Endometriosis

Endometriosis is a condition when cells similar to the lining of the womb (the endometrium) are found elsewhere, usually in the pelvis around the womb, ovaries and fallopian tubes. It is not cancer and it is not infectious.

It affects about 10% of women. It is more prevalent among women who suffer from infertility, quoted to be as high as 15-20%. It is more common among women whose mum and sister had endometrisis.

The exact cause of endometriosis is not known. It is thought to happen when cells that line the womb are carried to the pelvis via the fallopian tubes during your period. These cells respond to your hormones and bleed. This can cause pain, inflammation and scar tissue formation and possibly damage to your pelvic organs.

Endometriosis can affect any part of the peritoneum (lining of the abdomen & pelvis), around the womb, Fallopian tubes, ovaries and between the vagina and rectum. It may also affect the muscles of the womb (adenomyosis), bladder and rectum. It can also cause cysts on the ovaries called endometrioma (chocolate cyst).

Endometriosis can give no symptoms. Women who have endometriosis tend to have chronic pelvic pain, painful periods, pain during intercourse, irregular periods. It can cause infertility, pain during defecation and micturition.

Endometriosis can be suspected during ultrasound scan if there is a “chocolate” cyst on one or both ovaries. The only way to diagnose endometriosis definitively is through laparoscopy (telescope down the abdomen) which is done under general anaesthesia.

Treatment of endometriosis can be either medical or surgical treatment. Medical treatment can be either the combined oral contraceptive pills, Mirena coil, mini pill or progesterone injection every 3 months. Another very effective treatment is to have one injection every 4 weeks to switch the ovaries off but they can cause menopausal symptoms and hence, women may take HRT tablets to reduce these side-effects.

Surgical treatment of endometriosis can be done at the same time of diagnostic laparoscopy when the tissue of endometriosis can be excised or destroyed using diathermy or laser. Laparoscopy and treatment of endometriosis can improve the chance of achieving pregnancy before starting IVF treatment.