"Unfortunately for many Australian women, endometriosis means pain, heavy periods and, for those in their reproductive years, infertility, which makes it a particularly debilitating disease. Because of the difficulty in diagnosing endometriosis, damage from the disease can be significant. Many women consider lower abdominal or pelvic pain to be an unwelcome but ‘normal’ part of their menstrual cycle. This may mean they don’t seek help for their symptoms for many years. By speaking to your doctor, you and your doctor may be able to treat and manage the condition to reduce the impact period pain and endometriosis may have on your quality of life."
Dr Christine Bennett
Chair, Medical Advisory Panel, Bupa Australia.
What is endometriosis?
The lining of a woman's uterus (womb) is called the endometrium. Each month the endometrium thickens under hormonal influence and then sheds during the monthly bleed (period). For reasons we don't yet understand, sometimes endometrial tissue grows outside the uterus—most commonly on the ovaries, fallopian tubes or inside the pelvis in an area between the uterus and the rectum. It may also grow on the bowel, bladder or elsewhere. This condition is known as endometriosis.1
Because this tissue follows the same hormonal cycle as it would inside the uterus, it bleeds during the period but this blood has nowhere to go. Consequently, small collections of blood develop inside the pelvis or elsewhere and may cause irritation. The irritation can lead to inflammation. This can, in turn, lead to the formation of tight bands of scarring called adhesions.1
The causes of endometriosis are not well understood but theories include a genetic link, an immune system dysfunction or excessive menstrual blood flowing in through the fallopian tubes instead of out through the vagina.2
What are the symptoms?
If you have endometriosis you may experience one or more of the following symptoms:1, 3
- lower abdominal “period” pain that often starts a day before the period and lasts for two to three days
- deep pelvic pain, sometimes during or after sex
- heavy, prolonged and/or irregular periods
- difficulty falling pregnant
- lower back or upper thigh pain
- pain and possibly bleeding when opening bowels or passing urine
- constipation or diarrhoea
- fatigue
- bloating
- mood changes.
Often, women consider the lower abdominal or pelvic pain of endometriosis to be an unwelcome but normal part of their menstrual cycle. This may mean they don’t seek help for their symptoms for many years. To find out whether your period pain may be a symptom that requires intervention, speak with your doctor. If your doctor suspects you have endometriosis, they may initially offer simple treatments such as anti-inflammatory medication or hormone therapy such as the contraceptive pill. If these treatments are ineffective, they may refer you to a specialist gynaecologist with an interest in endometriosis.
What is the impact of endometriosis?
Women with endometriosis may find that in the long-term the condition interferes with their productivity and ability to enjoy life. Recurrent monthly pain can cause inconvenience and discomfort due to days off work or study and the need for strong painkillers. If left undiagnosed, endometriosis can have more serious effects such as impacting a woman’s fertility.
Am I at risk of developing endometriosis?
Endometriosis affects about 10 percent of all women of reproductive age.2 If a family member has endometriosis, you may be at increased risk of developing the condition. Some other suspected risk factors include early onset of puberty, heavy or painful periods, short menstrual cycles (less than 27 days) and/or a lengthy period (more than seven days), allergies and obesity.
Endometriosis can occur at any age between puberty and menopause. It should be considered as a possible diagnosis in women who are unable to get adequate relief from standard period pain treatments.
How is endometriosis diagnosed?
There is no simple diagnostic test for endometriosis and delays in diagnosis are common. Without an invasive test, it can prove difficult to distinguish endometriosis from common hormone-based menstrual discomfort. Your doctor may suspect the condition if you complain of pelvic pain, including painful periods or painful sex, particularly when the pain isn’t relieved by standard painkillers.
Your doctor may perform abdominal and internal pelvic examinations. Although sometimes an ultrasound examination may suggest endometriosis, the only definitive way to diagnose the condition is by direct observation with laparoscopy. Laparoscopy is a surgical procedure under anaesthesia where a telescope-like instrument attached to a camera lens is inserted into the abdomen to view the pelvic organs.1,3
How is endometriosis treated?
If your doctor diagnoses you with endometriosis, they’re likely to recommend one of the following treatment options, depending on your individual circumstances:
- Observation with pain relief. If you have a mild case, it may respond to anti-inflammatory medications such as ibuprofen or other mild analgesics together with a ‘wait and see’ approach and ongoing monitoring by your GP.
- Hormonal medications. The menstrual cycle, including the thickening and shedding of the endometrium, is governed by hormones, primarily oestrogen and progesterone. The aim of hormone therapy for endometriosis is to manage the cycle to reduce the symptoms you experience. Your doctor may prescribe one of several types of hormone therapies with different actions and side effects; most act by stopping your monthly periods.1,2
- Surgery. Surgery is the most likely treatment to cure endometriosis, giving more than 80 percent of women relief from symptoms that rarely return.4 It’s usually carried out under a general anaesthetic. If your doctor decides that surgery is an option for you, laparoscopic (keyhole) surgery may be offered. This involves very small incisions in the abdomen to allow insertion of the telescope and other equipment for the operation, making it much safer than conventional surgery. The abnormal tissue may then be removed or destroyed using electrical apparatus or a laser. This treatment may sometimes happen at the same time as the diagnosis is being made. In some severe cases, a laparotomy may be preferred. This involves making a larger incision to allow the surgeon to access the pelvic area and remove larger abnormal patches of tissue and, if appropriate, affected organs such as ovaries. Rarely, a hysterectomy—removal of the uterus and possibly the ovaries—may be advised. Where possible, an ovary may be left in place to prevent early menopause. Sometimes surgery may be combined with hormone treatment.1,2,3,4
In addition to your medical treatment, you might like to consider complementary therapies such as massage, acupuncture and dietary changes to help you cope with the emotional strain of endometriosis.2
Further information
The Jean Hailes Foundation: Endometriosis
www.endometriosis.org.au
Endometriosis.org
www.endometriosis.org
Endometriosis Association (Queensland)
www.qendo.org.au
Sources
- The Jean Hailes Foundation for women’s health. Endometriosis [Internet] [Updated 2009 July 31; cited 2011 June 21]. Available from http://www.endometriosis.org.au/about-endometriosis
- Better Health Channel (Victoria Government) Endometriosis [Internet] 2010. [Updated 2011 January; cited 2011 June 21]. Available from http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/endometriosis?open
- Endometriosis Care Centre of Australia [Internet] 2008. [Cited 2011 June 21] Available from http://www.ecca.com.au/symptoms
- Wood, R. Surgery. Endometriosis.org [Internet] 2005-2011. [Updated 2011 April 12; cited 2011 June 21] Available from http://endometriosis.org/treatments/endometriosis-surgery/
Last published: 30 July 2011
