Nov 13 2009
Its not Life threatening, BUT its definitely “Quality of Life” Threatening Condition!
Most people know endometriosis as a condition that can cause infertility, but the commonest symptom is pain. Pain with periods, pain with sex, pain opening their bowels, or pelvic pain on most days of the month. Many women with endometriosis become pregnant easily.
Endometriosis is common, but because many women don’t talk about their symptoms, we often don’t realise that it affects between 1 in 10 and 1 in 20 women. For many years, endometriosis was thought to be an uncommon condition of women in their 30s and 40s. We now know that it is a common condition of women in their teens and 20s.
The lining of the uterus is called endometrium. This is the tissue that grows each month and bleeds away during a period. When tissue like endometrium is found outside the uterus it is called endometriosis.
How is endometriosis diagnosed?
The only reliable way to diagnose endometriosis is by laparoscopy. This is an operation where a telescope is inserted through the umbilicus (belly button) to view the organs inside the pelvis. Endometriosis lesions can be clear, pink, red, brown or black.
An ultrasound examination is usually normal unless there are large cysts of endometriosis in the ovaries. These are called endometriomas or chocolate cysts. So, even if an ultrasound is normal, endometriosis can still be present.
What sort of problems can endometriosis cause?
Endometriosis presents in many ways. Common presentations include:
- Women with no pain, who are found to have endometriosis during investigation for infertility.
- Women who have severe period pain, often from their teenage years, but are well at other times of the month. Pain with periods is called dysmenorrhoea.
- Women who have a mix of pain symptoms on most days of the month. This is called chronic pelvic pain. They may have a variety of symptoms including sharp or stabbing pains, changes in bladder function or changes in bowel function.
How is endometriosis managed?
Each woman with endometriosis is different, so the best treatment for each woman will depend on what type of problems she has.
In couples who are unable to become pregnant:
- It is important to get a full picture of all the possible contributing factors. This includes testing her husbands’ semen. Endometriosis may be only one of the fertility problems present.
- A laparoscopy to remove the endometriosis may be enough to improve her fertility
- If pregnancy does not occur after this, then invitro fertilisation (IVF) may be necessary
In women with painful periods, but who are otherwise well the pain may be from the uterus, from endometriosis lesions in the pelvis or from both these areas:
- It is best to first try medications such as anti-inflammatories (e.g. ibuprofen, naproxen, diclofenac), because not all women with painful periods have endometriosis. The medications should be taken early in the period and continued regularly until the pain resolves.
- If no better, then the oral contraceptive pill or acupuncture may be helpful
- If no better, then a laparoscopy with excision (cutting out) of any endometriosis should be considered.
- Sometimes a device called a mirena iucd is used. This is a way of putting progestogen medication inside the uterus and is often very helpful at making periods light and less painful
In women with chronic pelvic pain, treatment is more complicated. Often there are many different symptoms, so no single treatment will fix all her problems. It is often helpful to write down each symptom and plan treatment for each one:
- Period pain over several days (rather than just 1-2 days), pain opening bowels with periods, and endometriomas are best managed with high quality laparoscopic surgery. This can be very difficult surgery and it is important that the surgeon involved has extensive experience with laparoscopic surgical excision. Other alternatives include norethisterone tablets taken daily to avoid periods or a mirena iucd.
- Sharp, stabbing pains, increased sensitivity in the abdomen, soreness near the opening of the vagina, sharp pains that wake her at night, and some types of pain with intercourse are often due to a change in the way nerves in the pelvis function. This is called neuropathic pain. It responds best to medications such as amitriptyline or gabapentin in very low dose. It will also be worse if she is overtired or overstressed.
- Bladder symptoms of frequency (going to toilet more often), nocturia (getting up at night), urgency (needing to rush to the toilet) and some types of pain with intercourse may be due to a condition called interstitial cystitis. It is common in women with endometriosis and needs a special type of test called a cystoscopy and hydrodistension to diagnose. Useful information can be found at www.ic-network.com
- Bowel changes such as constipation, diarrhoea and pelvic discomfort sometimes improve with surgery, but are often due to food intolerances or an irritable bowel.
- Pelvic pain which is worse in different positions or with different activities and some types of pain with intercourse is often due to spasm of the pelvic floor muscles. The muscles just inside the vagina are tight and pressure on them causes pain. Treatment options include pelvic floor physiotherapy, botox injections in the pelvic floor muscles to relieve the spasm, and sometimes low doses of amitriptyline.
Many women with chronic pelvic pain also suffer tiredness and may feel generally unwell. Even when their symptoms improve, they require a lot of emotional support from their family and friends to return to an active and healthy life.
Written by; -Dr Susan Evans is a Pelvic & Laproscopic Surgeon & author of ‘Endometriosis and other pelvic pain’ written for women with endometriosis. It is available from her website: http://www.drsusanevans.com
She is also the co-founder of the Asia Pacific Endometriosis Alliance & co-founder of Australian Endometriosis Centre, Adelaide Branch.
Her books will be available in Singapore in the World Women Health 2009, November 28th 2-6pm. Suntec City – Rooms303-306.
Registration details at
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