“Endometriosis” describes deposits of ectopic endometrium outside the uterus. Traditionally, gynaecologists believe that these “deposits” of endometrium bleed during your period and cause pain. A better view is that the pain is caused by injuries to your pelvic nerves. These injuries are caused by difficult first labours, straining on the loo, and, gynaecological surgery (GS Atwal, 2005).
”Endometriosis” was first described in 1860 though it has had many reincarnations since that date. The theory associated with deposits of ectopic endometrium has, therefore, had 150 years to cement itself into medical minds and habits. Injured nerves were discovered in 2005 ! So it is going to take a little while to change hearts and minds ? And it is not going to be easy because many doctors make enormous sums of money ablating, or excising, ectopic endometrium.
What is the evidence that ectopic endometrium causes “cyclical, premenstrual pain” ? There is NONE. But that does not stop muti-disciplinary teams of surgeons doing all-day operations to excise and ablate these deposits. WIth no benefit to the woman ! She still has her injured nerves and her pain – but she has been through a very dangerous procedure with no benefit to her ? She would be much safer with an MRI scan and medical treatment. Treatment is to “reduce pelvic blood flow” using OCP, Mirena IUS (with or without endometrial ablation) and, in very severe cases, oophorectomy.
This website will provide the relevant evidence to support the “autonomic denervation” (injuries to nerves) view.