What is endometriosis?
Endometriosis is a condition that occurs when the tissue that usually lines the uterus (called the endometrium) grows outside the uterus. It can be an extremely painful condition, with affected areas commonly being the ovaries, fallopian tubes, and the tissue lining the pelvis. About 10% of women in their reproductive years will experience endometriosis. Brisbane specialists, such as ours, specialise in this field, helping women to deal with symptoms and causes. Endometriosis has an adverse affect on fertility, making it difficult for affected individuals to conceive.
The endometrium normally responds to the hormones oestrogen and progesterone, which cause it to thicken and grow in preparation for implantation of a developing embryo after fertilisation. In endometriosis, the pockets of misplaced endometrium also respond to the hormones. However, while the endometrium in the uterus is shed as a period, the misplaced tissue cannot escape the body, bleeding onto the surface of surrounding organs and tissues. This can cause inflammation and scarring, sometimes severe enough to cause organs and tissues to stick together, or cause cysts.
What causes endometriosis?
Currently, there is no agreement about the cause of this condition.
One popular theory is ‘retrograde menstruation’, which suggests that a backward flow of menstrual bleeding through the fallopian tubes and into the pelvis causes endometrial cells to fix themselves on other organs.
Another theory suggests that the immune systems of some women fail to control or stop the growth of endometrial tissue outside the uterus, causing endometriosis.
There is also a suggestion that there are genetic links, as female family members sometimes share the condition.
What are the symptoms of endometriosis?
- Pelvic pain
- Heavy periods
- Painful periods
The most common symptom is pelvic pain that feels like period pain.
The pain of endometriosis may be:
- Period pain, immediately before and during period;
- Pain during or after sexual intercourse;
- Abdominal, back and/or pelvic pain (usually occurring outside of menstruation);
- Pain on bowel movements or urination; or
- Abdominal pain at the time of ovulation.
Bleeding may be:
- Heavy bleeding, with or without clots;
- Irregular bleeding with or without a regular cycle; or
- Premenstrual spotting.
Endometriosis may reduce fertility, or even cause infertility.
How is endometriosis diagnosed?
Diagnosis of endometriosis can be difficult.
Diagnosis can be difficult. A detailed medical history, taken by a doctor, is the first step to exclude other possible causes of the symptoms. Other tests that can help diagnosis are:
This is a surgical procedure performed under general anaesthetic, where a long, thin telescope (called a laparoscope) is inserted into the abdomen through a cut near the navel, to examine the pelvic organs.
The surgeon performing the test will look for signs of endometriosis and take tissue samples for testing. Sometimes, existing endometrial implants may be removed during this procedure.
A vaginal or abdominal ultrasound test takes an image of your pelvic organs.
A colonoscopy passes a medical instrument with a video camera attached (colonoscope) into your bowel, to look for signs of endometriosis in your bowel.
What are the treatments for endometriosis?
Treatment of endometriosis depends upon the severity of the condition, and your objectives for treatment. For example, treatment for pain relief may be different to treatment for fertility issues related to endometriosis.
Hormone therapy can be an effective treatment in mild cases of endometriosis, where the aim is to slow or stop the growth of the abnormal endometrial tissue. This process can be conducted at our Brisbane clinic, enabling a reduction in pain and bleeding symptoms. These treatments are not the best option for women who are trying to conceive, as they will also suppress the endometrium growth and disrupt ovulation. Hormone therapies include gonadotrophin- releasing hormone (GnRH) agonists, progestogens, androgenic steroids, and the oral contraceptive pill.
Surgical procedures such as laparoscopy (described above) or laparotomy (i.e., open abdominal surgery) can remove endometrial implants and scarring. Surgical treatment may improve fertility. If symptoms persist after drug and early surgical intervention, a hysterectomy (i.e., removal of the uterus) may be the last resort for relief of persistent, severe pain.
Treatment of infertility
In Vitro Fertilisation (IVF) procedures can be highly effective in improving fertility in many women with endometriosis. There are a number of factors to consider when suggesting IVF in cases of endometriosis-associated infertility, including the age of the patient, the severity of the endometriosis, the presence of other infertility factors, and the results of previous treatments. Please seek advice and guidance from Dr Das a medical professional, such as our endometriosis specialist in Brisbane, regarding therapy and care for endometriosis, and understand your own goals for treatment.