Endometriosis - affecting 1 in 9 women
What is endometriosis?
Endometriosis is a condition where cells, similar to the lining of the uterus (endometrium), are found in other parts of the body. Endometriosis affects 1 in every 9 women and the symptoms can range from mild to severe.
What are the symptoms of endometriosis?
Endometriosis can present with a variety of symptoms, and because of this, it can be difficult to diagnose. Some common presenting symptoms include:
Heavy periods or bleeding between periods
Pelvic pain - before, during or after your period
Painful ovulation
Pain that radiates to your lower back, hips or legs
Painful sex: the pain is usually felt deep in the pelvis and can be worse around the time of your period
Bowel changes: painful passing of stools, irritable bowel syndrome, diarrhoea
Painful urination: if patches have formed on the bladder it may cause painful urination, blood in urine, or aching in the bladder area
Infertility: endometriosis can cause scar tissue to form in the fallopian tubes that can cause narrowing or damage. If the fallopian tubes don’t work properly, egg fertilization is difficult. Endometriosis can also release substances that can affect the mobility of sperm and the ability of pregnancy to implant and continue to develop.
Depression and anxiety
Our brilliant and sought-after team of Adelaide female Gynaecologists can assist you in your endometriosis treatment.
How does endometriosis occur?
Endometriosis cells respond to hormonal changes in the menstrual cycle. When you get your period, these cells form patches that bleed and can’t pass out of your body like menstrual blood can. This results in inflammation, pain and scarring. In some circumstances, the blood builds up to form a cyst, which is called an endometrioma or ‘chocolate cyst’.
The most common sites for endometriosis patches to form are:
Uterus-endometriosis within the wall of the uterus is called Adenomyosis
Ovaries
Fallopian tubes
Pouch of Douglas (the area behind the uterus)
Uterosacral ligaments (the ligaments that are behind the uterus)
The surface of the bowel
The surface of the bladder
What causes endometriosis?
Unfortunately, this is unknown. There are a few theories about how it can arise, however:
Family history: endometriosis can run in families. Having a close relative with endometriosis increases your risk of developing the condition up to 10 times
Retrograde menstruation: the backwards flow of blood through the fallopian tubes and into the pelvis is also thought to play a role. When the blood flows backwards into the pelvis it is believed to contain endometrial cells, which can then deposit and grow in the pelvis and abdomen
Other theories include immune system problems, environmental causes, or cells changing function to resemble different cells (metaplasia)
How is endometriosis diagnosed?
Your doctor will take a careful history from you and ask lots of questions about any bleeding and pain you have experienced. A physical examination, including an internal examination to check for tenderness or masses is recommended. An internal examination is only appropriate if you have ever been sexually active.
An ultrasound scan may be useful to check the anatomy of your uterus and to exclude any cysts on the ovaries. Ultrasounds can only detect large patches of endometriosis (endometriomas). Most cases of endometriosis can’t be seen with an ultrasound.
The only definitive way to diagnose endometriosis is with a surgical procedure called a laparoscopy. A small camera is inserted into your abdomen via a small cut near your belly button. If endometriosis is seen it can be removed as much as possible. This surgery can be used to both diagnose and treat endometriosis.
What treatment is available for endometriosis?
Sadly, there is no cure for endometriosis; it is a chronic and progressive condition that requires a holistic approach with a compassionate and experienced team of professionals (like ourselves, at Womankind Health!) to manage symptoms. Some management options include:
Surgery: the aim of surgery is to reduce your symptoms by removing as much endometriosis tissue as safely as possible. Surgery can also improve your fertility. A laparoscopy is the most common surgery performed to remove endometriosis. In severe cases, open surgery is necessary.
Hormone therapy: this can suppress the growth of endometriosis and help alleviate disease symptoms and progression. There are many types of hormone therapy that your doctor can discuss with you, they include tablets, implants, injections, or intrauterine devices.
Pain medications: these can help alleviate symptoms, and include non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and voltaren. In some cases, stronger medication is necessary to relieve pain or to reduce muscle spasm.
Physiotherapy: a physiotherapist who specialises in pelvic floor dysfunction can help alleviate symptoms
Psychology: endometriosis can have a significant impact on your quality of life and relationships, and it can also lead to depression and anxiety. Having someone to speak to about how you are feeling can help you manage. A mental health care plan with your GP may be beneficial
Exercise: there is excellent evidence supporting the use of exercise to reduce painful symptoms. General fitness is encouraged, even if it is gentle exercise such as walking. Core strength exercises should be approached with caution as this may activate pelvic floor muscles that are already inflamed. An exercise physiologist will be able to guide you to choose the exercise that is right for you
Our supportive and highly regarded team of female Gynaecologists here in Adelaide look forward to speaking with you and assisting you to explore successful endometriosis management.
Support is also available through the following resources:
https://www.jeanhailes.org.au/health-a-z/endometriosis
https://www.endometriosisaustralia.org/