Endometriosis? Treatment
What is Endometriosis?
Every month a woman produces endometrium within the cavity of her uterus. Endometrium consists of glands that ready the uterus for pregnancy if an egg is fertilised. If not, after two weeks that endometrium begins to shed and the woman has her period. If these glands grow outside the uterine cavity, e.g. in the pelvis, this is known as endometriosis.
Stage 1 endometriosis. Superficial lesions associated with endosalpingiosis.
Stage 4 endometriosis with obliteration of the Pouch of Douglas
Who can develop endometriosis?
Endometriosis is common and can occur in any woman from the onset of her menstrual life through to her late thirties. In fact, many young women do not realise they have endometriosis until later in life. This happens because younger women are often prescribed the contraceptive pill for severe pelvic pain during menstruation. The pill then masks signs and symptoms of progressive endometriosis throughout their lives until they decide (usually in their twenties or thirties) to stop taking it in order to try and get pregnant. This is when many women realise they have endometriosis. It can affect many compartment of a woman's life (fertility, sexuality, pain, quality of life). Here is a link towards an e-book with some testimonies.
How do I know if I have endometriosis?
The major symptoms of endometriosis are
- Painful periods often causing missed school or work
- Deep pain during sex
- Pain passing a bowel motion during a period
- Infertility
- Nausea or vomiting associated with a period
- Pain radiating to the back, upper thighs or buttocks
- Heavy or irregular menstrual bleeding
How does it cause pain?
Every month, while the endometrium within the uterus is growing and then shedding, the endometrial glands situated elsewhere also grow and bleed. This bleeding is not usual for the abdominal cavity and the tissue responds by scarring, contracting and often sticking to surrounding structures. These adhesions stop the normal movement of structures within the pelvis and can also affect nerves in underlying tissues, both causing acute pain. Furthermore, excess bleeding within the pelvis may irritate the lining causing discomfort.
Are there any signs?
The best way to check for endometriosis is by having your gynaecologist observe your personal medical history and the results of a pelvic examination.
If the ovary is involved, such as with an ovarian cyst (endometrioma), this may show up on an ultrasound. Trained ultrasound technicians will comment if the ovaries do not move freely or are tender when the probe pushes on them, suggesting endometriosis.
It is important to note that some patients with very mild endometriosis may have severe symptoms whilst those with severe disease may report only moderate symptoms
How is it treated?
The most effective way to remove endometriosis is with laparoscopic (keyhole) surgery. While a laparotomy (or open surgery) is also an option, the precise nature of keyhole surgery is better suited to the difficult task of completely removing all diseased tissue while preserving the normal structures (tubes, ovaries) in those young women wishing to preserve their childbearing potential.
What do I do now?
A/Prof Reyftmann is one of the few practitioners offering laparoscopic treatment of complex endometriosis in the Illawarra, and is probably one of the most experienced. He would be happy to provide further information if desired. If you think these issues relate to you and you wish to organise a personal consultation please call
(02) 4227 6589 to make an appointment.
Dr Reyftmann appears in the Illawarra Mercury on the 4th of June 2012. Endometriosis help.
Additional Resources
The pharmaceutical company Merck Serono has edited a useful patient booklet dealing with endometriosis. The quality of the information is excellent and I don’t find it biased. I am very happy to host a link towards this PDF file on my own website.
irml.fertilityportal.com.au
