Endometriosis

What is endometriosis?

Endometriosis is a chronic condition where tissue similar to the endometrium (the lining of the womb) is present outside the uterus.  During your menstrual cycle, the displaced endometrial tissue behaves like normal endometrial tissue, thickening, and breaking down, leading to inflammation, pain and sometimes the formation of scar tissue.

How common is endometriosis?

In Australia the condition affects 10% of women and girls.

 What are the symptoms of endometriosis?

Endometriosis can present in different ways for different people and may include:

  • Period pain

  • Pelvic pain

  • Pain with intercourse

  • Fatigue

  • Bloating

  • Bowel and bladder symptoms, and

  • Infertility. 

It is not normal to experience these symptoms.  Dr Brown will evaluate your symptoms and tailor treatment to your needs.

More information about Endometriosis & Pelvic Pain

What investigations help form the diagnosis?

The diagnosis of endometriosis typically involves a combination of:

  1. Clinical evaluation (with patient history and pelvic examination).

  2. Diagnostic tests with pelvic ultrasound and/or MRI.  A transvaginal ultrasound can be used to visualise the pelvic organs and look for ovarian cysts (endometriomas) or other signs of endometriosis.  Unfortunately though, both ultrasound and pelvic MRI do not detect all cases of endometriosis, especially if the lesions are superficial or located in deeper tissues.

  3. Laparoscopy: the gold standard for diagnosis endometriosis is laparoscopic surgery.  During this minimally invasive procedure the surgeon can directly visualize and biopsy any suspicious lesions to confirm the presence of endometriosis.

It is important to note that endometriosis can sometimes be challenging to diagnose and the symptoms can overlap with other conditions. 

What is the treatment for endometriosis?

The treatment of endometriosis depends on the severity of symptoms, the extent of the condition, and the individual’s goals, such as managing pain, improving fertility or both.  Some common approaches to treating endometriosis include:

  1. Pain medication: simple pain relief such as ibuprofen may help manage pain associated with endometriosis.

  2. Hormonal therapy: hormonal medications such as combined oral contraceptive pill, progesterone tablets, IUDs (ie mirena) can regulate hormone levels and reduce the growth and shedding of endometrial tissue.

  3. Pelvic physiotherapy.  With endometriosis the pelvic floor muscles can seize up due to endometriosis pain.  Pelvic floor physiotherapists can tailor treatment to stretch and down-regulate these muscles to help reduce pelvic pain symptoms.

  4. Gonadotropin-releasing hormone (GnRH) agonists: these medications can effectively reduce oestrogen production, temporarily inducing a menopause-like state, which can help shrink endometrial tissue and alleviate symptoms.

  5. Surgical management is recommended as the “gold standard” for diagnosis and treatment.  Not only will it confirm or exclude the endometriosis in people but excising it will remove the endometriosis.  This can provide relief from pain and improve fertility.  If fertility is complete, hysterectomy with full excision of the endometriosis tissue is an option.  Surgery is reserved as an option when conservative and medical management has failed.

What other complementary therapies can help reduce the symptoms of endometriosis?

  1. Diet: adopting an anti-inflammatory diet rich in colourful fruits and vegetables, whole grains and lean protein may help reduce inflammation associated with endometriosis.

  2. Exercise: regular physical activity can help manage pain and improve overall well-being.  Low impact exercises like yoga, swimming and walking might be beneficial.

  3. Natural therapies: N-acetyl cysteine (amino acid), zinc, turmeric all have anti-inflammatory properties and can help with pain symptoms.

  4. Heat therapy: applying a heat pack or warm compress to the lower abdomen can help ease pelvic pain and muscle discomfort.

  5. Acupuncture:  when performed by a qualified practitioner, has shown to reduce pain and improve quality of life for some individuals with endometriosis.

  6. Stress management:  techniques like medication, deep breathing exercises or mindfulness practices can help manage stress which might indirectly alleviate symptoms.

Remember that the effectiveness of natural therapies can vary from person to person, and what works for one individual may not work for another. 

What are common myths regarding endometriosis?

  1. It is normal to have terrible pain during your periods

  2. A normal pelvic ultrasound means you don’t have endometriosis

  3. Endometriosis only arise in older women and not teenagers

  4. Pain from endometriosis only arises at the time of menstruation (periods)

  5. Surgery will fix all your pain and cure you of endometriosis.