What is endometriosis?
Endometriosis is a condition where there is tissue that is like the tissue that lines the uterus that occurs outside the uterus. Like the tissue lining the uterus, it responds to hormonal stimulus and therefore grows like the lining of the uterus through the menstrual cycle and is shed like the lining of the uterus when the period occurs.
Endometriosis is a disorder that involves your ovaries, fallopian tubes, and the endometrium (the tissue lining the uterus). If you often experience painful periods, excessive bleeding or pain during intercourse, I recommended booking an appointment at our Perth gynaecology clinic.
With endometriosis, the tissue that lines the uterus grows outside of the uterus. There is no cure for the condition, but modern gynaecology allows us to manage and reduce the symptoms for many of our Perth patients.
One of the potential complications you may experience if you are diagnosed with endometriosis is an increased risk of infertility. This is where my three decades of experience as a gynaecologist can help work out the most suitable treatment plan for you.
Painful periodsWhen the period occurs, the endometriosis also sheds but is trapped locally and stretches the lining of the pelvis, triggering pain.
Pain during intercourseThe deposits of the endometriosis can be sensitive and interfourse will bump and stretch those deposits, causing pain.
Pain with bowel movements or pain with urinationIn the same way, bowel and bladder activity can upset endometriotic deposits causing pain.
There is an association between endometriosis and fertility delay. It is not a very strong association: Women with endometriosis can conceive, the reduction in conception rate is small. Treating endometriosis surgically improves spontaneous fertility a little.
Backward menstruation, or retrograde menstruationRetrograde menstruation is essentially normal. When you bleed through the cervix and vagina, it is very common for some menstrual blood to flow up the tubes into the pelvis. The area where the blood is deposited, at the base of the pelvis, just behind the cervix, is the most common area to see endometriosis. Not every woman has endometriosis so this is not enough to explain the condition.
Some research mentions inheritance as a factorIf your mother or sister had or have the condition, then you are more likely to as well.
Your immune systemIf your immune system fails to stop the growth of endometrial tissue outside the uterus, you may be more likely to develop symptoms.
Risks to the mother include
So, how is endometriosis diagnosed?
Your GP may have referred you to us to get clarity if you are showing signs of endometriosis. This is because endometriosis does not usually show up in an internal pelvic examination. As a gynaecologist, I will examine your medical history as this may suggest a possible diagnosis.
Special investigations are required to make a formal diagnosis.
UltrasoundIt is difficult to make a diagnosis on ultrasound, with the significant exception of endometriosis affecting the ovary, or an endometrioma.
Blood testsBlood test have very little value in the diagnosis.
LaparoscopyA surgical procedure under general anaesthetic using a camera to examine your pelvic organs remains the primary method of making a diagnosis. This is a moderately invasive procedure and we need to think carefully about performing this operation.
ColonoscopyThe same principle is used to examine the bowel if we suspect that endometriosis may be affecting the area, a less common presentation of endometriosis.
Endometriosis treatment does not cure the condition. However, medication or surgery can help to reduce the impact of the symptoms you experience.
Treatment will be medical or surgical.
The cells of the tissue that grow outside the uterus behave like endometrial cells and they respond to hormones. The oral contraceptive can be an effective treatment for many women. There are more powerful medications often with a more adverse side effect profile that may be required.
Surgical management is the mainstay of treatment. Burning or removal of endometriotic deposits is conservative treatment as well as the removal of ovarian endometrioma. Removal of the uterus, tube and ovaries is more definitive treatment and is clearly contraceptive and only appropriate when fertility is no longer an issue. Menopause is mother nature’s treatment, as the low oestrogen state after menopause will suppress endometriosis.
Endometriosis & fertility
Treating endometriosis will improve spontaneous pregnancy rates.