Endometriosis

What is endometriosis?

Where does it occur?

What symptoms does it cause?

How common is it?

How is it diagnosed?

What treatments are available?

What are the goals of treatment?


Endometriosis

At Sunshine Coast Advanced Laparoscopic Surgery, Dr Orford aims to achieve the best outcome for women suffering with endometriosis.

What is endometriosis?

The endometrium is the inner lining of the uterus. Under the effect of ovarian hormones (oestrogen and progesterone) during the menstrual cycle this lining gradually thickens as it prepares to receive a possible fertilised egg. If no pregnancy occurs by the end of the monthly cycle the endometrium then sheds away as a period, and the cycle re-starts. Endometriosis is a condition where tissue identical to endometrium appears in other sites. Most commonly it occurs in the pelvis, but can also rarely appear in more distant sites.

Where does it occur?

Endometriosis is most commonly found in the pelvis, usually on the mucosal lining of the pelvis called the peritoneum. It can appear on the ovaries, the tubes, the bladder, and the bowel.

What symptoms does it cause?

As endometriosis responds to ovarian hormones the same way that normal endometrium does, it will become inflammed and possibly bleed at the time of the period.

The most common symptom is pain, classically at the time of the period and just prior to the period. This pain might be felt in the lower stomach, or either side. It may be felt more in the lower back, or with bowel motions less commonly.

It can cause pain with sexual intercourse.

It can be associated with infertility, either through anatomical distortion / blockage, or by the inflammatory mediators present in the pelvis.

How common is it?

This is difficult to exactly measure, as some women with endometriosis may not have symptoms. Endometriosis has been discovered in 10-15% of women having a laparoscopy to have their tubes tied (this is probably a low risk group as they have no pain, no infertility). It is present in perhaps 30% of women with infertility, and 50% if they also experience painful periods or painful intercourse.

How is it diagnosed?

Unfortunately there is no reliable "imaging" test for endometriosis (ie ultrasound). The only definite test is laparoscopy. Usually it is possible to remove endometriosis laparoscopically at the time of diagnosis. Obviously this is only done if agreed to by the patient before surgery.

What treatments are available?

  1. Wait and see. Some women may decide that their symptoms are not severe enough to warrant further investigation or treatment.
  2. Natural: Vitamin B, zinc, calcium have been suggested as possibly helpful supplements. There may be some benefit from acupuncture, or chinese medicine.
  3. Exercise - 20-30 mins of mildly aerobic exercise, a few times a week, has been shown to help reduce symptoms of endometriosis
  4. Stress management / relaxation
  5. Medical : medications used for control of symptoms include
    • NSAIDs (Non steroidal anti-inflammatory drugs) - eg Naprogesic , Ponstan , Neurofen
    • oral contraceptive pill - can be useful in younger women still wanting contraception, but may cause side effects.
    • progesterones - may cause "premenstrual" side effects ie weight gain, loss of libido, skin changes, mood depression, bloating. Doesn't remove endometriosis, but suppresses it, so symptoms often return once treatment ceases.
    • GnRH analogues - these induce temporary menopause. Low oestrogen levels cause atrophy (wasting) of the endometriosis deposits, and are very effective. However they cannot be used for more than 6 months, are contraceptive during use (so not helpful for women wanting to conceive), and symptoms return fairly steadily over the following few years after cessation of treatment.
     
  6. Surgical:

Via the laparoscope usually an excellent view of the extent and severity of endometriosis is obtained. Except in very severe cases, endometriosis can usually be "excised" or "resected" through laparoscopic surgery at the time of diagnosis.

Rather than just "burning" or ablating the surface disease, the endometriosis is picked up with laparoscopic instruments and cut away / resected. This leaves a small, raw defect in the lining of the pelvis (peritoneum) which grows over quite quickly (usually days), without the endometriosis.

Resection can be quite simple, or at times very difficult if the endometriosis is close to major organs / blood vessels. In these cases it requires careful dissection to ensure the safety of the patient. Rarely, it may be so risky to proceed that no treatment is undertaken, but the extent is documented / photographed, and a discussion is had at a later date as to how to proceed.

Surgical treatment seems to offer longer, and more complete relief from symptoms, and avoids the side effects of medications.

Surgical treatment also has an advantage over medical therapy for those wishing to conceive earlier.

Risks of surgical treatment of endometriosis include:


What are the goals of treatment?

- the main aim of treatment is to leave the patient free of symptoms (pain / infertility)
- ideally this includes removing all disease