What is Endometriosis?

Endometriosis is a disease characterized by the presence of tissue resembling the endometrium (the inner lining of the uterus) outside the uterus. This triggers chronic inflammation with the formation of scars (adhesions and fibrosis) within the pelvis and other areas of the body.[i] Like the lining of the uterus, the extrauterine (outside the uterus) endometrial tissue grows under the influence of the major female hormone oestrogen.

The most common sites for growth of endometrial tissue in the pelvis are; the ovaries (96.4%)[ii], fallopian tubes, pelvic peritoneum and uterosacral ligaments. It may also grow on the gastrointestinal tract, urinary tract, abdominal wall and sometimes in the chest (alternatively called the “extra pelvic” sites)

[i] https://www.who.int/news-room/fact-sheets/detail/endometriosis

[ii] Lee, H. J., Park, Y. M., Jee, B. C., Kim, Y. B., & Suh, C. S. (2015). Various anatomic locations of surgically proven endometriosis: A single-center experience. Obstetrics & gynecology science, 58(1), 53–58. https://doi.org/10.5468/ogs.2015.58.1.53

The endometrial cells:

may start to grow and form patches or nodules on the affected organs
has the same cyclical/menstrual changes as that inside the uterus
may bleed at the same time as your period (menstruation).

Endometrial tissue found outside the uterus grows to form lesions or patches that bleed and leak fluid in response to your hormones at the time of the period. This leads to inflammation and scarring.).

How common is the problem? (Epidemiology).

Worldwide, it is estimated that endometriosis affects 1 in 10 women and girls of reproductive age. There is a dearth of data on the prevalence of Endometriosis in Women in Africa. Some studies showed the prevalence to range between 0.2-48.1%.

[i] The prevalence is higher in women with infertility and those with chronic pelvic pain.[ii]

[i] Wanyoike, G. , Parkar, R. and Wanjiru, N. (2017) Systematic Review of Prevalence of Endometriosis among Indigenous Africans. Open Journal of Obstetrics and Gynecology, 7, 835-845. doi: 10.4236/ojog.2017.78084.

[ii] https://www.medscape.com/answers/271899-6223/what-is-the-prevalence-of-endometriosis

There may be different forms or types of endometrios:

Superficial endometriosis: here, superficial areas of disease appear on the lining of the pelvis and abdomen (called the peritoneum). These do not invade deeply into the tissues, however can still cause significant pain.
Deep-infiltrating endometriosis: endometriosis lesions do invade deeply (more than 5mm) into the tissues and can lead to scarring and nodules. These can grow into nearby organs, such as the bladder, bowel , appendix and ovary
Ovarian disease: this may occur and is often considered a separate form of the disease. Here, burrowing lesions on and under the ovaries can lead to the development of ‘chocolate cysts’ or endometriomas
Adenomyosis: the endometrial cells grow inside the muscle of the uterus
Outside the pelvis: this is rare
Upper abdomen, eg on the diaphragm(most common area outside of the pelvis)
In the liver, nose, eye, lungs (these are rare)
Abdominal wall: often associated with previous operation scarring. (usually following caesarean section)

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