What is endometriosis?
Endometriosis is a common condition that effects around 1 in 10 women. It is present when tissue that is similar to the lining of the uterus (womb) occurs outside the uterus. The tissue that lines the uterus is known as the endometrium, and this is the layer of tissue that sheds each month with a menstrual period. In the condition endometriosis this endometrial tissue occurs in abnormal places, most commonly within the pelvis.
What problems can endometriosis cause?
The abnormal deposits in endometriosis can cause a number of symptoms, with the most common being pain and infertility.
It is possible to have endometriosis and not have any symptoms or problems, and the degree or severity of the symptoms does not always indicate the damage the disease is causing. It is also possible to have pain or problems conceiving and not have endometriosis. If endometriosis is not causing any symptoms it usually does not require treatment.
How is endometriosis diagnosed?
The only way endometriosis can be diagnosed is to undergo laparoscopic surgery and have a biopsy (tissue sample) taken. Laparoscopy is ‘keyhole’ surgery done under a general anaesthetic, where a thin fibreoptic camera is passed through the umbilicus (belly button) to see inside the pelvis and abdomen. The laparoscope magnifies the tissues and can allow even small amounts of disease to be seen. Abnormal tissue that is thought to contain endometriosis can be removed and sent to pathologists to confirm the diagnosis.
The diagnosis of endometriosis can be suggested by the symptoms a woman is experiencing (for example pain with periods or with sexual intercourse), by findings on physical examination, or by abnormalities seen on pelvic ultrasound (for example endometriotic cysts affecting the ovary). The only way a diagnosis can be made with 100% certainty is with laparoscopy and biopsy.
It is not always essential to make a certain diagnosis, especially as diagnosis requires an invasive surgical test. Whether you need to undergo a laparoscopy will depend on factors like your clinical symptoms and your plans for pregnancy in the immediate future.
What is the treatment for endometriosis?
There are three kinds of treatments for endometriosis:
Medical treatments (involving medications)
Surgical treatments (involving an operation)
Complementary treatments (e.g. physiotherapy, psychology, alternative therapies, etc)
Before starting any treatment you should discuss the risks and benefits with your doctor. There are advantages and disadvantages to each, and sometimes it is necessary to try several approaches to find the right combination for you.
Medical treatments are divided into hormonal and non-hormonal therapies. Hormonal therapies include the oral contraceptive pill and progestogens and come in a variety of forms. Non-hormonal medications include pain relieving medications and non-steriodal anti-inflammatory drugs that relieve the painful symptoms of endometriosis but do not reduce the amount of disease present.
Surgical treatment is usually done via laparoscopy or ‘keyhole’ surgery. Laparoscopic surgery is preferred as it causes less scarring, less pain, less time in hospital, and allows better visualisation of the areas where endometriosis can occur. Surgical treatment aims to remove or reduce the amount of endometriosis present and restore normal anatomy and function.
Complementary therapies can be very helpful in the management of endometriosis. Physiotherapists and psychologists can play an integral role in restoring function and dealing with the ramifications of chronic pelvic pain and infertility. Your doctor may recommend specialist therapists in this area.