Endometriosis

What is Endometriosis?

Endometriosis is a common gynaecological condition in women of reproductive age. It occurs when the glandular tissue of the inner lining of the uterus (endometrium) grows outside the uterus.

Unfortunately, the diagnosis of endometriosis is often delayed, with women at times spending many years searching for the cause of their pain.

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 the rectum and appendix).

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

How does Endometriosis Affect Women?

Endometriosis is:

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

Causes of Endometriosis

The exact cause of endometriosis is not known. Popular theories include: 

• Retrograde menstruation (the blood flows into the pelvic cavity instead of outside through the vagina),
• Genes have been isolated, which are associated with severe endometriosis. There will at times be a family history of endometriosis. 
• Endometriosis can be associated with a defect in the immune system, and
• Other factors, including stress, dioxins and xenoestrogens, could aggravate symptoms. They are not valid concepts of aetiology.

No theory explains all the findings. 

Symptoms of Endometriosis

Patients may experience various levels of:

• pain in the lower abdomen, back or in pelvis during menstruation
• pain during intercourse,
• painful bowel movements or urination and
• infertility
• tiredness/fatigue

Diagnosis of Endometriosis

Endometriosis may be suspected in medical history. Your doctor will

• Ask you about your general health and symptoms, perform a pelvic examination to feel for the presence of large cysts or scars, and
• Ultrasound will be requested to assess for severe endometriosis if endometriosis is suspected. Many cases of endometriosis are not detected on ultrasound.
• Occasionally  MRI or CT scans will be requested as well. Only a few ultrasound providers specialise in endometriosis, and we may refer you to one of these. 
• Laparoscopy is the gold standard for diagnosis, however it is not always required. A diagnostic laparoscopy (key-hole surgery) is a day procedure under general anaesthesia. Laparoscopy involves a long thin camera that is inserted through an incision in the abdomen. If endometriosis is found it will often be removed (by excision) at the same time. A biopsy is often taken for histopathological testing.

Treatment for Endometriosis

Pain medication for Endometriosis

Over-the-counter pain medication, such as non-steroidal anti-inflammatory medications or Paracetamol, may be helpful for pain.

Other forms of analgesia may be required.

Hormonal treatment for Endometriosis

Hormone treatment is recommended for mild endometriosis symptoms. This can be in the form of the oral contraceptive pill, mini pill, Implanon, Progesterone based IUD or injections.  Visanne is a progestogen pill used to treat endometriosis, but it is not considered a contraceptive. 

Hormone treatment can suppress the activity of endometriosis or decrease recurrence after surgical treatment. This is not appropriate when trying to conceive.