Many women have heard of endometriosis but may not know or have only a vague idea as to what it really means. Up until recent years, endometriosis is a little-discussed gynaecological condition despite 1 in 10 women or 176 million women worldwide suffer from the condition. More alarmingly, there is an average of 7 to 10 years delay between first presentation of symptoms to diagnosis, in both adults and teenagers.
Endometriosis is a condition where the cells that line the inside of the uterus are found in other parts of the body. Its symptoms vary from woman to woman, but common symptoms are:
• Severe period pain
• Recurring pelvic pain
of more than 6 months
• Cyclical bladder or bowel symptoms,
such as painful bowel movements
• Deep pain during or after sex
Many women, especially teenage girls, suffer from period pain. It is therefore easy for women and sometimes doctors to discount the pain as normal, hence the delay in diagnosis. Endometriosis can be difficult to diagnose as its symptoms are non-specific. To add further to the challenge, there is no examination, blood tests, or scans that is sensitive enough to allow diagnosis.
The only way to diagnose endometriosis is by a laparoscopy a.k.a. keyhole surgery. Even with laparoscopy, surgeons without experience in endometriosis may miss the diagnosis as these lesions can be subtle and it appearances do vary. It is important not to overlook the subtle lesions, as there is no connection between the severity of the disease to symptoms. Women with severe disease may have no or minimal symptoms but women with subtle disease could have debilitating symptoms. It also takes a surgeon with experience in the technique to remove all these lesions by cutting as these lesions are often seen close to important structures, such as ureters, bladder or bowel.
Endometriosis frequently begins when a girl started having periods. In fact, we now know that it is a common cause of chronic pelvic pain in adolescent girls with endometriosis found in 70% to 73% of adolescents with pelvic pain who did not respond to medication. Yet, some doctors would be reluctant to commit to the diagnosis let alone recommend or offer laparoscopy.
Of course, endometriosis symptoms can be managed without surgery using hormonal or non-hormonal medication but surgery is useful as a diagnostic and therapeutic tool when performed by gynaecologists with experience in endometriosis when the symptoms are not controlled with medication and it is affecting quality of life.
Another group of women who may benefit from laparoscopy are women with infertility, especially after failing multiple IVF cycles. Approximately 40% of women with unexplained infertility are found to have endometriosis if they proceed to a laparoscopy and successful pregnancies were shown in women with infertility after removal of endometriosis lesions even when the disease is mild.
Endometriosis is a complex disease that we do not yet understand or know much. It is important for you to speak to your doctor or gynaecologist if you experience the above problems.
Dr Phoebe Hong
Level 2 Cairns Central Plaza, 58-62 McLeod Street, Cairns QLD 4870 (opp Cairns Shopping Centre)
Ph: (07) 4230 0030
F: (07) 4079 5490