Endometriosis occurs when tissue similar to the lining of the uterus (endometrium), is found in areas outside of the uterus, in other words, where the tissue should not be, and can cause pain (eg period pain), abnormal vaginal bleeding, and/or infertility.
Generally, endometriosis is found in the pelvic cavity. It is still not exactly certain what causes the condition. It can attach to any of the female reproductive organs (uterus, fallopian tubes, ovaries), the uterosacral ligaments, the peritoneum, or any of the spaces between the bladder, uterus/vagina, and rectum.
Symptoms of endometriosis can include:
- Cramping or severe period pain
- Long, heavy periods
- Bowel and urinary disorders eg: pain on opening your bowels
- Nausea and/or vomiting
- Pain during sexual activity
It is possible to have endometriosis and not have any of these symptoms.
The only conclusive way to confirm a diagnosis of endometriosis is to undergo a diagnostic laparoscopy and have a biopsy taken. This operation is performed under a general anaesthetic. Sometimes, a transvaginal ultrasound may detect endometriosis by finding an abnormal-looking cyst on your ovary, a nodule in the pelvis, or poor movement of your bowel behind the uterus (the sliding sign).
While there is no cure for endometriosis, it can be managed in a number of ways.
Hormonal treatments work by shrinking the endometriosis and preventing its growth. Hormonal treatments include the oral contraceptive pill, or progesterone, which can be given via the Mirena® intrauterine device or as an oral tablet.
Non hormonal medications such as paracetamol, non-steroidal anti-inflammatories, and stronger pain relievers may help to manage the pain symptoms. Pelvic physiotherapy and/or osteopathy may help to manage chronic pelvic pain.
Some women find pain relief with acupuncture, meditation, behavioural modification (clinical psychology) and exercise. Being active and eating healthy foods is helpful in combating pain and fatigue from endometriosis. Botox injections into pelvic muscles may be of help for women with chronic pelvic pain and over contraction of pelvic floor muscles, which can contribute to the pain.
Surgery for endometriosis is usually performed by laparoscopy (keyhole surgery), where the surgeon carefully excises or removes the endometriosis. Laparoscopic surgery causes less scarring, less pain, less time in hospital, and better visualizes the areas where endometriosis can grow, than laparotomy (open surgery).
In cases of severe endometriosis involving the bowel and/or other pelvic structures, a bowel resection and or/open surgery may be required to remove the diseased tissues.
There is no ‘best treatment’, since treatments will work differently for individual women with endometriosis. You should be aware of the different kinds of treatments, and their possible effects and side effects or complications. A combination of treatments may be necessary to relieve the symptoms associated with endometriosis.
Dr Farrell is highly experienced at removing endometriosis with surgery. She also works closely with other colleagues including physiotherapists, psychologists, and fertility specialists, who can be of great assistance in managing the pain and other problems associated with endometriosis.