Endometriosis

Endometriosis is a condition in which the tissue that forms the lining of the uterus (the endometrium) is found outside the uterus.

The places where endometriosis is frequently seen are the ovaries and areas in front, back and side of the uterus. Occasionally, it affects bowel, bladder and fallopian tubes. Very rarely has it been reported from distant areas e.g., lungs. Some women with endometriosis have few or no symptoms while others have pain or difficulty becoming pregnant. There are several treatment options but unfortunately there is no cure. The treatment is personalised for each person according to their needs.

Exact prevalence of endometriosis is not know as it requires an operation to diagnose it.

Endometriosis has been found to be present in:

  • 1-7 percent of women undergoing tubal sterilisation.
  • 12-32 percent of women of reproductive age undergoing laparoscopy for pelvic pain.
  • 9-50 percent of women undergoing laparoscopy for infertility
  • 50 percent of teenagers undergoing laparoscopy for evaulation of chrinic pelvic pain or dynmenorrhea

The cause of endometriosis is not known. A common theory is that some menstrual blood and endometrium flows backwards through the fallopian tubes and into the pelvis during menstruation. This tissue then implants and grows where it landed. This is called the retrograde (backwards) menstruation theory. However, there are also several other theories.

Endometriosis implants respond to changes in oestrogen. The implants may grow and bleed like the uterine lining does during the menstrual cycle. Surrounding tissue can become irritated, inflamed and swollen. The breakdown and bleeding of this tissue each month also can cause formation of scar tissue, called adhesions. Sometimes adhesions can cause organs to stick together.

Some women with endometriosis have no symptoms. The most common symptom is pelvic pain, especially with periods.

Pain may occur:

  • Just before or during a period
  • Between periods, with worsened pain during the period
  • During or after sex
  • With bowel movements or while urinating, especially during the period

Period pain can also be caused by many other conditions, such as pelvic infections, bladder conditions and irritable bowel syndrome. Often women with endometriosis have  more than one condition contributing to their pain.

How is endometriosis diagnosed?

Diagnosis is via laparoscopy or ‘keyhole’ surgery. Sometimes a small amount of tissue, a biopsy, is removed to confirm the diagnosis.

Endometriosis is considered mild, moderate, or severe depending on what is discovered in the surgery and cannot be predicted on symptoms alone. Women with mild disease can have severe symptoms, and women with severe disease can have mild symptoms.

What problems can I expect from Endometriosis?

  • Pelvic pain
  • Fertility issues
  • Ovarian cysts (endometriomas)

How is endometriosis treated?

Treatment depends on the extent of the disease, your symptoms, and whether you want to have children. Treatment may include medication, surgery or both. Treatments include:

  • Non-steriodal anti inflammatory drugs e.g. Nurofen
  • Oral contraceptive pills
  • Other forms of hormone treatment (GnRH)
  • Surgery

Surgery may be performed if you:

  • Have severe pain
  • Previous medicines have been ineffective
  • Have a cyst or mass in the pelvic area
  • Are having trouble becoming pregnant and endometriosis is suspected.

The goal of laparoscopy surgery is to remove endometriosis implants and scar tissue. More than 80 percent of women have less pain post surgery. Hormone treatment is prescribed to reduce the risk of reoccurrence.

If the pain is severe post surgery and you do not want further children, your doctor may discuss the option of a hysterectomy with or without the removal of your ovaries. This is uncommon, however.

An adhesion is the abnormal binding of tissue surfaces,  usually by scar tissue as a result of inflammation. Massive adhesion is a dense area of adhesion. This abnormal union of surfaces can impair the healthy functions usually seen when the tissues are separate.

Symptoms

Adhesions can appear anywhere within the body, more commonly after abdominal and pelvic floor surgery; most patients experience post surgery scarring. Adhesions caused by this scarring are often harmless. Occasionally adhesions can cause painful sexual intercourse, pain during ovulation and pelvic pain.

Complications

Occasionally abdominal and pelvic adhesions can contribute to infertility.

Rare adhesion complications such as ureteral obstruction may occur.

Treatments

Adhesions can be removed or reduced with laparoscopy and anti adhesive agents to reduce their reoccurrence.