Endometriosis

Endometriosis

What is Endometriosis?

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

How Does Endometriosis Occur?

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

It can also involve the vagina, cervix, and vulva or caesarean scar.

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

How can Endometriosis Affect a Woman?

Endometriosis is

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

Symptoms of Endometriosis

Patients may experience

pain in the lower abdomen, back or in 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.

Diagnosis of Endometriosis

Endometriosis may be suspected in medical history.

Ultrasound

Ultrasound will be requested to assess for endometriosis. Occasionally CT or MRI will be requested as well. Some sonologist specialise in endometriosis and they may recommend Sonovaginography to assess for deep infiltrating endometriosis.

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.

This can be done by diagnostic Laparoscopy (key-hole surgery) which is a day procedure under general anaesthesia. 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

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

Other forms of analgesia may be required.

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 is mild endometriosis. This can be in the form of OCP, mini pill, Implanon or Progesterone based IUD or injections.

Visanne is a Progesterone pill used for the treatment of endometriosis but it is not considered a contraceptive.

Birth control pills help to decrease the amount of menstrual bleeding or can be used to stop or skip periods.

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
fertility problems
pain during intercourse

Laparoscopic excision of endometriosis

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