Endometriosis explained

One in 10 women are affected by endometriosis, a condition you’ve probably heard of but may not realise is more than just painful periods and pelvic pain. So, what is endometritis exactly? Here, a gynaecologist fills us in on this common gynaecological condition, including endometriosis symptoms, treatment options and more.

What is endometriosis?

During a woman’s regular menstrual cycle, tissue in the uterine lining builds up. If there is no pregnancy, this tissue breaks down and is discarded though the vagina in the form of a period, explains DR ANUPRIYA AGARWAL – senior consultant obstetrician and gynaecologist, fertility specialist and advanced laparoscopy surgeon at Parkway hospitals. She says that, in some women, this tissue back-flows through the tubes and implants in parts of her pelvis or abdomen.

“Each month, this out-of-place tissue responds to the hormonal changes of the menstrual cycle just as it would on the inside of the uterus. This means that the tissue builds up and thickens, then breaks down and bleeds. But, because it’s on the outside of the uterus, this bleeding becomes trapped inside of the pelvis. This, in turn, can cause inflammation, swelling and scarring of the surrounding areas.”

This condition where the tissue from a woman’s uterine lining (endometrial tissue) grows outside of the uterus is called Endometriosis. Endometriosis can develop on a woman’s ovaries, fallopian tubes, bowel or the tissues lining her pelvis.

While there is no known cause of endometriosis, it is possible that the age of a woman when menstruation starts, immunological, hormonal and other gynaecological factors are at play.

Additionally, women may be at a higher risk of developing endometriosis if they have a family history.

What are the symptoms of endometriosis?

The symptoms of endometriosis vary from woman to woman. Some experience mild symptoms, while others experience severe symptoms. The severity of your pain, however, may not correlate with the severity of endometriosis, explains Dr Anupirya.

“Someone with severe endometriosis may experience only mild or no pain, while someone with mild endometriosis may experience debilitating pain,” she says. “Many of our patients only discover that they have endometriosis upon seeking fertility treatment with us.”

Painful periods, pelvic pain and other endometriosis symptoms

Most women who do experience symptoms report painful periods, and lower abdominal or pelvic pain. Pain during having sex is another common symptom.

“While painful period cramps can be normal, you should talk to your gynaecologist if you have severe cramps that affect your ability to function, and require regular painkillers,” advises Dr Anupriya. “In severe cases, painful period cramps could turn into chronic pelvic pain, whereby you experience pelvic pain throughout the month.”

Some women with endometriosis also commonly experience discomfort with bowel habits.

Infertility

Many women with the disorder have difficulty getting pregnant, as endometriosis is one of the major causes of infertility, says Dr Anupriya.

How do I know if I have endometriosis?

While endometriosis is a common disease, not many people understand what it actually is, explains Dr Anupriya. In fact, she says many patients only know about their endometriosis after seeing a gynaecologist with experience treating this condition.

This lack of awareness can potentially mean a delay from when a woman first experiences symptoms until she is eventually diagnosed and treated. 

“If you suspect that you have endometriosis, it’s important to visit a gynaecologist who’s experienced in treating the condition. Not all gynaecologists are well-versed in diagnosing and treating endometriosis. A gynaecologist will need to take a detailed medical history and do a thorough pelvic examination for you specifically looking for endometriosis.”

Additionally, she says an ultrasound scan can check for the presence of endometriotic cysts in the ovaries or endometriotic deposits in the pelvis. And, in severe cases that require surgery, an MRI scan may be required to check for scarring and adhesions.

Can endometriosis be treated?

For some women, endometriosis symptoms decrease or disappear when they reach menopause.

While there is no cure for the lifelong condition, symptoms of endometriosis can be managed by working closely with your gynaecologist. “Treatment options vary and depend on a woman’s symptoms, stage of endometriosis and her plans for fertility,” says Dr Anupriya.

There are hormonal medications that can be taken to suppress symptoms of endometriosis. However, if symptoms are severe and don’t cease with hormonal medications, surgery may be the necessary route.

Luckily, there is an effective, minimally invasive surgery called gynae laparoscopy to remove endometrial tissue.

“Because it’s not possible to visualise and treat all areas of endometriosis with conventional open surgery, laparoscopic surgery is the way to go,” says Dr Anupriya, who is an experienced laparoscopic surgeon. “It is important to choose a gynaecologist who is specially trained in performing endometriosis surgery, as these surgeries tend to be more complicated. Complete clearance is important to minimise the risk of the disease recurring.”

Additionally, Dr Anupriya says the procedure involves fewer surgical incisions than traditional open surgery, and is associated with less pain and a faster recovery time.

Other ways to help manage symptoms of endometriosis

Aside from hormonal medications and surgery, there are other ways to help manage symptoms of endometriosis. These include:

• exercise;
• diet changes, which may include avoiding dairy and wheat products, and aiming for a diet that’s rich in antioxidants;
• psychological counselling; and
• Traditional Chinese Medicine, acupuncture and reflexology.

Of course, it’s best to your doctor about what type of treatment is right for you.