Put very simply, endometriosis is a disease that occurs when cells that normally line the inside of the uterus (womb) implant and grow outside the uterus, within the pelvis. These cells grow in response to the hormone cycle, causing painful localised irritation, inflammation and scarring.
The most common symptoms of endometriosis are: Period pain, pelvic pain, spotting before the period, ovulation pain (mid cycle pain), infertility and changes in bowel, bladder and sexual function.
If you have any of the symptoms listed above you could have endometriosis. However, there are certain signs that point toward a more obvious diagnosis. They are: a) Period pain that is not relieved by simple measures such as Panadeine, Naprogesic, hot packs etc b) Prolonged periods (bleeding for more than 7 days each month) c) Abnormal bleeding such as heavy or prolonged bleeding, spotting before the period d) A family history of endometriosis e) Symptoms are cyclical i.e. they occur mid cycle and/or at the time of the period.
There are certain women said to be at high risk of developing endometriosis. They are: a) Women who have not had children b) Women who are overweight c) Women with heavy or prolonged periods d) Women who had their first period at an early age ( before 12 years of age) e) Women who have a family history of endometriosis ¬ mother, sister etc. Women in this group are twice as likely to develop the disease and are also likely to have a more severe form of the disease.
Not necessarily. Infertility occurs in only 20% of women with endometriosis. If untreated it can lead to infertility.
No. Drug treatment essentially "puts endometriosis to sleep". The most common mode of action of drug treatment is to lower the level of oestrogen in the body. Oestrogen is the female hormone produced by the ovaries and facilitates the growth of endometriosis. Drug treatment may reduce the symptoms of endometriosis and make life more ‘bearable’, but once the drug is withdrawn, symptoms usually recur in 60% of women. Drug treatment may be useful as a preoperative measure, to shrink large deposits and make surgery less complicated.
Surgery is the proven method for removal of endometriosis with long term research suggesting a recurrence rate of only 25% over 3 years. Complete excision of endometrial deposits is required to completely remove the disease. An ongoing management plan incorporating use of the oral contraceptive pill, diet, exercise and the use of complimentary therapies such as naturopathy and Chinese medicine is then required to reduce the risk of recurrence of disease.
Laparoscopy is a minimally invasive operation, where a small telescopic instrument is passed via a small incision in the umbilicus (belly button) to view the organs in the pelvis. Two to three other small incisions may be made to insert instruments so that deposits of endometriosis can be removed. Most women recover quickly after laparoscopy and are back to work and normal activities within a short period of time. Recovery however, will be determined by the amount of endometriosis present and the length and extent of surgery performed. The most common after effects of laparoscopy include: a) Shoulder tip pain ¬ caused by gas becoming trapped in the abdomen at the time of surgery. This is usually resolved within 36 hours and can be relieved by simple pain relievers, application of hot packs or lying down. b) Abdominal bloating ¬ again caused by the gas within the abdomen and also distension of the bowel. This usually resolves within 7 days Most women return to work on average within 7 days after laparoscopy.
Not necessarily. If the uterus alone is removed and endometriosis elsewhere within the pelvis is not treated, the disease will persist. Hysterectomy should always be the last option for treatment after all other methods have failed. If a specialist in the treatment of endometriosis performs a hysterectomy, it will be as a last option and all endometriosis within the pelvis will be removed at the same time. Drug treatment may be necessary after surgery in severe cases to reduce the risk of recurrence form microscopic deposits not seen at the time of operation.
Diet and exercise can help, as does weight reduction and continuous trimonthly use of the oral contraceptive pill.
Endometriosis is defined as the presence of normal tissue in an abnormal place. The endometrium (lining) of the uterus spreads to the pelvis through the tubes and settles most commonly in the pelvis. Like the lining of the uterus, the endometrium grows under the influence of the major female hormone oestrogen. The most common sites in the pelvis are on and below the ovaries, and deep in the pelvis behind the uterus, called the Pouch of Douglas. Here the endometriosis grows on the ligaments behind the uterus and on the vagina and rectum. It also may grow on the bladder, appendix, abdominal wall and even sometimes in the upper abdomen.
Retrograde menstruation which causes most endometriosis
The most common sites of endometriosis