis. They can be found virtually anywhere in the body but mainly occur on the walls of the pelvis, the outside of the uterus, on the ovaries and even on parts of the bowel near to the womb itself. In rare cases deposits of Endometriosis have been found in distant parts of the body such as the eyes, lungs and even the nose.

Like the normal lining of the womb itself, deposits of Endometriosis respond to hormones from the ovary. They grow in size and eventually bleed in a similar manner to the normal period. But, because of their location, they often induce inflammation, which in turn causes the typical symptoms of Endometriosis.

How do I know if I've got Endometriosis?
The most common symptoms are:

• Pre-menstrual pain
  
• Painful periods
  
• Pain during intercourse - often worse just prior to a period
  
• Pain during defecation or passing urine
  
• Monthly bleeding from bowel, bladder or umbilicus (rare)
• Infertility

How common is it?
Around 10 to 15% of women are said to have Endometriosis. The severity of the condition varies from woman to woman. Interestingly, there doesn't appear to be any relationship between the amount of Endometriosis and the severity of symptoms. One woman may have a small amount of Endometriosis, but only mild symptoms, while another may have extensive Endometriosis but no symptoms at all.

What causes Endometriosis?
Although there are several theories, the cause of Endometriosis remains unclear.
One of the most popular theories is that it occurs a result of back-flow of menstrual blood into the abdominal cavity via the tubes during a normal period. This doesn't really stand up because doctors have now discovered this occurs normally in most women.

It's more likely that the causes of Endometriosis are more complex. Scientists now believe that it has something to do with the way the immune system deals with menstrual blood in the abdominal cavity.

How is Endometriosis diagnosed?
Having a history of symptoms suggests a high likelihood of Endometriosis.
An ultra-sound scan of your pelvic region may be helpful, because when Endometriosis occurs on the ovaries it often causes readily visible cysts.

Ultimately, the best method of diagnosing Endometriosis is to perform an operation called a Laparoscopy, a keyhole operation to look directly into the abdomen and pelvis, allowing an accurate diagnosis to be made. Although this is performed under general anaesthetic most women don't need to stay in hospital overnight.

Will having Endometriosis make me infertile?
There is a link between Endometriosis and reduced fertility. If a woman has severe Endometriosis it often causes severe damage and scarring to her fallopian tubes and ovaries.

However, even women with minimal or mild Endometriosis may have reduced fertility. No-one's certain exactly why this is so. Most women who have mild Endometriosis and can't conceive are given fertility treatment.

How is Endometriosis treated?
There are a number of options, including drug treatment and surgery.

1) Drug treatments:
Most drug treatments are hormonally-based and designed to stop deposits of Endometriosis growing again and again (this happens when they're stimulated by the normal production of hormones from the ovaries). The main drugs used for the treatment of Endometriosis are:

• Contraceptive pill
  
• Danazol
  
• Gestrinone
  
• Progestagens
  
• GnRH agonists

As with any hormonal preparations, it is not uncommon to experience side effects when taking these drugs and you should ask your doctor about these before you start.
Usually, you will need to take drugs for at least six months. Unfortunately, when the drugs are stopped some women will gradually get a recurrence of symptoms, although your symptoms won't be as bad as before. You may need to repeat drug treatments several times.

2) Surgery:
Surgery can also be used to treat Endometriosis.
Using the Laparascopic keyhole surgery technique, visible areas of Endometriosis can be destroyed using a laser or hot wire (called a diathermy). This technique can also be used to drain or remove cysts which have occurred on the ovaries due to Endometriosis.

3) Hysterectomy:
If you have severe symptoms and have completed your family, or no longer wish to be fertile, you might consider having a hysterectomy - the removal of your womb - together with the removal of your ovaries (so hormones stimulating Endometriosis are no longer produced). This will lead to long term relief from symptoms.

Note: Just having your womb removed won't be enough to cure your Endometriosis. You will need to have your ovaries removed too. That's because deposits of Endometriosis may be spread widely throughout the pelvis and if the ovaries remain, ongoing stimulation will occur despite removal of the womb.

Having a hysterectomy is a drastic measure, so it's usually a last resort, after other treatment methods have failed.

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