Endometriosis

What is endometriosis?

In a healthy menstrual cycle, the uterine lining thickens and sheds each month. In endometriosis, similar tissue appears in areas such as the ovaries, fallopian tubes, pelvic walls, or bladder.

During each cycle, this tissue thickens and bleeds but because it’s outside the uterus, the blood has no way to exit, leading to inflammation, scarring, and adhesion formation.

The condition ranges from superficial peritoneal implants to deep infiltrating endometriosis (DIE), where lesions penetrate more than 5mm into surrounding structures including the bowel wall, bladder, and ureters. Endometriomas, blood-filled ovarian cysts also known as "chocolate cysts", are a common structural manifestation. MRI is most clinically valuable for identifying deep infiltrating disease and endometriomas, which ultrasound frequently underestimates.

Endometriosis affects millions of women during their reproductive years, but with early recognition and monitoring, symptoms can be managed effectively to support long-term health and fertility.

Symptoms of endometriosis

Endometriosis symptoms vary significantly between individuals and do not correlate reliably with lesion extent. Some women with extensive disease have minimal symptoms, while others with small implants experience severe pain. Common signs include:

• Severe period pain (dysmenorrhoea) that interferes with daily activities

• Pelvic or lower back pain present throughout the cycle

• Deep pain during or after intercourse (dyspareunia)

• Painful bowel movements or urination — particularly during menstruation; suggests bowel or bladder involvement

• Heavy or irregular menstrual bleeding

• Bloating and digestive discomfort around menstruation

• Persistent fatigue — often driven by chronic pain and anaemia

• Difficulty conceiving — endometriosis is identified in 30–50% of women investigated for infertility

What causes endometriosis?

• Retrograde menstruation: menstrual blood flows backward through the fallopian tubes into the pelvic cavity; in susceptible individuals, endometrial cells implant and proliferate

• Immune dysfunction: impaired immune surveillance fails to clear ectopic endometrial tissue; chronic inflammation perpetuates lesion growth

• Oestrogen dominance: endometriosis is oestrogen-dependent; elevated oestrogen drives implant growth and prostaglandin production, amplifying pain

• Genetic predisposition: first-degree relatives of women with endometriosis have a significantly higher lifetime risk

• Environmental factors: exposure to endocrine-disrupting chemicals may alter hormonal signalling and immune function

How is endometriosis detected?

While definitive diagnosis requires laparoscopy (surgery), pelvic MRI and blood testing can identify structural and hormonal patterns that significantly reduce diagnostic delays.

Pelvic MRI: MRI is superior to ultrasound for identifying deep infiltrating endometriosis and endometriomas. Elfcare’s full body MRI includes the pelvis as standard, directly imaging the ovaries and surrounding structures. For symptomatic women, we also offer targeted pelvic MRI for more specialized, high-resolution assessment. It can detect:

• Endometriomas: characterised by "shading" on T2-weighted MRI sequences from repeated haemorrhage

• Deep infiltrating lesions: involving the rectovaginal septum, uterosacral ligaments, bowel wall, bladder, and ureters

• Adhesions and distorted pelvic anatomy: relevant for surgical planning

• Associated findings: adenomyosis (endometriosis within the uterine wall), which frequently coexists

Blood tests cannot diagnose endometriosis directly but assess the hormonal and inflammatory environment driving the condition. Relevant markers in Elfcare's panel include:

• Oestradiol and progesterone: Assess the estrogen dominance that drives lesion growth.

• LH and FSH: evaluate the hormonal axis regulating your menstrual cycle.

• AMH: monitors ovarian reserve, which can be impacted by endometriomas.

• Iron, ferritin, and haemoglobin: iron deficiency anaemia is common from heavy menstrual bleeding

• CRP: Monitors the chronic inflammation that fuels endometriosis activity.

• Vitamin D: Deficiency is linked to increased inflammatory activity and risk.

• tTG-IgA: Rules out coeliac disease, which mimics endometriosis-related bloating and pain.

Why early detection matters

The typical 7–10 year delay in diagnosing endometriosis isn't inevitable; it often stems from normalized pain and delayed testing. During this gap, inflammation can progress into adhesions, damage ovarian reserves, and compromise fertility. Early identification, through MRI-detected lesions or hormonal blood markers, allows for immediate specialist referral and treatment to halt disease progression.

Taking a proactive approach through early screening helps you:

• Prevent complications: stop the formation of adhesions and protect your ovarian reserve.

• Hormonal balance: use lifestyle or medical guidance to manage estrogen dominance.

• Fertility planning: enable earlier assessment and proactive planning for future conception.

• Informed care: provide your gynecologist with data to move past "normal" pain.

By detecting changes early, you can access simpler, more effective treatments that preserve your long term well-being.

How Elfcare can help

Elfcare’s full body MRI provides a structural assessment of the pelvis, identifying endometriomas and deep lesions with greater accuracy than ultrasound. Our blood panel evaluates the hormonal and inflammatory markers, such as oestradiol, progesterone, and CRP, that drive the condition's progression.

Together, these tools provide the clinical evidence needed to bypass years of diagnostic delay and secure an immediate specialist referral. If any irregularities are detected, we manage all follow-up diagnostics and connect you directly with a gynaecologist.