Endometriosis is an inflammatory condition that affects approximately one in 10 Australian women. It can cause symptoms including pain and infertility and adversely affect your ability to participate in school, work and leisure activities. But you don’t have to put up with endometriosis pain – relief is available through a range of medical and surgical treatment options.
What is endometriosis?
The internal lining of the womb (or uterus) is called the endometrium. This lining is shed when a woman has a period. Endometriosis is a medical condition where endometrium-like tissue deposits itself outside of the uterus. These deposits are primarily found in the pelvic cavity – the bowl-like space within the bones of the pelvis that contains the reproductive organs, bladder, colon and rectum. However, they can potentially occur anywhere in the body.
“Persistent inflammation can lead to chronic pelvic pain, adhesions and scarring. In some women, this can create a difficult environment for a pregnancy to occur in.”
This tissue continues to function as it would in the womb, so when a woman has a period, it also bleeds and sheds. Unfortunately, this blood remains within the pelvis, leading to inflammation and pain.
As time progresses, persistent inflammation can lead to chronic pelvic pain, adhesions and scarring. In some women, this can create a difficult environment for a pregnancy to occur in, leading to infertility.
What are the symptoms of endometriosis?
“Pelvic pain primarily occurs during periods or with intercourse. But it can also be chronic and present all the time.”
The main symptom of endometriosis is pain. Pelvic pain (that is, pain experienced in the area between your belly button and the top of your legs) primarily occurs during periods or with intercourse. But it can also be chronic and present all the time. Pain symptoms can range from minimal to severely debilitating.
Other associated symptoms include heavy menstrual bleeding, pain with passing urine or opening your bowels, abdominal bloating, nausea, diarrhea or constipation, persistent tiredness, and lack of energy.
In some women, unexplained infertility can be the primary symptom of endometriosis.
How common is endometriosis?
Endometriosis is relatively common with approximately one in 10 women having the disease. It can be present in up to 70% of those with pelvic pain, and up to 50% of those with infertility.
How is endometriosis diagnosed?
“Getting an endometriosis diagnosis can involve a long and challenging journey.”
For some women, getting an endometriosis diagnosis can involve a long and challenging journey. Delays in diagnosis can be related to lack of awareness, limited access to medical expertise, vague onset or dismissal of symptoms – “it's all in your head” or “it's part of being a woman”.
Medical imaging tests such as ultrasounds often offer little diagnostic value because mild or superficial endometriosis may not show up on these scans. A normal pelvic ultrasound does not rule out endometriosis.
The gold standard for endometriosis diagnosis involves taking a tissue biopsy during a diagnostic laparoscopy (keyhole surgery). Accuracy of diagnosis in turn depends on the location of deposits, the severity of disease and the expertise of your surgeon.
What are my treatment options?
Treatments for endometriosis can be divided into medical and surgical options, but often a combined approached is required.
Medical treatment
The aim of therapy is symptom relief using medicines including:
- anti-inflammatories (eg Ponstan®)
- hormonal contraception aimed at period suppression (eg oral contraceptive pill or Mirena IUD), or
- complete suppression of ovarian function through the use of hormones known as GnRH analogues (eg Zoladex ®).
Surgical treatment
Surgery for endometriosis is done through a keyhole procedure and usually involves a day admission. Surgery aims to make a definitive diagnosis and remove as much visible disease as possible.
“Better outcomes are achieved by advanced laparoscopic surgeons familiar with the surgical treatment of endometriosis.”
Surgery is usually considered for women who:
- need definitive tissue diagnosis
- have persistent symptoms despite medical therapy
- have infertility issues
- have complications secondary to adhesions and scar formation.
Most women who undergo surgical excision experience improvement in pain symptoms.
Unfortunately, surgery alone is not always enough as up to 20% of women will require repeat surgery within two years. For this reason, post-operative medical therapy is recommended. This can reduce symptom recurrence and thus reduce your risk of needing multiple surgeries.
For women who do not plan to have children in future, a hysterectomy (with or without removal of ovaries) may be offered as definitive surgery.
Better outcomes are achieved by advanced laparoscopic surgeons familiar with the surgical treatment of endometriosis.
Do you need help for managing endometriosis?
At Sunnybank Centre for Women, we offer specialist management for women with endometriosis. Our vision is to provide high quality care that is readily accessible to all women.
Our specialists Dr Nelson Gonzalez, Dr Joseph Jabbour and Dr Jennie Connell are dedicated to providing individualised care to women with endometriosis.
Sunnybank Centre for Women and Sunnybank Private Hospital have joined together to provide a surgical package for endometriosis treatment.
This package has been tailored to be affordable and provide prompt access to high quality gynaecological care.
Find out more on our website or contact our helpful team on (07) 3345 4947.