What is endometriosis?
Endometriosis is a condition when cells from the inside lining of the uterus are found outside the uterus. It can lead to painful period, pelvic pain and difficulty in getting pregnant. Endometriosis is a very common condition affecting up to 1 in 10 women of reproductive age. There is usually a delay in the diagnosis of endometriosis, averaging up to 10 years.
What causes endometriosis?
The are a few theories on how endometriosis occurs. The most common theory is retrograde (backwards) menstruation. When a woman has a period, the blood flows out of the vagina, but also backwards along the fallopian tubes into the pelvis. In some women, this endometrial tissue starts to grow outside the uterus.
A major risk factor for endometriosis is family history. Women who have a close relative with endometriosis are up to 7-10 times more likely to get the condition.
Other risk factors of endometriosis are:
- having first pregnancy at an older age
- heavy bleeding during periods and longer lasting periods (more than five days)
- having shorter regular menstrual cycles
Symptoms of endometriosis
The symptoms vary from woman to woman. Some women have many symptoms and severe pain, whereas others have no symptoms.
Pain: the pain occurs in places that the endometriosis has grown. It is mostly in the pelvis. For many women, the first thing they notice is worsening pain with periods. Women with endometriosis often have pain with sex too.
Heavy Periods: some women may experience changes in their menstrual cycle which can be a sign of endometriosis, with some experiencing heavy periods especially if they also have adenomyosis.
Infertility or problems conceiving: endometriosis can make it difficult to get pregnant. Some women only have endometriosis diagnosed when they start trying to get pregnant, with up to 25% of women presenting with infertility if they have endometriosis.
Diagnosing endometriosis
Endometriosis is diagnosed through a laparoscopy. If endometriosis is seen during laparoscopy, it can be removed at the same time and confirmed through testing (biopsy).
In the majority of women with endometriosis, the endometriosis found in the pelvis has only implanted superficially on the internal lining of the pelvis and abdomen (called peritoneum) or surface of pelvic organs such as uterus or ovaries. Superficial lesions of endometriosis can never be diagnosed on imaging tests such as ultrasound or MRI as they have no real mass. Ultrasound or MRI can however detect severe endometriosis and endometriosis cysts in the ovaries (endometrioma – chocolate cysts) because they form a mass in the pelvis.
Endometriosis can be classified as mild, moderate or severe depending on what is found at the time of surgery. However the severity of endometriosis does not always correlate with severity of symptoms. Women with mild endometriosis can experience severe symptoms, while women with severe disease may have mild or no symptoms at all.
What treatments are there for endometriosis?
Endometriosis is a chronic disease, however there are many treatments available to manage it. Treatments include medical and surgical options; but it is always best to talk to your gynaecologist for treatment options.
Medications include non-hormonal medications to treat pain – such as anti-inflammatory analgesia, and hormonal medications to control or stop menstrual periods – such as the contraceptive pills or progesterone (oral progesterone or progesterone containing intrauterine device). Hormonal medications also aim to suppress the growth of endometriosis.
Surgery usually involves a laparoscopy to excise the endometriosis. The goal of surgery is to completely remove the endometriosis and scar tissue in the safest manner. A majority of women have less pain after the surgery. However, surgery is not curative and there is a good chance the endometriosis will eventually recur and pain returns. Hormonal treatment after surgery such as hormonal contraceptive pills or intra-uterine device can reduce this chance.
A hysterectomy is occasionally recommended to treat endometriosis. It is recommended to women who continue to have severe symptoms despite other treatments, and have completed their family.
Kent is available to see his private patients in Epworth Freemasons in East Melbourne and Werribee.
What happens if endometriosis is left untreated?
If left untreated, some endometriosis will improve, while some will become more severe, leading to more severe period pain, bladder and bowel irritability, reduced fertility. Endometriosis is diagnosed through a laparoscopy. Removing it safely and sending it for confirmation through biopsy is essential. After surgery, treatments are usually offered to help relieve the symptoms rather than curing endometriosis itself. The risks and side effects of any treatments need to be balanced against how these symptoms are affecting your daily life. These symptoms will settle in most women once they go through the menopause.
Can endometriosis make you infertile?
Endometriosis is a common cause of reduced fertility as severe endometriosis can distort the tubes and ovaries. Scarring (adhesions), inflammation of pelvic organs, changes in immune functioning, impaired implantation, changes in egg quality associated with endometriosis may play a part in this. Approximately 25-50% of women with endometriosis have reduced fertility. While 25-50% of women having difficulty conceiving are subsequently also diagnosed with endometriosis.
Is there a cure for endometriosis?
Although there is no cure for endometriosis, there are many treatments options available to manage the pain associated with endometriosis – simple pain relievers, hormonal therapies, surgery such as laparoscopy, physiotherapy and other complementary therapies. These treatments aim to ease symptoms of endometriosis and minimise its impact on quality of life.
Further Information
Link to RANZCOG Patient Information on Endometriosis.
