Endometriosis

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

In can cause Chronic Pelvic Pain and Infertility.

Unfortunately women spent several years searching for the cause of their pain and/or infertility before receiving the diagnosis of endometriosis.

What is Endometriosis?

Endometriosis occurs when the tissue resembling the uterus (or womb) grows outside the uterus on other organs or structures in the body.

Where does Endometriosis Occur?

Endometriosis can occur on the pelvic organs which include

  • ovaries,
  • outer surface of the uterus,
  • the Fallopian Tubes,
  • the lining of the pelvic cavity,
  • the tissues that hold the uterus in place (utero-sacral ligaments).

It can also involve the vagina, cervix, vulva, bladder and bowel (including rectum and appendix).

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

How Can Endometriosis Affect a Woman?

Endometriosis is

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

Symptoms Of Endometriosis

Patients may experience

  • painful cramps in the lower abdomen, back or in the pelvis during menstruation
  • painful sex
  • heavy menstrual bleeding
  • painful bowel movements or urination and
  • infertility

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. Endometriosis can be associated with a defect in the immune system.

Other factors including stress, dioxins and xenoestrogens could aggravate symptoms. They have not been shown to be valid concepts of aetiology.

Diagnosis of Endometriosis

Dr Gailani will

  • ask you about your general health and symptoms
  • perform a pelvic examination to feel for the presence of large cysts or scars.
  • ultrasound scan may also be performed to look for ovarian cysts (ovarian endometriomas).

The ultimate diagnosis is to visually prove the existence of endometriosis. This can be done by diagnostic laparoscopy.

Treatments For Endometriosis

There are several treatment options available to minimise the pain as well as control heavy bleeding.

Pain Medication for Endometriosis

Non steroidal anti-inflammatory medications will be prescribed by Dr Gailani in cases of severe pain. Other forms of simple analgesia (over the counter pain relievers) may be helpful for mild pain.

Hormone Treatment for Endometriosis

Hormone treatment is recommended if there is a small growth and mild pain. Progesterone type medications or a medication that decrease or block the production of Oestrogen.

Progesterone can be

  • an oral pill (Visanne),
  • injections,
  • intra-uterine device (Mirena).

Birth control pills help to decrease the amount of menstrual bleeding.

Surgery for Endometriosis

Surgery is an option for women who have:

  • multiple growths,
  • severe pain, or
  • fertility problems.

Laparoscopy

During this surgery, the areas of endometriosis are removed.

This is a minimally invasive technique and does not harm the healthy tissues around the growth. It will achieve improvement in pain.

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

Laparoscopy with excision of endometriosis has also been shown to improve fertility. An increased pregnancy rate is observed for up to 12 months following excision of endometriosis.

Some women may still require IVF to achieve a pregnancy.

Hysterectomy

Hysterectomy is surgery that involves the removal of the uterus.

This procedure is done when there is significant pain and generally when other options have failed and if the patient is not planning a pregnancy.