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WHAT IS ENDOMETRIOSIS?

WHAT IS ENDOMETRIOSIS?
14 February 2022

What Is Endometriosis?

Endometriosis is a common gynaecological condition in which tissue similar to the lining of the uterus (endometrium) grows outside the uterus. These growths may be found around the ovaries, fallopian tubes, pelvic lining and other areas of the pelvis.

The tissue can respond to hormonal changes during the menstrual cycle, which may lead to inflammation, pain, scar tissue and adhesions.

What Causes Endometriosis?

The exact cause of endometriosis is not fully understood. Several factors may contribute to its development, including:

  • Reverse flow of menstrual blood through the fallopian tubes

  • Genetic or family history of endometriosis

  • Hormonal factors

  • Immune system-related factors

  • Previous pelvic surgery or inflammation

Endometriosis can affect women during their reproductive years and may vary significantly from one person to another.

What Are the Symptoms of Endometriosis?

The symptoms of endometriosis can range from mild to severe. Some women may have significant endometriosis with few symptoms, while others may experience considerable pain.

Common symptoms include:

  • Pelvic or lower abdominal pain

  • Pain before or during periods

  • Pain during sexual intercourse

  • Painful bowel movements, particularly during periods

  • Pain or discomfort while passing urine

  • Heavy or irregular menstrual bleeding

  • Bloating and pelvic discomfort

  • Chronic pelvic pain

  • Difficulty in conceiving or infertility

  • Fatigue, especially around menstruation

The severity of pain does not always correspond to the extent of endometriosis.

Endometriosis and Fertility

Endometriosis can sometimes affect fertility. Endometriotic tissue and pelvic adhesions may interfere with the normal function of the ovaries and fallopian tubes.

Women experiencing difficulty conceiving may require evaluation for endometriosis along with other possible causes of infertility. Treatment is planned according to age, symptoms, ovarian reserve, fertility goals and severity of the disease.

How Is Endometriosis Diagnosed?

Diagnosis usually begins with a detailed discussion about symptoms and menstrual history, followed by a physical examination.

Investigations may include:

1. Pelvic Ultrasound

An ultrasound scan can help identify ovarian endometriotic cysts, commonly called endometriomas, and may also provide information about the pelvic organs.

2. MRI Scan

In selected cases, an MRI may be recommended to assess deep endometriosis and understand the extent and location of disease.

3. Laparoscopy

Laparoscopy may be considered in selected patients when symptoms persist, the diagnosis remains uncertain, or surgical treatment is required. It allows direct visualization of the pelvic organs and, when appropriate, treatment can be performed during the same procedure.

What Are the Treatment Options for Endometriosis?

Treatment depends on the patient's symptoms, age, fertility plans, severity of disease and previous treatment.

The main goals of treatment are to:

  • Reduce pain

  • Control symptoms

  • Prevent or reduce recurrence

  • Improve quality of life

  • Preserve or improve fertility where appropriate

Medical Treatment

Hormonal treatment may be recommended to reduce hormonal stimulation of endometriotic tissue and control symptoms.

Treatment options may include:

  • Combined oral contraceptive pills

  • Progestogen tablets or injections

  • Hormonal intrauterine systems such as Mirena

  • GnRH analogues in selected cases

  • Pain-relieving medicines when appropriate

The choice of medication should be individualized according to the patient's symptoms and reproductive plans.

Surgical Treatment for Endometriosis

Surgery may be considered when symptoms are severe, medical treatment is ineffective or not suitable, significant endometriosis is present, or there are fertility-related concerns in selected patients.

Surgical procedures may include:

  • Removal of endometriotic ovarian cysts

  • Excision or removal of endometriotic lesions

  • Adhesiolysis to release pelvic adhesions

  • Treatment of deep endometriosis when required

Whenever appropriate, surgery can be performed using laparoscopic (keyhole) techniques, although open surgery may be required in selected complex cases.

What Happens After Endometriosis Treatment?

Follow-up after treatment is important because endometriosis can recur in some patients.

Depending on individual circumstances, follow-up may include:

  • Monitoring of symptoms

  • Hormonal treatment to reduce recurrence

  • Assessment of fertility requirements

  • Repeat imaging when clinically indicated

  • Lifestyle and pain-management support

The treatment plan may need to be adjusted over time according to symptoms and future pregnancy plans.

When Should You Consult a Doctor?

You should consider consulting a gynaecologist if you experience:

  • Severe or worsening period pain

  • Persistent pelvic pain

  • Pain during intercourse

  • Pain during bowel movements or urination, particularly around periods

  • Difficulty conceiving

  • Symptoms that interfere with daily activities

  • Persistent pelvic pain despite pain medication

Early evaluation can help identify the cause of symptoms and allow appropriate treatment to be planned.