Endometriosis is quite prevalent.  1 in 10 women is afflicted by it.

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Endometriosis occurs when tissue similar to the lining of the uterus grows in other areas of the body. It commonly found in the pelvic area on:

• the lining of the pelvis,

• the ovaries,

• the fallopian tubes,

• the areas between vagina and rectum,

• the rectum,

• the Pouch of Douglas,

• the bowel, or 

• anywhere in the pelvic area.

It is also found inside the ovary. A cyst of endometriosis found in the ovary is referred to as a chocolate cyst or endometrioma.

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Endometriosis has been found in the lungs, diaphragm and other peripheral organs.

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Because the endometriosis tissue should not be there, many problems are likely to develop including scar tissue and adhesions. 

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CAUSE

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Presently, the cause of endometriosis is unknown but there are a number of theories postulating genetic, immunlogical and environmental factors.  

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According to Endometriosis New Zealand [ENZ],the cause is now generally considered multi-factorial with a strong genetic link.

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Vast research continues in this area.

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STAGES 

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For surgical purposes, endometriosis is often classified in stages.

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Stage I- Minimal Stage: The endometriosis deposits are few and isolated.

Stage II- Mild Stage: There are small superficial adhesions, scar tissue and growths.

Stage III- Moderate Stage: The growths are profound and the scar tissue and adhesions are prominent.

Stage IV- Severe Stage: The deep growths are numerous and the adhensions are extensive.

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However, the stages do not necessarily correlate with the  severity of the symptoms experienced.  

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SYMPTOMS

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Some of the symptoms may include but not limited to the following:

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• painful, sometimes distressing cramps which may include the rectum and legs during periods (dysmenorrhea); the pain may get progressively worse over time

• pelvic pain

• painful intercourse (dyspareunia)

• infertility or sub-fertility

• bowel issues such as constipation, diarrhoea and bloating

• heavy and irregular bleeding

• tiredness and low energy

 

The most common symptoms are pelvic pain and dysmenorrhea.

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DIAGNOSIS

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While a doctor may suspect endometriosis based on the patient's medical history and symptoms, endometriosis is only confirmed by surgery.

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In keeping with current best practice, endometriosis is diagnosed by key hole (laparoscopy) surgery. This involves the insertion of a device to veiw to the pelvic cavity. This is done by an experienced gynaecologist. The endometriosis should be removed (excised) and sent to the lab for confirmation (histology).

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There exists a delay of 8 to 10 years from first presentation of symptoms to diagnosis.

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Women and girls experiencing endometriosis symptoms are urged to seek medical attention immediately.

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TREATMENT

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Presently, there exists no cure for endometriosis but the disease can be treated and according to current best practice, a multi-disciplinary approach involving medical and surgical treatments and self-management is most effective. However, for the most effective treatment, endometriosis patients are to discuss treatment options with their medical practitioners so that their needs are met.

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Medical Treatment

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Currently, there exists no medication that cures endometriosis. However, there are those that may treat the symptoms of endometriosis.  Medical treatment is usually a first line approach to control the symptoms of endometriosis. Endometriosis patients are to discuss options with medical practitioners for best results and the medical practitioners should prescribe the medications that best suit the patients needs.

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Here a some medications that are commonly used:

• Pain killers                                                                Non- steriodal Anit-inflammatory Drugs [NSAID] are usually recommended and are to be taken before the pain comes on too strong.

• Hormone treatment                                                            These include Oral Contraceptive Pills [OCP], GnRH analogues, intrauterine device or system and other hormone medications may be recommended.  

 

Often times, medical treatment are used in conjuction with surgery to control endometriosis.

 

Endometriosis patients are to understand the benefits and side effects for each medication before starting treatment.

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Surgical Treatment

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Laparoscopy (Key hole Surgery)

This surgical procedure is done under anaesthesia. The abdomen of the patient is distended with a special gas, which makes the organs visible, and a laparoscope (a special tube with a camera and light) is inserted in a tiny incision.  The surgeon examines the extent of the disease and cut out (excises) all the endometriosis, if present. Other tiny incisions on the abdomen are necessary for this. It is critical that a skilled surgeon is secured for this surgery.  The two main factors of a successful surgery rest with the skill of surgeon and thoroughness of the surgery.  

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Hysterectomy

This surgical procedure removes part or all of the uterus. A hysterectomy may be considered for severe and painful cases of endometriosis. While it may help or eliminate the  symptoms for some patients, a hysterectomy is not a cure for endometriosis. Many factors are to be seriously considered before deciding on a hysterectomy.

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Oophorectomy

This surgical procedure removes one or both ovaries. Several factors are considered before deciding on the removal of the ovaries, the major being the severity of the damages to the ovary that is usually caused by an endometrioma(s).  The removal of both ovaries induces menopause.  Hormone Replacement Therapy (HRT) is recommended but is dependent on several factors.

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Endometriosis patients are to understand that all surgeries have risks and the risks are to be thoroughly discussed with their medical practitioners and understood before consenting to surgery.

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SELF MANAGEMENT

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This focuses on what an endometriosis patient can do to control the symptoms of the disease so that she enjoys a better quality of life. Self management includes diet, exercise, etc.

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