Endometriosis 1

Endometriosis is a common condition that affects 1 in 10 women of reproductive age. It is a condition where tissue similar to the endometrium (inner lining of the uterus), becomes abnormally located outside the uterus.

What causes Endometriosis?

We do not know the exact cause of endometriosis. There are various theories, one of which is that of retrograde menstruation. This theory explains that during menstruation, the menstrual blood and endometrial cells travel backwards through the fallopian tubes, and deposit outside the uterus. Retrograde menstrual flow occurs to some degree in most women, but not everyone develops endometriosis. Therefore there must be other factors at play. It may be that women with moderate to severe endometriosis have an immune system that does not adequately destroy the endometrial cells that deposit outside the uterus following retrograde menstrual flow. Another theory suggests that some cells in the lining of the pelvis may have the potential to turn into endometrial cells when women reach puberty. It is also common for women to have a family history of endometriosis, so if your mother or sister has it you are more likely to develop endometriosis.

It is most probable that various factors are implicated in the causation of endometriosis, but not all are well understood at present.

Common sites of Endometriosis Deposits

  • surface of ovaries, fallopian tubes and uterus
  • inside walls of the pelvis near the ovaries
  • endometriotic cysts in the ovaries called endometriomas or chocolate cysts
  • pouch of Douglas which is the space behind the uterus, and between the rectum and the uterus
  • uterosacral ligaments
  • surface of bladder and bowel
  • when more severe, the endometriotic deposits can grow into the wall of bladder or bowel

Other less common locations include the vagina, caesarean section or laparoscopy scar, lungs etc. The endometriotic deposits can also cause the occurrence of scar formation or adhesions.

Endometriosis Symptoms

The severity of endometriosis symptoms do not correlate well with the severity of the disease. Some women with severe endometriosis do not have pain at all, and others with minor endometriosis have chronic pelvic pain. The common symptoms of endometriosis include:

  • painful periods
  • painful intercourse
  • pain in between periods
  • pain with bowel motion or urination especially if during periods
  • menstrual irregularities

Infertility and Endometriosis (Endometriosis and Pregnancy)

In cases of severe endometriosis, infertility can be caused by scarring or adhesions from endometriosis resulting in blockage of the fallopian tubes. Even women with functioning tubes and mild to moderate endometriosis can still experience difficulty falling pregnant. Again it is not clear why this occurs, and current research suggests that endometriotic deposits release substances that adversely affect sperms and embryo development.

Diagnosis of Endometriosis

A diagnosis of endometriosis may be suggested by:

  • the women’s symptoms
  • physical examination of the pelvis

ultrasound that demonstrate endometrioma (endometriotic ovarian cyst)
However, the definitive diagnosis can only be made with laparoscopy (key hole surgery). Endometriosis can also be surgically treated during laparoscopy .

Endometriosis Treatment

You should consult your gynaecologist and discuss your options. If you have mild or no symptoms from endometriosis, then treatment may not be required. The aim of treatment is to reduce symptoms and improve fertility.

Treatment options include:

01 Pain killers

  • Non-Steroidal Anti-inflammatories such as Ponstan, Naprogesic or Nurofen
  • Deal only with the symptoms

02 Contraceptive Pill

  • reduces or stops periods, thus lessening period pains
  • provides contraception at the same time

03 Progesterone-like medications

  • lessen period pains
  • can result in irregular or no periods
  • may stop growth of endometriosis if taken in adequate doses
  • some forms are also contraceptive

04 Mirena Intra-Uterine Device

  • special form of IUD with progesterone impregnated in the device
  • some women will have no periods, and the majority will have much lighter periods, and thus lessen period pains
  • good contraception

05 Menopause-causing medications

  • called Gonadotropin-releasing hormone (GnRH) agonists
  • can be a nasal spray or implant
  • can reduce the amount of endometriosis and lessen symptoms
  • can only be used for 6 months because of the risk of osteoporosis, unless “add-back” therapy (small dose of oestrogen and progesterone) is used

06 Surgery

  • most women with endometriosis can be treated by laparoscopy or key-hole surgery
  • mostly performed as day surgery
  • diagnoses and surgically treat the endometriosis at the same time
  • more effective than medical treatment in cases of severe endometriosis or endometrioma (endometriotic cyst on the ovary)
  • more severe endometriosis may require open surgery
Any form of treatment will have its advantages and disadvantages. Medical treatment can also be used in conjunction with surgery. You should consult your Melbourne Gynaecologist for more detailed discussion of your treatment options.
5 female specialist obstetricians, O&GCG Melbourne, Dr Jean Wong, Dr Leah Xu, Dr Natalia Khomko, Dr Perri Dyson and Dr Robin Thurman

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