Endometriosis is a condition that only affects women. It occurs when tissue that normally grows within a woman’s uterus (her womb) – called endometrial tissue – grows elsewhere in the body. During a woman’s “period”, or menstruation, the endometrial tissue in the uterus breaks down and bleeds. However, the endometriosis lesions located elsewhere in the body also break down, causing bleeding and inflammation; this is what produces the pain of endometriosis.
Sites commonly affected by endometriosis include:
The ovaries or Fallopian tubes
The bladder or bowel, including the appendix
The outside surface of the uterus
Ligaments in the pelvis or the side walls of the pelvis
Occasionally, the cervix or vagina may be affected
Endometriosis is not life threatening but can cause significant pain, and difficulty falling pregnant.
Around 10% of women may suffer from endometriosis. Some risk factors include:
Close family history (mother or sister with endometriosis)
Short duration between periods
Young age at first period
A lean build (tall, slim)
Not having children
Some women do not have symptoms of endometriosis, but may have trouble falling pregnant, or have ovarian endometriomas found when medical imaging tests are done for other reasons. Many women, however, experience lower abdominal discomfort or pain. Symptoms commonly experienced may include:
Pain during sex
Pain with passing urine or having a bowel motion, especially around the time of a period
Often, symptoms only occur, or are worse, around the time of the menstrual period. However, they may be persistent at any time during a menstrual cycle. Additionally, many women experience similar symptoms without having endometriosis.
There is no simple test to prove or disprove the presence of endometriosis. Often a pelvic ultrasound may be arranged to look for some causes of pelvic pain and, sometimes, ovarian endometriomas may be revealed. In most cases, however, a pelvic ultrasound is normal despite the presence of endometriosis. If your doctor suspects endometriosis, he or she may discuss presumptively treating you on the basis of your symptoms, or refer you to a specialist gynaecologist for further investigation and treatment. Ultimately, endometriosis can only be diagnosed by direct visualisation and biopsy of lesions at surgery.
Endometriosis can be treated with medications, surgery, or both. The type of treatment chosen depends on your symptoms and whether or not you’re trying to fall pregnant. Medications may include:
Pain medications: often paracetamol or anti-inflammatories
The contraceptive pill
Other hormonal therapies
Surgical treatment of endometriosis can usually be performed through small “keyhole” incisions, and can significantly improve symptoms in up to 80% of women. Surgery may be chosen instead of medical therapy, where medical therapy has failed to adequately improve symptoms, or to improve fertility where pregnancy is desired. Medical therapies do not improve fertility.
In some women, endometriosis can resolve without treatment. In women who receive treatment, up to 50% may experience recurrence of endometriosis at a later stage.
Endometriosis may reduce the chance of falling pregnant each month, but it does not completely prevent it. Around 30-50% of women with endometriosis will experience infertility. As such, surgical treatment is not necessary just to “protect” your fertility, if you are not currently trying to have a baby. If endometriosis has been found during investigation of infertility, however, there is research evidence that your chances of falling pregnant are improved after surgical treatment. In some cases, natural pregnancy is still delayed after treatment, and assisted fertility treatments (such as in vitro fertilisation, IVF) may be necessary.
Your general practitioner may be able to provide you with more information, or may refer you to a specialist for further advice and management.
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David is a Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, and undertook his specialist training in Queensland. He is highly skilled in the management of complex and high-risk pregnancies, and has special training in minimally-invasive surgery, endometriosis, pelvic floor and incontinence surgery. David has completed a Master of Reproductive Medicine and is skilled in the assessment and management of fertility problems, and can offer the full range of assisted reproductive treatments. He is a Senior Lecturer with The University of Queensland Medical School, and has published both medical journal and textbook contributions.
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