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Endometriosis

Endometriosis is a common gynaecological condition affecting women of reproductive age. The average age of a woman suffering endometriosis is 27 years.

It can cause Chronic Pelvic Pain and Infertility.

Unfortunately, women spent several years searching for the cause of their pain and/or infertility before receiving the diagnosis of endometriosis.

What is Endometriosis?

Endometriosis occurs when the glandular tissue resembling the inner lining of the uterus (or endometrium) grows outside the uterus, pelvis, ovaries or other pelvic organs or structures in the body.

Where does Endometriosis Occur?

Endometriosis can occur in the pelvic organs which include

ovaries,
the outer surface of the uterus,
the Fallopian Tubes,
the lining of the pelvic cavity,
the tissues that hold the uterus in place (uterosacral ligaments).

It can also involve the vagina, cervix, vulva, bladder and bowel (including rectum and appendix).

In rare cases, it has been found in other parts of the body such as diaphragm, lungs, brain and skin.

How can Endometriosis Affect a Woman?

Endometriosis is

one of the top three causes of female infertility
the most common cause of pelvic pain in women between age 10 and 50 years.

Symptoms of Endometriosis

Patients may experience

painful cramps in the lower abdomen, back or in the pelvis during menstruation
pain during intercourse,
heavy menstrual bleeding,
abnormal bleeding between periods,
painful bowel movements or urination and
infertility

Causes of Endometriosis

The exact cause of endometriosis is not known. It is thought to possibly relate to:

Genes have been isolated which are associated with severe endometriosis.
Associated with a defect in the immune system,
Developmental abnormality during the growth of the embryo, or
Retrograde menstruation (the blood flows into the pelvic cavity instead of outside through the vagina).

Other factors could involve environmental factors including:

stress, dioxins and,
xenoestrogens.

There have not been shown to be valid concepts of aetiology.

Diagnosis of Endometriosis

Endometriosis may be suspected when clinical history is suspicious. Your doctor will:

ask you about your general health and symptoms, and
perform a pelvic examination to feel for the presence of large cysts or scars.

Ultrasound

Using an ultrasound scan may also be performed by your doctor to look for ovarian cysts (ovarian endometriomas). Where abnormalities may be seen.

Pathology

Sometimes, a pathology test can be used to measure raised levels in the tumour marker CA125 which can suggest endometriosis.

Laparoscopy

The only direct way to diagnose endometriosis is by visualising it during Laparoscopy prove it's existence.

This can be done by diagnostic Laparoscopy which is a day procedure under general anaesthesia. A Laparoscopy involves a thin long camera that is inserted through an incision in the abdomen. A biopsy is taken for histopathological testing.

Treatments for Endometriosis

There are several treatment options available to minimise the pain as well as control heavy bleeding.

Pain Medication for Endometriosis

Pain Medication: Over the counter pain relievers may be helpful for mild pain, such as non-steroidal anti-inflammatory medications or paracetamol.

Other forms of simple analgesia (over the counter pain relievers) may be helpful for mild pain.

Sometimes stronger medication is required. Non-steroidal anti-inflammatory medications can be prescribed by your doctor in cases of severe pain.

Hormone Treatment for Endometriosis

Hormone Treatment can suppress the activity of endometriosis or decrease recurrence after surgical treatment. This is not appropriate when wanting fertility.

Hormone treatment is recommended if there are small growths or mild pain. Progesterone type medications or a medication that decreases or blocks the production of Oestrogen.

Progesterone can be

an oral pill (Visanne),
injections,
intra-uterine device (Mirena).

Birth control pills help to decrease the amount of menstrual bleeding.

Hormone Treatment can suppress the activity of endometriosis or decrease recurrence after surgical treatment. This is not appropriate when wanting fertility.

Surgery for Endometriosis

Surgery is the best option for women trying for fertility, as well as those with severe pain. Surgery is an option for women who have:

● multiple growths,

● severe pain, or

● fertility problems.

Laparoscopy

Endometriosis surgery is most often done laparoscopically.

This involves a minimally invasive technique and does not harm the healthy tissues around the growth. It will achieve improvement in pain.

Laparoscopy has also been shown to improve fertility. An increased pregnancy rate is observed for up to 12 months following excision of endometriosis. Some women may still require IVF to achieve a pregnancy.

The laparoscope uses a long thin camera that is inserted through a small incision in the abdomen, where the areas of endometriosis lesions are removed at the time of operation.

The tissue is sent to for histopathological diagnosis. Excision of endometriosis is known to be the optimal treatment for endometriosis.

Laparotomy

Laparotomy or major abdominal surgery: This involves a larger cut in the abdomen which allows Dr Alexander to reach and remove the endometrial growth.