Endometriosis

Endometriosis is when some of the cells similar to those that line the uterus (womb), called the endometrium, grow in other parts of the body. They usually grow in the pelvis, but can move to almost any part of the body.

Period pain will often result in a conversation with your GP or your gynaecologist about endometriosis.

I can help you with the diagnosis and the management of your endometriosis symptoms.

On this page I discuss the symptoms, the treatment options and the link between endometriosis and potential infertility problems.

What is endometriosis?

Endometrial tissue lines the inside of the uterus allowing a pregnancy to attach. When you have endometriosis the same endometrial tissue grows outside your uterus, commonly on your ovaries, the sidewall of your pelvis and the pouch of Douglas (the small area between the uterus and rectum).

Endometriosis is a common condition affecting women, causing:

• period pain
• pain with intercourse
• infertility

Causes   

While there are lots of theories as to why this disease occurs, the exact cause is unknown.
“Several theories have pros and cons. These fall into 2 camps. Either “retrograde menstruation”, or the transformation of peritoneal cells into endometriotic cells."

Occasionally endometriosis can occur in surgical wounds.

Symptoms

The classic sign of endometriosis is pelvic or lower abdominal pain, just before your period starts and continuing through the period. Sometimes endometriosis can cause an alteration in bowel or bladder function around the time of your period, or pain when you are using your bladder or bowels. It can be associated with heavy periods and pain with intercourse. Endometriosis can also cause infertility and as such, not being able to conceive can be a symptom of endometriosis.

Diagnosis

There is no clear, easy way to diagnose this condition. The “gold standard” involves surgery, with excision of endometriosis and histological testing to confirm the diagnosis. Your medical history and an ultrasound can provide clues to the diagnosis. Ultrasound will not show small deposits of endometriosis and your symptoms are important then to make a diagnosis.

“Endometriosis is an incredibly variable disease. It can have an inflammatory component, where the inflammation associated with endometriosis causes lots of pain. Endometriotic nodules can get large, 3-4cm or more, but they can also sometimes be very small, just 1-2 mm!” – Dr Poonam Arora

Endometriosis can also cause scarring and adhesions and these lesions often do not cause pain directly but they can alter your pelvic function. So both you as a patient and the treating doctor can be left with a situation that is not entirely clear. Treatment can involve surgery or a number of less invasive medical treatments.

Treatment

All standard contraceptives, such as the pill, Mirena or Implanon, have a moderate effect on endo, helping with the pain but also slowing the progression of the condition.

Surgery can help, with excision of all visible endometriosis and normalisation of anatomy if there is scarring or adhesions. Medications to induce a temporary medical menopause, such as Zoladex, are occasionally used after big endometriosis surgeries to prevent recurrence of the disease and to allow healing.

Am I infertile when I have endometriosis?

Endometriosis is common and there are many women who complete their families without difficulty, despite having this condition. One in nine Australian women will develop endometriosis by the age of 44. There is evidence that laparoscopic treatment of mild or minimal endometriosis improves subsequent pregnancy rates, but only a little bit. It is estimated that 12 women would need surgery for 1 extra pregnancy.

Endometriosis becomes more common and tends to be worse as you get older and have more periods. It also acts together with other things that make fertility more difficult.

“I tend to reserve surgery for those women with evidence of bulky endometriosis on ultrasound and those women who have specific symptoms such as pain with intercourse, where sometimes quite small amounts of endometriosis cause disproportionate symptoms.”

Like a lot of areas in Women’s Health, it can feel like you are the only one afflicted with a set of symptoms. Getting a firm diagnosis can be difficult. We can do this together. There is lots of support and treatments available to help with endometriosis.