Endometriosis is a difficult disease to understand because the medical profession does not understand it completely themselves.
What is endometriosis?
In endometriosis cells from the endometrium are found in the pelvis or the abdomen, not inside the uterus where they belong. Early endometriosis may look like clear dots but as it grows it may become dark in colour, the colour of old blood and may look like blood blisters spotted on the pelvis. Severe endometriosis causes scarring or organs to stick together as the endometrial cells grow and regress. On the ovaries endometriosis can form “chocolate cysts” which are full of old blood which has a dark brown colour.
The most favoured theory at the moment is that this occurs from blood going backwards through the tubes into the pelvis at the time of a period.
Why do some people get endometriosis and others don’t?
There is certainly a hereditary component but a lot of people have endometriosis without anyone else in their family having it. We don’t understand completely why some women form endometriosis and others don’t.
What are the symptoms of endometriosis?
- Pain with periods, especially before the bleeding starts
- Deep pain with intercourse
- Pain opening bowels or passing urine during a period
- Pain can become more constant and occur at times not related to a period
How is endometriosis diagnosed?
Endometriosis is often suspected from someone’s symptoms of their pain.
Severe endometriosis, especially if there are “chocolate cysts” on the ovaries, can be diagnosed by a specialist ultrasound.
MRI may diagnose deposits of endometriosis or adhesions in the pelvis.
The gold standard for diagnosing endometriosis however is key-hole surgery. Only visualising these small “blood blisters” with a camera inside the abdomen is the only sure way to be certain if someone has endometriosis or not.
How is endometriosis treated?
Usually a combination of treatments is necessary. It is very important treatment is tailored to an individual’s symptoms and needs.
Tablet treatment including hormone tablets and pain relief is often effective. Alternatively a hormone implant such as a Mirena (which is placed inside the uterus) or an Implanon (which is placed in the arm) helps others.
Key-hole surgery known as a laparoscopy to excise the endometriosis is the most definitive treatment however ongoing hormone therapy is often required to stop recurrence.
Pelvic stretches or physiotherapy is vital to many women as muscles often become tight as a response to the pain. Review by a pain psychologist can also be an important part of the treatment. As long term pelvic pain has an enormous affect on a patient’s life, their partners, family and even their workplace.
O&G and endometriosis
O&G has a group of practitioners dedicated to the treatment of endometriosis. This includes;
Gynaecologists specialising in diagnosing endometriosis
Ultrasound subspecialist who can perform a dedicated pelvic ultrasound looking for cysts and nodules of endometriosis, adhesions, reduced mobility and tenderness.
Laparoscopic surgeons who have an exclusive interest in excising endometriosis completely.
Pelvic pain physiotherapist who can instruct in pelvic floor stretches and release of pelvic floor muscle tension especially when there is pain with intercourse.
Psychologist supporting pain management strategies, mindfulness and support for partners and relationships.
Dietitian may be involved as women with endometriosis may benefit from alternative dietary regimes.
Care will be individualised to the specific needs of each patient.