Endometriosis

Endometriosis is a common gynaecological problem affecting women of reproductive age. It occurs when the glandular tissue of the uterus lining is found outside the uterus in the pelvis, ovaries or other pelvic organs. It can cause painful cramps in the lower abdomen, back or in the pelvis during menstruation, pain during intercourse, abnormal bleeding between periods, painful bowel movements or urination, and infertility.

Cause

The exact cause for the endometriosis is not known, but it is thought to relate to genes, or developmental abnormality during the growth of the embryo, or may be modified by environmental factors.

Investigations

Endometriosis may be suspected when clinical history is suspicious, or abnormalities are seen on ultrasound. Sometimes, raised levels in the tumour marker in CA125 can also suggest endometriosis.

However, the only direct way to diagnose endometriosis is by visualising it during laparoscopy (day procedure under general anaesthesia) where a thin long camera is inserted through an incision in the abdomen and a biopsy is taken for histopathological testing.

Treatments

Pain Medication: Over the counter pain relievers may be helpful for mild pain, such as non-steroidal anti-inflammatory medications or paracetamol. Sometimes stronger medication is required.

Hormone Treatment can suppress activity of endometriosis or decrease recurrence after surgical treatment. This is not appropriate when wanting fertility.

Surgery is the best option for women trying for fertility, as well as those with severe pain. This is most often done laparoscopically with the aid of a long thin camera inserted through small incisions in the abdomen, where endometriosis lesions are removed at the time of operation. Endometriosis can also be removed during an open operation called a laparotomy where a long incision is made on the abdomen.

Pelvic Clearance operation and hysterectomy is another option reserved for women not desiring fertility, or who experience very severe symptoms.