Endometriosis
Endometriosis is a common health condition that affects many people, often causing pelvic pain and making it harder to get pregnant. If you’re experiencing chronic pelvic pain or struggling with fertility, it’s worth discussing these concerns with a healthcare professional.
What is endometriosis?
Endometriosis occurs when tissue resembling uterine lining grows outside of the uterus. It is a chronic condition that affects the ovaries, fallopian tubes, and pelvic tissue. This abnormal tissue reacts to hormonal fluctuations during menstrual cycle, causing swelling, pain, and the formation of scar tissue called adhesions. Consequently, some endometriosis sufferers may experience difficulties conceiving.
Endometriosis Stages
Endometriosis is classified into four stages, based on the location, spread, and amount of endometrial tissue. However, the stage doesn’t always reflect the severity of symptoms. Someone with stage 4 may have little to no symptoms, while someone with stage 1 could experience severe pain.
Adenomyosis vs Endometriosis
Endometriosis and adenomyosis involve abnormal growth of endometrial cells but differ in location. Endometriosis occurs when tissue grows outside the uterus, while adenomyosis involves tissue growing into the uterine muscle.
These conditions typically affect different age groups. Endometriosis is more common in younger women, while adenomyosis usually affects women aged 40-50.
Both can cause pelvic pain and fertility issues. Endometriosis may also cause pain during intercourse, bowel movements, or urination, along with fatigue. Adenomyosis often leads to heavy or prolonged periods.
Common Symptoms of Endometriosis
- Pelvic pain
- Painful periods (dysmenorrhea)
- Heavy menstrual bleeding (menorrhagia)
- Pain during intercourse (dyspareunia)
- Infertility
- Fatigue
- Bloating or nausea
- Bladder problems
- Depression or anxiety
Endometriosis symptoms often improve after menopause, but not always.
Causes of Endometriosis
The exact cause of endometriosis is still unknown, but one leading explanation is the 'retrograde menstruation theory'. This theory suggests that during menstruation, some menstrual blood and endometrial tissue flow backward through the fallopian tubes into the pelvic cavity.
Once there, the tissue attaches to surrounding areas and begins to grow. While this is a widely accepted idea, other theories have been proposed, and researchers continue to investigate the root causes of this complex condition.
Diagnosis of Endometriosis
- Clinical Evaluation
- Medical History: Detailed history of symptoms, such as menstrual pain and pelvic pain.
- Physical Examination: A pelvic exam to detect cysts or scars.
- Imaging Tests
- Ultrasound: Useful for detecting ovarian cysts but not small lesions.
- MRI: Provides detailed images, especially for deep infiltrating endometriosis.
- Surgical Diagnosis
- Laparoscopy: The gold standard, involving a camera to visualize and biopsy pelvic organs.
- Histopathology
- Biopsy: Confirms diagnosis by examining endometrial tissue under a microscope.
Treatments of Endometriosis
- Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can help manage endometriosis pain by reducing inflammation but won’t treat the condition itself. Taking them 1–2 days before your period improves effectiveness, and stronger prescription options are available if needed. While helpful, NSAIDs may not work for everyone and can cause rare side effects like stomach or kidney issues. Combining them with other treatments may offer better results.
- Hormonal birth control: Hormonal birth control methods, such as birth control pills, patches, injections, and IUDs, can reduce menstrual bleeding and manage pain effectively. Progestin-based options are ideal for those who can't use estrogen. While side effects like nausea, bloating, or irregular bleeding may occur, they often improve over time. Serious complications are rare, especially for non-smokers.
- Other forms of hormone treatment: Gonadotropin-releasing hormone (GnRH) analogs (agonists and antagonists) are used to reduce estrogen and relieve endometriosis pain in over 80% of patients. Agonists like Leuprolide are available as injections or sprays, while antagonists like Elagolix are in pill form. Treatment is limited to 12–24 months due to bone loss risk, managed with add-back therapy. Aromatase inhibitors, such as Letrozole, block estrogen and can be combined with other treatments for long-term pain relief but are not suitable for those trying to conceive.
- Surgery: Surgery is often used to treat endometriosis when medications fail or pain is severe. Laparoscopic surgery can remove or destroy endometriosis tissue, offering pain relief, though symptoms may return. It may also address fertility issues or endometriomas. In severe cases, removing the uterus or ovaries may be considered, with hormone therapy sometimes recommended afterward.
What to do after endometriosis surgery?
- Use pain relief as recommended to stay comfortable during recovery.
- Monitor your bladder habits and ensure you're emptying it properly.
- Stay hydrated by drinking water, following any dietary instructions from your care team.
- Wear anti-embolism stockings before surgery to reduce the risk of blood clots.
- Shower 1–2 days after surgery to keep the area clean and promote healing.
- Rest and recover—most people need 2–6 weeks off work, depending on their job.
- Avoid sexual activity and heavy lifting for at least 6 weeks to allow proper healing.
- Don’t drive for 2–6 weeks, or until your doctor says it’s safe.
Can women with endometriosis get pregnant?
Yes, women with endometriosis can get pregnant, and several treatments are available to address infertility. The best option depends on your age, the severity of your condition, and other fertility factors. Here are some possible treatments:
- Ovulation-Inducing Medications: Drugs like clomiphene or letrozole can stimulate ovulation and boost your chances of conceiving.
- Fertility Medications with IUI: Combining fertility drugs with intrauterine insemination (IUI) can help some individuals.
- Surgery: Removing endometriosis tissue through surgery may improve fertility.
- In Vitro Fertilization (IVF): IVF is a common option, especially for endometriosis-related infertility.
Pain Management, Fertility, and Quality of Life
With an emphasis on improving quality of life and symptom relief, our experienced team of gynaecologists at Prince Court Medical Centre offers a comprehensive approach to endometriosis diagnosis and treatment. We are committed to providing patients with the least amount of disruption to their daily lives possibly by focusing on hormone therapy, pain management, minimally invasive surgical techniques, and cutting-edge diagnostic procedures. As a result, patients are able to resume their active lifestyles with renewed energy.
