Gynaecology

Endometriosis

Endometriosis is a condition where the endometrium that generally lines the uterus, grows in other locations. Endometriosis may cause adhesions. The uterus can become stuck to the ovaries, fallopian tubes and bowel.

Condition

What is the percentage of population affected by endometriosis?

One in 10 women are affected by endometriosis.

How does endometriosis affect you?

The two main problems that endometriosis can cause are:

  • Pain
  • Infertility

Which part of the body is affected?

The female reproductive system is made up of the following parts:

  • Vagina: opening of the reproductive system, which allows the entry of sperm
  • Cervix: narrow region that connects the vagina to the uterus
  • Uterus: womb, where a fertilised egg implants and grows to develop into a baby
  • Ovaries: organs on either side of the uterus, which release an egg each month in the prospect of a pregnancy
  • Fallopian tubes: narrow tubes that open out at the ovaries to pick up the released egg for fertilisation

The uterus is made up of three layers – The innermost layer is called the endometrium, the second layer, myometrium and the third layer, the serosa. Every month, the endometrial layer is built and thickens in preparation to accept the fertilised egg for implantation and provide nourishment to the growing embryo, until birth. If the egg does not get fertilised, the layer of tissue that is formed sloughs off and passes out in the form of your monthly period.

What are the causes of endometriosis?

Although the exact cause is not certain, some of the possible explanations may include:

  • Retrograde menstruation: back flow of menstrual tissue
  • Transformation of peritoneal cells or cells that line the abdomen into endometrial cells
  • Transformation of embryonic cells during puberty
  • Attachment of endometrial cells to a surgical incision
  • Transport of endometrial cells by the blood or lymph system
  • Immune system disorder that fails to recognise endometrial cells growing in other organs as abnormal

Who is at risk of endometriosis?

Some of the common factors that could increase your risk of developing endometriosis are:

  • Never giving birth before
  • Early puberty (start of your first period)
  • Late menopause
  • Short menstrual cycles
  • Higher levels of oestrogen or greater exposure to oestrogen in your lifetime
  • Low body mass index (BMI)
  • Alcohol intake
  • Family history
  • Medical condition that stops the normal outflow of period
  • Uterine abnormalities

What are the signs and symptoms of endometriosis?

The symptoms of endometriosis vary widely from woman to woman and the severity of symptoms is not necessarily related to the severity of the condition. While some women have few or no symptoms, others experience severe and incapacitating pain that recurs each month for many years. Endometriosis is characterised by:

  • Pain during periods (dysmenorrhoea)
  • Pain with intercourse (dyspareunia)
  • Pain during urination or bowel movements
  • Heavy bleeding
  • Bowel disturbances – including painful bowel motions, diarrhoea, constipation, bleeding from the bowel
  • Difficulty getting pregnant
  • Painful urination
  • Lower back, thigh and/or leg pain
  • Premenstrual syndrome (PMS)

Many women think that painful periods are normal. If you have bad period pain, you should see Dr. Alex Polyakov. The anticipation of recurrent pain or discomfort each month may also lead to feelings of anxiety, stress and depression. It is important to acknowledge these emotional difficulties that may arise from endometriosis.

What are the related disorders that occur with endometriosis?

Endometriosis can be associated with infertility and ovarian cancer.

What are the stages of endometriosis?

There are four stages (stage I to IV) of endometriosis based on the location, size, depth and extent of its implantation into the foreign tissue, presence of scar tissue and its severity, and the presence and size of endometrial tissue in the ovaries. The stages do not determine the extent of pain or other symptoms, or chances of infertility.

Superficial implantation with mild scarring are classified under minimal or mild stage. Moderate and severe forms of endometriosis are characterised by cysts and severe scarring. Stage IV endometriosis is characterised by infertility.

How is endometriosis diagnosed?

When you present to your doctor’s clinic with severe pelvic pain, your medical history is reviewed and a thorough physical examination performed. An ultrasound or transvaginal ultrasound may be ordered to view the reproductive organs for cysts.

The standard diagnosis for endometriosis is a laparoscopic procedure, where a lighted tube called a laparoscope is inserted into your pelvic region through your belly button. The images captured by the camera on the laparoscope are relayed on a big screen for your doctor to see clearly. A biopsy or a sample of the suspected tissue is removed for further examination and confirmation of endometriosis.

Is diagnosis needed?

Diagnosis with the laparoscopy may not be required in most cases. Your doctor may suspect endometriosis just by your symptoms, a physical exam and an ultrasound. If you do not intend to get pregnant immediately, you can discuss the need for an invasive procedure such as laparoscopy surgery.

Treatment

What are the consequences of not treating endometriosis?

Left untreated, endometriosis can remain as it is or become more severe. Mild forms of endometriosis may improve with time and most often resolve after menopause. Your decision to treat or not to treat is based on balancing the effects of endometriosis on your life and the risks of treatment.

When should I consider watchful waiting of endometriosis?

Your doctor may suggest watchful waiting if you have mild endometriosis, to observe the course of the disease and if you are approaching menopause.

What are the treatment options for endometriosis?

There is no cure for endometriosis but pain relief and pregnancy can be achieved by the following methods:

  • Medication: these can be in the form of
    • Hormonal: oral contraceptive pills and progesterone (a female hormone) administered orally, as an injection, through an intrauterine device or device inserted under your skin
    • Non-hormonal: pain relievers, NSAIDs
  • Surgery:
    • Conservative surgery: to remove endometrial implantations
      • Laparoscopy
      • Laparotomy
    • Radical surgery: to remove the uterus, cervix and ovaries
      Hysterectomy

Often, surgery is combined with medical therapy either before the procedure to decrease the size of the lesion or after, to lower the chances of recurrence.

Book an appointment with Dr. Polyakov today.