Endometriosis is a chronic and often painful condition where tissue that is similar to the inner lining of the uterus (endometrium) grows outside the uterus. This tissue, known as endometrial implants, can develop on various organs within the pelvis, such as the ovaries, fallopian tubes, outer surface of the uterus and the tissue lining the pelvis.

During the menstrual cycle, the endometrial lining of the uterus thickens, breaks down and sheds as menstrual blood. In women with endometriosis, the implants also respond to hormonal changes during the menstrual cycle, leading to inflammation, scarring and the formation of adhesions. These adhesions can cause organs to stick together, leading to further pain and complications.

Endometriosis can affect individuals of any age who have menstrual cycles, but certain factors may increase the risk of developing the condition. These include:

• Age: Endometriosis most commonly affects women in their reproductive years, typically between the ages of 25 and 40. However, it can also occur in adolescents and postmenopausal individuals.
• Family history: Having a close relative (such as a mother, sister or aunt) with endometriosis increases the likelihood of developing the condition. This suggests a genetic predisposition to the disorder.
Menstrual history: Early onset of menstruation (before age 11), short menstrual cycles (less than 27 days) and heavy or prolonged periods may be associated with a higher risk of endometriosis.
• Menstrual abnormalities: Conditions such as irregular menstrual cycles, shorter menstrual periods, or anatomical abnormalities of the reproductive organs may be associated with a higher risk of endometriosis.
• Hormonal factors: Imbalances in oestrogen and progesterone levels may contribute to the development and progression of endometriosis. This is supported by the fact that hormonal treatments targeting these hormones can help manage symptoms.

Endometriosis manifests differently in each individual, but common symptoms include:

	Pelvic pain Debilitating pain before and during menstruation is hallmark symptom. It can also occur during ovulation too.
	Menstrual irregularities Heavy periods, irregular bleeding or spotting between cycles could indicate endometriosis.
	Painful intercourse Discomfort or pain during sex, known as dyspareunia, is a common but often overlooked symptom.
	Digestive issues Bloating, diarrhoea, constipation – endometriosis can wreak havoc on the digestive system.
	Painful bowel movements or urination Pain during bowel movements or urination, especially during menstruation, could indicate endometriosis affecting nearby organs.
	Chronic fatigue Constant exhaustion that doesn’t improve with rest can be a sign of underlying health issues like endometriosis. Chronic fatigue often accompanies the constant battle with pain.
	Infertility or pregnancy complications Difficulty conceiving or recurrent miscarriages may signal endometriosis.

Impact on mental and physical health^1,2

• Mental strain: Coping with chronic pain can lead to anxiety, depression and feelings of isolation.
• Disrupted daily life: Endometriosis doesn’t just affect periods; it affects relationships, careers and hobbies.
• Delayed diagnosis: Many suffer for years before getting a diagnosis, amplifying the emotional toll.
• Treatment trials: Managing endometriosis often involves a trial-and-error process with medications, each with its own side effects and impact on mental health.

Diagnosing endometriosis can be challenging due to the variability of symptoms and the lack of definitive diagnostic tests. Typically, diagnosis involves a combination of medical history, pelvic exams, imaging studies such as ultrasound and sometimes laparoscopic surgery to visualize and biopsy the implants.

While there is no cure for endometriosis, various treatment options aim to alleviate symptoms and improve quality of life.

Early treatment can prevent the progression of endometriosis, minimizing long-term complications such as infertility and chronic pain. Don't wait in silence; seek help from a healthcare professional as soon as symptoms arise.

Endometriosis is a complex and often misunderstood condition that affects millions of women worldwide. By shedding light on its symptoms, challenges, and the importance of early intervention, we can empower individuals to seek help, advocate for their health, and find support in their journey toward managing endometriosis.

Together, through education, awareness, and compassion, we can break the silence surrounding this silent struggle and offer hope to those affected.

References

1. Szypłowska M, Tarkowski R, Kułak K. The impact of endometriosis on depressive and anxiety symptoms and quality of life: a systematic review. Front Public Health. 2023;11:1230303.
2. van Barneveld E, Manders J, van Osch FHM, et al. Depression, Anxiety, and Correlating Factors in Endometriosis: A Systematic Review and Meta-Analysis. J Womens Health (Larchmt). 2022;31(2):219-230.