Endometriosis is far too common, it seems we all know at least one lady crippled by this troublesome condition, which is not surprising when it effects at least one in ten ladies.
But just what is endometriosis?
Dr Sam breaks it down to the basics that everyone needs to know.
The term endometriosis has its roots with the word ‘endometrium’. The endometrium is the lining of the womb (uterus) that changes with the normal menstruation cycle, shedding away to cause your ‘period’. In endometriosis, little patches of this lining occur in places they shouldn’t – all through the pelvis and abdomen – attached to your ovaries, bowel, abdominal wall, and every other organ that gets in their way. Influenced by the natural cycling of hormones, these patches grow and change just like a normal endometrium should, consequently inflaming and irritating tissues around them. A variety of symptoms result, but the most classic are pain and infertility. It’s possible to have endometriosis and experience no symptoms at all. Some suffer symptoms only occasionally, but some are crippled with bychronic pain or infertility.
So how do I know if I have it?
Whilst symptoms can strongly suggest endometriosis is present, the only real way to diagnosis it 100% is to do a laparoscopy. A laparoscopy is a simple surgical procedure (don’t worry – you're asleep!) involving a surgical telescope that’s poked into your abdomen. Here the gynaecologist can go looking for endometriosis patches and take biopsies of them for formal diagnosis under a microscope. Sometimes larger endometriosis patches might be visualised on scans or during other examinations.
Some ladies ask whether it’s essential to have endometriosis diagnosed. Basically, it’s not. It all depends on whether you can tolerate symptoms such as pain, or how significantly fertility is effected. Whilst the laparoscopy is a simple procedure, it’s not without its risks – for example a small risk of cutting your bowel or an infection – so the decision to undertake one needs to be made carefully. If it is found coincidentally but you aren’t experiencing any symptoms, then it doesn’t need to be treated, but your gynaecologist may recommend a monitoring regime.
Ok, so I have endometriosis, how do I treat it?
Diagnosis and management should be coordinated by your friendly gynaecologist. But most importantly it must be tailored to you. There are two main options available, but underlying any option should be good pain relief.
Pain Relief - These options won’t actually treat the troublesome patches, but merely control pain. Ladies are urged to start with simple medications such as paracetamol or anti-inflammatories – shown to be effective for the majority. Sometimes stronger medications are required, but if so, strong consideration should be given to the two mainstay treatments below.
Hormonal Treatments - The main options here are the oral contraceptive pills and progestogens. Both regulate the cycling of reproductive hormones and hence the cycling and irritation caused by the endometriosis patches. Progestogen can come in a tablet, three monthly injection (Depot), or the little rod that’s inserted under the skin of your arm (Implanon) that lasts up to three years. There are a couple of other hormonal treatments, but their side effects ensure they are only used in very specific circumstances by gynaecologists.
Surgery - Most endometriosis can be visualised and treated using the laparoscope, with the patches carefully cut out or burnt away. When the disease is severe or widespread there's sometimes a requirement to perform a laparotomy – a MAJOR operation where the abdomen is opened up and the patches painstakingly removed by hand.
But what else can be done?
We’ve discussed above three obvious options, however, there is thankfully more that can be done. Many ladies respond well to pelvic physiotherapy, psychology support, or complementary therapies such as acupuncture. Pelvic physios can assess and assist with other contributing issues such as pelvic floor weakness, or bladder or bowel control problems. The chronic pain consequences of endometriosis often lead to unhelpful ruminations, avoidance behaviours, or low and anxious mood states for sufferers – hence a psychologist is invaluable for support.
How successful can the treatments be?
Even if all endometriosis patches are eradicated, pain may still occur – this is because for a lot of ladies their natural periods are painful, or the patches weren’t the problem in the first place. However, up to 70% of ladies should expect decent improvement with the right therapy. If you end up with surgery, endometriosis comes back in about a third with mild/moderate disease, and over two thirds of ladies with severe disease. Frustratingly there’s no way of predicting whether that will be weeks, months, or years down the track. Unfortunately there’s no cure for endometriosis as we don’t really know what the underlying cause is. Ultimately, treatment aims to improve quality of life and fertility for as many women as possible.
A bit more on fertility…
When it comes to fertility, the hormonal treatments for endometriosis are pretty useless, as they’re generally very effective contraceptives! This narrows options down the basic conservative ones or surgery. The good news is that surgical removal of endometriosis patches improves fertility in a large proportion of ladies. However, if things still don’t go to plan, then an early referral to a fertility specialist for IVF or other treatments might be required.