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Endometriosis

What is Endometriosis?

The lining tissue of the uterus is called endometrium. Each month a woman produces endometrium within the cavity of the uterus. The lining tissues are shed through the cervix into the vagina during the menstrual periods.

For unknown reasons, in some women these tissues grow outside the uterus. This is called endometriosis.

The blood and other biochemicals released by the endometriosis cells can irritate the surrounding tissues, causing pelvic pain. When these cells become active during menstrual bleeding, they cause painful periods. Eventually the body may form scar tissue around the injuries caused by endometriosis tissues, causing more severe chronic pain and difficulty in falling pregnant.

Who can develop endometriosis?

Endometriosis is a common condition among women of all ages, races and backgrounds. Some clinical studies estimated that 1 in 10 women have endometriosis.

In general, endometriosis is more common in women in their 20’s and 30’s, but even adolescents can develop endometriosis. It decreases with menopause.

There are various hypotheses on the causes and formation of endometriosis, but to date there is still no single theory that can fully explain its exact cause. However, there seems to be a genetic component. If a woman’s mother or sister has had endometriosis, she herself is more likely to have endometriosis as well.

How do I know if I have endometriosis?

Although endometriosis is a common condition, many young women do not realize they have endometriosis until they have severe pain or difficulty in getting pregnant.

The major symptoms of endometriosis are:

Painful periods often affecting normal activities, causing missing school or work
Deep pain during sex
Pain when opening bowel especially during a period
Cyclical pain starting 1-2 days before menstrual bleeding
Pain radiating to the back, upper thighs or buttock
Difficulty in getting pregnant

If you have these warning symptoms, your doctor may advise you as to whether you should be checked for endometriosis.

What are the consequences of endometriosis?

Endometriosis can cause severe pelvic pain that affect a woman’s normal activities and daily performance.

In addition, endometriosis can affect fertility. For a healthy woman in her 20s, the normal chance of getting pregnant is about 25% per month. Mild form of endometriosis can cause the chances to drop to around 7% per month. More extensive endometriosis that result in scarring, blocking of the fallopian tubes or “chocolate cysts” in the ovaries (endometrioma) reduce these chances further.

When endometriosis tissues are deeply implanted in the pelvis (called deeply infiltrative endometriosis), they cause scarring, adhesions between pelvic structures and irritation to the pelvic nerves. In some severe cases, they can grow on bowel, bladder and ureters, causing pain or dysfunction from these organs.

How can our Gynaecologist help you?

The best way to check for endometriosis is by having a specialist Gynaecologist observe your personal medical history and the results of a pelvic examination. Our Gynaecologist will then arrange the most appropriate tests for you.

If the endometriosis involves ovary, an ovarian “chocolate cyst” (endometrioma) may show up on a pelvic ultrasound scan.

If you have significant bowel symptoms, we can arrange a special scan called sonovaginography with an experienced ultrasound specialist to look at the chance of bowel involvement by endometriosis.

Based on your symptoms and test results, we will then work on a tailored treatment plan that fits your individual needs and conditions.

How is it treated?

Medical treatments can offer symptomatic relief. However, they do not treat the cause and the effects are only temporary. Painkillers may help to relieve painful periods or pelvic pain. Hormonal treatments like contraceptive pills can suppress the activities of endometriosis cells and temporarily reduce the symptoms, but the disease will return once the treatment stops. Hormonal treatments are also not suitable for women who are trying to fall pregnant.

The most effective way to remove endometriosis is with laparoscopic (keyhole) surgery. Robust clinical evidence have shown that removal of endometriosis by experienced surgeons can give the benefits of: