Endometriosis is a common gynaecological condition gaining increasing recognition in the community. It affects about 10% of women of reproductive age with a much higher prevalence in those with fertility issues.
Endometriosis is a condition where tissue that normally only lines the uterus (the endometrium) is present on other pelvic structures. Endometriosis can affect the ovaries, fallopian tubes, the outside of the uterus, the cervix, the lining of the pelvis, the bladder and the rectum. Very occasionally it is found on more distant structures. The presence of endometrial cells can result in a chronic, inflammatory reaction in the affected tissues which may result in damage.
The cause of endometriosis is not well established but it is now felt that a number of factors contribute. These include a genetic pre-disposition, altered immunity, altered cell functioning, abnormal hormonal function and abnormal movement of endometrial cells.
Endometriosis often presents with long standing pelvic pain, painful periods, pain during sex, painful urination and bowel movements. Pain levels are not well correlated with the severity of disease and some patients with what appears to be minor endometriosis will still have severe symptoms. Some patients may present with infertility alone. Endometriosis can also be associated with heavy periods.
Endometriosis is diagnosed through a mixture of patient history, examination findings, imaging and sometimes laparoscopic (keyhole) surgery. Ultrasound can be particularly useful in delineating severe disease and cysts but will not accurately identify all endometriosis. Laparoscopy isn’t always necessary but can useful where concurrent diagnosis and treatment is being considered.
There a range of treatment options available for patients with endometriosis which include non-hormonal medication, hormonal options, hormonal suppression and in some cases laparoscopic surgery.
