Endometriosis is a disease that affects women mainly (but not only) during their reproductive years. The tissue that lines the inside of the uterus establishes itself in other sites of the body – mostly within the pelvis.
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What is endometriosis?
Endometriosis occurs when the same tissue lining the inside of the uterus (endometrium) grows in areas other than the uterus, mostly within the pelvis. It functions in much the same way, growing through the cycle in response to the ovarian hormones and then shedding some of its tissue and also bleeding at the time of the period.
The amount of blood loss from any particular patch of endometriosis depends on how much tissue is present. Endometriosis can occur in tiny spots no larger than a pinhead, to masses larger than a cricket ball. Fortunately, minor endometriosis is more common than very severe levels of disease.
In the normal female menstrual cycle, the endometrium (the internal lining of the uterus) is very responsive to hormones. Endometriosis tissue, due to its abnormal site and blood supply, can be less responsive than the normal endometrium, but it essentially undergoes the same changes. The most damaging of these is the bleeding, which occurs at the time of the period. Menstrual-type blood can therefore be released into sites in which it was never meant to occur, such as inside the pelvis. This release of menstrual-type blood explains many of the side effects and symptoms that are associated with endometriosis.
Where does endometriosis occur?
Typically, endometriosis occurs in the pelvis. Endometriosis can occur at almost any site in the pelvis, but is most commonly found behind the vagina and uterus, underneath and on the ovaries. It can also occur in front of the uterus, between the uterus and the bladder.
Endometriosis sites behind the vagina and behind the cervix, on the uterus, are commonly associated with pelvic pain and, particularly, deep pain during intercourse. Similarly, endometriosis that occurs underneath the ovaries can also cause painful intercourse. Extensive endometriosis in and around the ovaries can also disrupt menstrual function, causing period abnormalities.
Rarely, endometriosis occurs in body sites away from the pelvis. It can occur in other parts of the abdominal cavity, such as on the surface of the liver, and has rarely been found in such places as abdominal wounds, or even in lung tissue.
Who gets endometriosis?
Almost any female of reproductive age is susceptible to endometriosis. However, endometriosis is more likely to occur in females through their twenties and into their thirties. Women who delay having children are more susceptible, although young women can still develop quite severe forms of endometriosis. It is believed that stress may play a part, and previous use of contraception may also be important.
Pregnancy often changes the course of endometriosis and cures it in many but not all women.
Symptoms & diagnosis of endometriosis
A common symptom of endometriosis is the onset of increasing period pain where this has not been a particular problem in the past. Women who have developed pain on intercourse or have vague, unexplained abdominal pain (which may be unrelated to either intercourse or periods) may also have endometriosis.
Endometriosis can sometimes be associated with period dysfunction and irregularity. Sometimes women may present with symptoms of pain or pressure due to endometriotic cysts in the ovaries. However, many women are in fact unaware they have endometriosis until they experience pregnancy delay.
There are a wide range of endometriosis symptoms, and the severity of these also varies greatly. In order to diagnose endometriosis we look for symptoms that include:
- Pain during intercourse (Dyspareunia)
- Period pain (Dysmenorrhoea)
- Pelvic and abdominal pain
- Abnormal bleeding
- Pelvic pain
- Pregnancy delay
- Feelings of pressure and discomfort in the pelvis
- Occasional bowel disturbance or bowel motion pain, especially during periods
Endometriosis can sometimes be diagnosed on pelvic examination. The gynaecologist may feel nodules of endometriosis at the top of the vagina and around the uterus or may suspect the presence of endometriosis by the fact that the uterus is tethered, rather than quite mobile, or that the ovaries are similarly tethered and perhaps tender to touch. Most endometriosis, however, needs to be accurately and directly diagnosed by direct observation during a minor form of surgery called a laparoscopy.
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How do we treat endometriosis?
Laparoscopic surgery, including removal of all the endometriosis, is considered by many to be the best treatment for most levels of endometriosis. Minor surgery, in the form of laparoscopy/laser treatment, may in some cases be as effective as drug treatment in relieving symptoms and producing pregnancies.
Hormonal (drug) therapy can be useful in treating minor endometriosis. However, while less invasive than surgery, it is often less effective.
If possible and appropriate, pregnancy can also be an effective way to treat endometriosis.
First appointment overview and costs
A Queensland Fertility Group Specialist can assist with diagnosing endometriosis and identifying the best course of treatment to help you get pregnant. All our doctors are expert gynaecologists – even if you are not trying to conceive, our specialists can help.
The approximate out-of-pocket cost for an initial consultation starts from around $90. If you are specifically seeking help to fall pregnant, it is recommended your partner attends as well. The approximate out-of-pocket cost for a first appointment for both you and your partner varies from around $100-$150.
Typically during a first appointment your specialist will assess your medical history, and will most likely recommend investigations such as blood tests (many of these are bulk billed) and an ultrasound scan. The results of these will help you and your Fertility Specialist determine the best next steps for your individual circumstances. You should feel comfortable to mention any concerns you may have, and ask questions.
Download our Endometriosis Booklet
If you know or suspect you have endometriosis and are trying to conceive, a Queensland Fertility Group Fertility Specialist can help. All of our doctors are expert gynaecologists and/or obstetricians who have undertaken additional training and specialise in fertility.
If you would like more information, to have your questions answered in a free phone consultation with a fertility nurse, or to book an appointment, please call 1800 111 483 or email us.
*Content courtesy of Dr David Molloy, Medical Director Queensland Fertility Group. For more information on endometriosis, visit: http://www.gynaecologymolloy.com/what-is-endometriosis.html