Gynaecology Services - Endometriosis

Endometriosis occurs when tissue, which normally lines the inside of the uterine cavity, grows outside the uterus. It looks and acts like endometrial tissue from the uterus.

No specific cause is known for this condition but there are many theories. It is a fairly common condition and will occur in about 10% of women between the ages of 20 and 40 years. Most women will have symptoms and it can occur without any symptoms at all.

Common sites for Endometriosis:

• Pouch of Douglas (behind the uterus)
• Surface of the uterus
• Ovaries and Fallopian tubes
• Bladder and ureters
• Rectum
• Other sites in the body - it uncommonly occurs in the upper abdomen, lungs, diaphragm and peritoneum

Symptoms

• Pelvic pain.

Pain may occur with periods, with sex, during urination or a bowel movement.

• Menstrual difficulties.

There may be irregular or heavy bleeding.

• Infertility.

Endometriosis is not an infrequent cause of infertility. However, it is thought to occur on either a biochemical basis or a mechanical one.

Diagnosis

The severity of pain does not indicate the extent of endometriosis. Some women with severe endometriosis may have minimal pain and, on the other hand, people with minimal endometriosis may have significant difficulties.

• Pelvic Examination.

This may give an idea as to whether endometriosis is present in the pelvis or not. There may be masses or tenderness in various areas of the pelvis.

• Ultrasound.

An ultrasound performed by your specialist gynaecologist may detect an endometrioma (enlarged ovary with endometriosis) or other endometriotic collections in the pelvis.

• Laparoscopy.

A laparoscopy is the gold standard for diagnosis of this condition. Endometriosis can be confirmed by its visual appearance and a small amount of tissue, called a biopsy, may be removed and will document the condition.

Treatment

Treatment for endometriosis by your specialist gynaecologist will depend on the symptoms, whether one wants to have children and the extent of the disease.

Medication

• Oral contraceptives.

The oral contraceptive pill will often help with endometriosis. This keeps the menstrual cycle regular and may relieve the pain. It may also be given so as to reduce the number of menstrual periods per year. This generally does not cure endometriosis but relieves the symptoms and is excellent for mild endometriosis.

• Progesterone.

This hormone can be used to shrink deposits of endometriosis in the pelvis. It acts as antagonist to oestrogen and, if it works well, patients should not have monthly withdrawal bleeds. Unfortunately, there are mild side effects.

• Danazol.

This type of hormone treatment will also shrink endometriosis significantly. It works very well but it is very infrequently used due to the significant side effects.

• Gonadotrophin releasing hormone (GnRH).

These drugs tend to suppress the ovaries and lower oestrogen level in the body. This in turn causes rapid and significant shrinking of the endometriosis. This can be given in various ways such as an implant or nasal spray. Again, there are some side effects but they can often be reasonably well controlled. The treatment only lasts 3-6 months.

• Surgery.

The principle of surgery in endometriosis is to remove the deposits and the scar tissue around the deposits. In severe cases of endometriosis, surgery is often the mainstay of treatment and the treatment of choice. The modern surgical form of therapy is by laparoscopy, which Dr Blumenthal has now performed as a Specialist for many years. In this way, most of the affected endometriosis can be removed and sent away for biopsy. In addition, adhesions and ovarian cysts or endometriomas can be removed at the same time. If the endometriosis is severe, then a laparotomy may be needed.

• Hysterectomy.

In longstanding cases of severe endometriosis, where there has been minimal or no response to conservative therapy and where childbearing is no longer an issue, a hysterectomy may be advisable. Please consult Dr Norman Blumenthal for any questions on this matter.

Summary

Endometriosis is a long term problem and condition. Symptoms and signs may occur intermittently over many years and even until the menopause. One should always keep in mind that various treatment options are available to allow one to cope and tolerate the symptoms better. You should ask your Sydney Specialist gynaecologist for any issues related to Endometriosis.