Endometriosis - sometimes it's hard to be a woman

As the old Country and Western song goes, 'Sometimes it's hard to be a woman' - and rarely is that more true than if you're one of the 1.5 million women in Britain thought to suffer from endometriosis.

As the old Country and Western song goes, 'Sometimes it's hard to be a woman' - and rarely is that more true than if you're one of the 1.5 million women in Britain thought to suffer from endometriosis. This women-only condition is fuelled by oestrogen, and happens when tissue lining the inside of the womb (called the endometrium) goes somewhere other than out when you shed a layer of lining during your period. The tissue is thought to travel backwards, up into your fallopian tubes. From there it can spill out and attach itself to your ovaries or the outside of your bladder, bowel or womb. These cells are still primed to respond to your body's natural surges in oestrogen, but they are trapped inside your pelvis. Perhaps not surprisingly, one of the most common symptoms is severe period pain, but it can also cause persistent pelvic pain, make sex too painful to contemplate and affect your fertility. Symptoms tend to settle once your oestrogen levels drop after the menopause, but that's scant comfort for a 25-year-old.

This week is endometriosis awareness week and the charity Endometriosis UK is launching a campaign called 'It's okay to talk. Period.' While the C list celebrities may be happy to offer all the gory details of their personal lives to the tabloids, most of us are rather more coy about telling all, even to our closest friends. Teenagers and young women in particular may put up with debilitating symptoms because they don't realise it's not normal, or they're too embarrassed to seek help. If they do talk, it's often to their mum or an older female relative - but endometriosis often runs in families, so their mum may not realise what they're going through isn't 'normal' either.

On average, it's thought to take seven years to be diagnosed with endometriosis. Of course it's hard to be accurate because years down the line women often can't remember how long they've been suffering. Only one of the problems is delay in seeking medical help. Another is that it's not that easy to diagnose. The 'gold standard' test is a laparoscopy in which a small telescope is passed into the stomach under general anaesthetic. It can't be diagnosed with certainty just by examining you, and traditional ultrasound examination of the pelvis often doesn't pick up endometriosis accurately.

Once it's diagnosed, there are effective treatments available - either to relieve symptoms or to improve fertility. Left untreated, endometriosis improves on its own in about one in three women, but gets worse in almost half of cases. In mild cases, painkillers may be all that's needed - but for more troublesome symptoms, there are a variety of hormone-related options. For instance, if you don't want to get pregnant, the combined oral contraceptive pill or the hormone-releasing contraceptive coil, Mirena®, can ease pain as well as period problems. Otherwise, surgery can be used to remove larger patches of endometriosis - again carried out using laparoscopy.

But to get access to treatment, you need a diagnosis; and to get a diagnosis you need to speak to your doctor about your concerns. You may get relief from years of misery if you discover that it's good to talk. Period.

Dr Sarah is unable to provide medical advice or respond directly to questions concerning your health. If you have health concerns we recommend contacting your GP.