What is Endometriosis? Endometriosis is a common gynaecological condition. It was described in medical literature more than 300 years ago and has since been recognised as a chronic, painful, and often progressive disease in women. The causes of endometriosis are unknown. Endometrial Implants Endometriosis. Endometriosis occurs when cells from the mucus membrane lining the uterus (endometrium) form implants that attach, grow, and function outside the uterus, generally in the pelvic region. What Does it Look like? Endometrial implants vary widely in size, shape, and colour. Over the years, they may diminish in size or disappear or they may grow. Early implants are usually very small and look like clear pimples. If they continue to grow they may form flat injured areas (lesions), small nodules, or cysts called endometriomas, which can range from sizes smaller than a pea to larger than a grapefruit. Implants also vary in colour; they may be colourless, red, or very dark brown. These so-called chocolate cysts are endometriomas filled with thick, old, dark brown blood that usually appear on the ovaries. Where can the Implants form? Implants can form in many areas Most Common Areas *  The peritoneum. This is the smooth surface lining that covers the entire wall of the             abdomen and folds over inner organs in the pelvic area. *   On or next to the ovaries. Less Common Areas *  The cul-de-sac, an area between the uterus and rectum. *  The Uterosacral Ligaments, the connective tissue that supports the uterus *  The vagina. *  Fallopian tube. *  In the urinary tract  *  In the gastrointestinal tract Very rare location *  has been reported in areas far from the pelvis, including the lungs and even the     arms and thighs. Process of Endometriosis The process of endometriosis mimics menstruation at certain stages: Each month, the exiled endometrial implants respond to the monthly cycle just as they would in the uterus: they fill with blood, thicken, break down and bleed. Products of the endometrial process cannot be shed through the vagina as menstrual blood and debris does. Instead, the implants develop into collections of blood that form cysts, spots, or patches. Lesions may grow or reseed as the cycle continues. They are not cancerous, but they can develop to the point that they cause obstruction or adhesions (web-like scar tissue) that attach to nearby organs, causing pain, inflammation, and sometimes infertility. What Are The Symptoms Of Endometriosis? Pain at the time of menstruation (dysmenorrhea) is the primary symptom and occurs in nearly all girls and women with endometriosis. Timing of Pain. In addition to during menstruation, endometrial pain can occur at other times of the month.  (A sharp pain during ovulation may be due to an endometrial cyst located in the fallopian tube that ruptures as the egg passes through.) Many women experience pain during intercourse. Adolescents are more likely to experience pain that occurs both during their periods and at other times in the cycle, while in older women endometrial pain is more likely to occur during menstruation. Location of Pain. Nearly all women with endometrial pain experience it in the pelvic area (the lower part of the trunk of the body). The pain is often a severe cramping that occurs on both sides of the pelvis, radiating to the lower back and rectal area and even down the legs. Occasionally, however, pain may also occur in other regions. Implants can also occur in the bladder (although rare) and cause pain and even bleeding during urination. Also rarely, implants form in the intestine and cause painful bowel movements or diarrhoea. Large cysts can rupture and cause very severe pain at any time in various locations. Severity of Pain. The severity of the pain also varies widely and does not appear to be related to the extent of the endometriosis itself. In other words, a woman can have very small or few implants and have severe pain, while those with extensive endometriosis may have very few signs of the disorder except for infertility. Infertility Infertility is the other major indication of endometriosis, particularly when dysmenorrhea is also present. Other Symptoms In addition to pain, patients may experience additional symptoms, which include the following: Fatigue Bloating Nausea Dizziness Heavy menstrual bleeding Headaches Depression and malaise (feeling generally low) Sleep problems How Serious Is Endometriosis?  Long-Term Outlook Without treatment, endometriosis gets progressively worse in most women. Even with treatment, endometriosis continues to advance in some patients. Cysts and implants may grow and spread to other parts of the pelvis, and in very severe cases, to the urinary or intestinal tracts. Eventually adhesions may form. These are dense, web-like structures of scar tissue that can attach to nearby organs and cause pain, infertility, and intestinal obstruction. Pain The most common problem for women with endometriosis is pain. The pain experienced around menstruation can be so debilitating for a lot of women with the condition. It can be incapacitated for two to six days of each month. In severe cases, regular activities may be curtailed for up to two weeks per month. For some Pain is continual. Sleeping problems have been reported in three quarters of patients, mostly due to pain. Infertility Medical literature indicates that endometriosis accounts for between 5% and 40% of infertility cases.  It should be noted that endometriosis rarely causes an absolute inability to conceive, but, nevertheless, it can contribute to it both directly and indirectly. Direct Effect of Endometrial Cysts. Endometrial cysts may directly prevent infertility in a number of ways. If implants occur in the fallopian tubes, they may block the egg's passage. Implants that occur in the ovaries prevent the release of the egg. Severe endometriosis can eventually form rigid webs of scar tissue (adhesions) between the uterus, ovaries, and fallopian tubes, thereby preventing the transfer of the egg to the tube. Emotional Effects The emotional effect of severe endometriosis can be almost as devastating as the pain. It can effect marriages and work. Women can suffer from the following emotional effects caused from having to live & battle with this condition: Depression during periods of pain. Irritability. Anxiety and anger. A feeling of being useless & frustration