Endometriosis is a common gynaecological condition affecting an estimated one in 10 women. The name of this condition comes from the word “endometrium”, which is the tissue that lines the uterus (womb).
Endometriosis is present when the endometrium tissue grows outside the lining layer of the uterus. It may cause pain, infertility, or both. It is also possible that you may not have any symptoms.
If endometriosis is not causing you pain and you have no problems in falling pregnant, it does not need to be treated. Your doctor may recommend monitoring with clinical examinations such as pelvic examination when you have your routine Cervical Screening Test, an ultrasound and other tests that may be appropriate for your circumstances.
Symptoms of Endometriosis
Severe Period Pain (dysmenorrhea)
Pain during or after intercourse (dyspareunia)
Infertility - difficulty in falling pregnant
Pain in your pelvic or abdominal areas
Pain with bowel movements
Pain with urination
Heavy or irregular vaginal bleeding
General fatigue
Diagnosis of Endometriosis
Your gynaecologist may suspect endometriosis if you present symptoms as above. It may also be suspected if you have a persistent ovarian cyst. However, many women may not present any symptoms at all. The options for diagnosis are:
Pelvic Examination
During a pelvic examination, your gynaecologist may discover a tender nodule behind the cervix or the uterus may lack mobility because of adhesions and scar tissue. One or both ovaries may be enlarged or in a fixed position. Occasionally, your gynaecologist can see the endometriosis if it has grown through the vagina. However, the only way to for a 100% diagnosis is via laparoscopy and/or biopsy.
Laparoscopy
Laparoscopy is a surgical procedure performed under general anaesthetic. A thin camera called a laparoscope is inserted into the abdomen, through a small cut ‘keyhole’, usually in the umbilicus (belly button). This allows your gynaecologist to see inside your abdomen and assess the organs of the pelvis and abdomen. For more information on laparoscopy, you may see this article on the Royal Australian and New Zealand College of Obstetricians and Gynaecologists website: RANZCOG Laparoscopy
Your gynaecologist may diagnose endometriosis because of your symptoms and findings during the pelvic examination rather than going through a laparoscopy procedure as it is an invasive test. Depending on your symptoms and family planning plans, your gynaecologist will discuss options for management. Surgery is not essential in the management of endometriosis.
Treatment of Endometriosis
Treatment options depend on your symptoms, diagnosis results and your goals i.e. pain reduction, plan to have children. Unfortunately, there is no treatment that can prevent the recurrence of endometriosis, especially in the reproductive age. Treatment falls into three categories:
Medications - hormonal and non-hormonal
Surgery
Alternative treatments i.e. physiotherapy, acupuncture, nutrition, etc.
Your gynaecologist will discuss this further before starting a treatment plan. You may need to have several treatments or combinations of treatments before finding the right treatment plan for you. Each treatment option has their own benefits, risks and limitations.
Hormonal treatments may include oral contraceptive pills and progesterones. They might be suitable for symptom control. However, they are not suitable if you were planning to get pregnant. Some of them are also only suitable for short term management due to side effects.
Non-hormonal treatments include pain relief medications such as paracetamol, non-steroidal anti-inflammatories and strong pain relievers. These medications are only designed for symptomatic pain relief and does not reduce the amount of endometriosis present. However, this may work well for some women, and that is all that is needed.
A medication treatment plan may be used as a standalone or in combination with surgery. Every woman with endometriosis is different and your gynaecologist will discuss the correct treatment plan for you.
For further self education, you may visit Jean Hailes, a national charity on women's health.
Dr Adeline Chan is a female gynaecologist in Sydney, serving the Western Sydney and Hills District region.